HARDModule 4 Textbook

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Questions and Answers

What percentage of total healthcare spending in Canada is attributed to long-term care?

5-10%

30-35%

12-16% (correct)

20-25%

What is the expected increase in adults utilizing home care by 2030?

150% more adults

120% more adults (correct)

90% more adults

80% more adults

Which of the following is NOT included in the range of services provided by home care?

Cleaning services

Emergency surgical procedures (correct)

Meal preparation

Physical therapy

What percentage of home care is expected to be provided by family caregivers?

75% Signup and view all the answers

How much are copayments for long-term care expected to range from monthly?

$1,000 - $34,000 Signup and view all the answers

What is one major reason Canadians feel unprepared for long-term care costs?

Lack of long-term care insurance Signup and view all the answers

In Canada, how many people aged 15 and older have provided care to a family member or friend?

1 in 4 Signup and view all the answers

How does Canada rank in terms of dollars spent proportionally on long-term care?

24th Signup and view all the answers

What is a major cause of chronic obstructive pulmonary disease (COPD)?

Smoking Signup and view all the answers

What is the primary effect of elastase on the lungs in COPD patients?

It leads to the destruction of elastin in terminal bronchioles. Signup and view all the answers

Which symptom is most commonly associated with amnesia?

Profound memory loss Signup and view all the answers

Which of the following is NOT a component of social determinants of health?

Chronic illnesses Signup and view all the answers

What aspect of aging can be positively influenced even in older age?

Psychosocial support Signup and view all the answers

What condition can mild cognitive impairment signify regarding Alzheimer's disease?

Risk for developing the disease Signup and view all the answers

What type of device is used to stimulate respiratory muscles?

SpiroTiger Signup and view all the answers

Which determinant of health focuses on the influence of one's community and environment?

Physical environments Signup and view all the answers

What is the primary focus of adult day programs in long-term care?

Addressing medical and social needs of older adults Signup and view all the answers

Which statement best describes the competence-press model in long-term care facilities?

It predicts optimal adjustment based on competence matching with environmental demands Signup and view all the answers

In nursing homes, what is a significant limitation observed in the care provided?

Focus primarily on physical needs Signup and view all the answers

What common psychological issue may arise during the relocation to a long-term care facility?

Feelings of regret, guilt, and depression Signup and view all the answers

Which of the following is NOT considered a criteria for Medical Assistance in Dying (MAiD)?

Condition must be curable and remediable Signup and view all the answers

What aspect of end-of-life care does hospice palliative care primarily focus on?

Person-centered comfort and support Signup and view all the answers

What has been a common criticism regarding staff experiences in long-term care facilities?

Daily exposure to violence and criticism Signup and view all the answers

Which dying trajectory involves a prolonged period with series of dips and recoveries?

Organ failure Signup and view all the answers

What does the 'good death' concept emphasize?

Autonomy in end-of-life decisions Signup and view all the answers

What defines the 'social death ethos' in contemporary dying practices?

Isolation of the dying from social interactions and family Signup and view all the answers

How does the green house model transform long-term care practices?

Creates a more home-like environment with small resident clusters Signup and view all the answers

Which factor is less commonly addressed in provincial standards for long-term care facilities?

Psychosocial aspects of care and quality of life Signup and view all the answers

Which is an essential recommendation for successful residential transitions for dementia patients?

Strong interprofessional collaboration among team members Signup and view all the answers

What physiological symptoms are commonly associated with bereavement?

Tightness of chest and sleep problems Signup and view all the answers

Which model describes coping with bereavement by alternating between the dimensions of restoration and loss?

Dual Process Model Signup and view all the answers

In the context of cardiovascular conditions, what is arteriosclerosis characterized by?

The hardening and thickening of arteries Signup and view all the answers

What is the defining characteristic of congestive heart failure?

Inability to pump sufficient blood to meet body needs Signup and view all the answers

Which blood pressure reading qualifies as hypertension?

140 mm Hg systolic or 90 mm Hg diastolic Signup and view all the answers

What role does tobacco smoking play in cardiovascular health?

Promotes arterial plaque formation Signup and view all the answers

Which of the following is NOT typically considered a physiological response to grief?

Increased energy levels Signup and view all the answers

What is a common behavioral risk factor for developing chronic diseases?

Tobacco use Signup and view all the answers

What is the leading cause of death worldwide attributed to cardiovascular disease?

Atherosclerosis Signup and view all the answers

Which of the following statements about the attachment view of bereavement is true?

It supports maintaining emotional connections with the deceased. Signup and view all the answers

Which aspect of chronic obstructive pulmonary disease (COPD) is characterized by long-standing inflammation of bronchi?

Chronic bronchitis Signup and view all the answers

What is a common cognitive effect experienced during bereavement?

Impaired attention and memory Signup and view all the answers

Which dietary approach is most recommended for reducing the risk of cardiovascular disease?

Mediterranean diet rich in vegetables and fruits Signup and view all the answers

What is the major implication of the dual process model in coping with loss?

Adaptation involves alternating between tasks related to loss and restoration Signup and view all the answers

Study Notes

### Long-Term Care

Long-term care is a range of services that support older adults with assistance in daily living, including medical care.
Long-term care services are provided in a variety of settings, from home care to assisted living and nursing homes.
The costs associated with long-term care have been steadily increasing, and nearly triple the amount of people are expected to require home care.
Canadians are not adequately financially prepared for long-term care, and long-term care insurance is not widespread.

Types of Long-Term Care

Home care focuses on providing support for older adults in their own homes, offering services such as meals on wheels, and restorative services.
Adult day programs are community-based services designed to meet the needs of older adults.
Supportive or Assisted Living communities offer care and services to individuals who don’t need skilled care.
Nursing homes provide medication management, therapy, meals, and medical care for individuals who need more intensive care.

### Relocating to a Long-Term Care Facility

The relocation process can be stressful for residents and their families.
A coordinated placement process helps to ensure that residents are placed in a facility that meets their needs.
Recommendations for successful transitions include having an evaluation of individual preferences, strong communication, and informed family members.

### Psychological Issues in Long-Term Care

The Competence-Press model suggests that residents are more likely to adjust well to a long-term care facility when their cognitive abilities and the demands of the environment match.

The Quality of Long-Term Care Facilities

Long-term care facilities are subject to provincial standards and inspections.
Staff shortages contribute to low-status, burnout, and high turnover rates.
Physical violence and abuse are prevalent in some facilities.

Suggestions for Improving Long-Term Care Facilities

An individualized algorithm for managing agitation for residents with neurocognitive disorders can be more effective than using medication.
Personal Support Workers can provide effective care by learning behavioural methods to help residents maintain independence.
Changes in building design, such as removing nursing stations, can contribute to a more home-like environment.
The Green House model promotes a small, home-like setting for residents, and can help create a more social, interactive environment.

Death and Dying

Death is the irreversible cessation of brain function.
Dying is the period where an organism loses its vitality.
Dying trajectories vary depending on the disease process.
The sociocultural perspective on death and dying is constantly evolving, with different social norms, beliefs, and rituals surrounding death across historical periods.
The five stages of dying suggested by Kubler Ross are denial, anger, bargaining, depression acceptance.
Death with dignity emphasizes personal control over end-of-life care and avoiding extreme physical dependency.
A good death allows for autonomy over decisions about end-of-life care.

Psychological Perspectives on Death and Dying

People may use identity assimilation to cope with the possibility of death by identifying with younger, healthier versions of themselves.
Legitimization of biography involves preparing a legacy to be left behind after death.
Awareness of finitude occurs when people begin seriously considering death, often after the death of someone close to them.
Erikson’s theory of ego integrity suggests that people near the end of their lives may re-evaluate their lives.
Terror Management Theory suggests that being aware of death can motivate individuals to strive for good habits, compassionate behaviour, and greater connection with others.

### Issues in End-of-Life Care

Advance directives are legal documentation of a person's wishes for end-of-life care if they become incapacitated.
A Do Not Resuscitate (DNR) order indicates that resuscitation efforts should not be performed in the event of a cardiac arrest.
Medical Assistance in Dying (MAiD) is a legal option for individuals who meet specific eligibility criteria, allowing them to end their lives with assistance from a physician or nurse.
Hospice palliative care provides holistic care for individuals who have chosen to forego active disease treatment.

End of Life Care

End of life care should be tailored to the individual's needs and preferences, adapting to their changing physical and mental state as they approach death.
Excellent palliative care is comprehensive, involving partnerships with the patient and family, delivered early on and at suitable levels.
It works alongside other medical interventions and can be augmented by specialized care when necessary. Patients are given the autonomy to choose their preferred setting for care.

Bereavement

Bereavement is the process of coping with the death of a loved one.
Older adults are more susceptible to bereavement due to experiencing more losses throughout their lives.
Physiological effects of bereavement: tightness in the chest, shortness of breath, decreased energy, sleep disturbances, digestive issues, and weakened immunity.
Emotional effects of bereavement: anger, depression, anxiety, emptiness, and preoccupation with the deceased.
Cognitive effects of bereavement: impaired attention and memory, social withdrawal, and increased risk of accidents.
Sociocultural effects of bereavement: changes in position within the family and community, potential loss of status, and potential financial burdens.
Losing a child is the most devastating form of bereavement.
- Parental bereavement significantly increases the risk of the surviving parent dying within 20 years.
- The impact is more severe for mothers than fathers.
The traditional view of bereavement focuses on working through grief and moving on. The assumption is that emotional bonds must be severed to resolve grief adequately.
The attachment theory of bereavement suggests that individuals benefit from maintaining emotional connections with the deceased. This involves cherishing objects, thoughts, and memories associated with the person. The deceased becomes a part of the survivor's identity.
The dual process model of coping with bereavement emphasizes two key dimensions: restoration and loss.
- Restoration involves adapting to new tasks and responsibilities.
- Loss focuses on managing the emotional consequences of death.
- Individuals navigate bereavement by alternating between these two dimensions.
- The effectiveness of individual approaches varies depending on attachment styles.
Mancini and Bonanno's research indicates that individuals who cope best with loss utilize flexible adaptation strategies.
- Repressive coping, where painful memories are suppressed, can be beneficial in certain situations.
- This aligns with the identity process theory, which suggests people choose to continue identifying with roles connected to the deceased, such as wife or mother.

Key Concepts in Health and Prevention

Health is a state of complete physical, mental, and social well-being, not just the absence of illness or disability.
Activities of daily living (ADLs) include bathing, dressing, transferring, toileting, and eating.
Instrumental activities of daily living (IADLs) include using the phone, shopping, preparing meals, housework, laundry, and managing transportation.
General behavioral risk factors for chronic diseases include tobacco use, excessive alcohol consumption, unhealthy diets, sedentary lifestyles, and obesity.
Chronic diseases are responsible for 41 million deaths annually worldwide, with a higher prevalence in low and middle-income countries, often affecting individuals under 70 years old.

Diseases of the Cardiovascular System

Atherosclerosis: Accumulation of fatty deposits in the artery walls, significantly reducing artery width and impeding blood flow.
Arteriosclerosis: The thickening and hardening of arteries, a natural aging process that occurs in everyone to some extent.
Coronary (ischemic) heart disease: The buildup of plaque in an artery restricts blood flow to a body part, leading to damage.
- When the heart is affected, it's called coronary heart disease.
Myocardial infarction (heart attack): Severe narrowing or blockage of the coronary arteries, restricting blood flow to the heart muscle (myocardium).
Hypertension: Chronic elevation in blood pressure.
- Systolic pressure: The force of blood pushing out of the heart during contraction.
- Diastolic pressure: The pressure of blood when the heart relaxes between beats.
- Blood pressure is measured in millimeters of mercury (mm Hg).
- Hypertension is defined as blood pressure equal to or greater than 140 mm Hg systolic or 90 mm Hg diastolic.
- Atherosclerosis contributes to hypertension as the plaque buildup forces blood to flow through narrower spaces, increasing pressure.
- High blood pressure places strain on artery walls and increases the heart's workload.
Congestive heart failure: The heart is unable to pump enough blood to meet the body's needs, leading to fluid buildup in tissues. This results in exhaustion, shortness of breath, leg swelling (edema), fluid in the lungs, and kidney problems.
Cerebrovascular disease: Disorders affecting blood circulation to the brain.
- Can lead to a cerebrovascular accident (stroke), an acute event where an artery leading to the brain bursts or becomes blocked by a clot or other particle.
- Transient ischemic attack (TIA) or ministroke: Caused by temporary clots in the cerebral arteries. While the effects are temporary, TIAs increase the risk of future strokes.

Incidence of Cardiovascular Diseases

Heart and cerebrovascular diseases were the two leading causes of death in Canada, accounting for approximately 25% of deaths.
Heart attacks and heart failure are among the top five reasons for hospital admissions.
Cardiovascular disease is the leading cause of death globally, with the highest fatality rates in Eastern Europe, Central Asia, and Central Europe.

Behavioral Risk Factors for Cardiovascular Diseases

Tobacco smoking: Damages arteries, making them vulnerable to plaque formation and accelerating aging through DNA methylation.
Sedentary lifestyle: Individuals aged 65 and older have the highest risk of heart disease but are the least likely to engage in 150 minutes of exercise per week (only 37% meet this target).
Diet: High body mass index (BMI) is a risk factor. Obesity affects one in four Canadians, with the highest prevalence among those aged 35-39 and 50-64.
Alcohol intake: High in calories and damages the cardiovascular system and brain.

Metabolic Syndrome

A cluster of symptoms associated with heightened risk factors for cardiovascular and related diseases.
Criteria for Metabolic Syndrome: Abdominal obesity, elevated triglycerides, low high-density lipoprotein (HDL) cholesterol, high low-density lipoprotein (LDL) cholesterol, and high glucose levels. At least three of these criteria must be present.
A study on Indigenous communities found that 85% of participants were at moderate-to-high risk for cardiovascular disease, highlighting barriers such as limited access to routine healthcare, challenges taking prescriptions, and financial constraints on medication costs.

Prevention of Heart Disease and Stroke

Diet: Consumption of a Mediterranean diet rich in vegetables and fruits can reduce the risk of metabolic syndrome. This is considered the most crucial preventative measure.
Relaxation training: Can help manage stress, a known contributor to heart disease.

Respiratory Diseases

COPD (Chronic Obstructive Pulmonary Disease): A group of diseases characterized by obstructed airflow into the respiratory system.
- Chronic bronchitis: Persistent inflammation of the bronchi, leading to increased mucus production, coughing, and sputum expectoration. It makes individuals more susceptible to frequent and severe respiratory infections. Narrowing or blockage of the bronchi causes difficulty breathing and disability.
- Chronic emphysema: Permanent destruction of the alveoli (air sacs in the lungs). The destruction of elastin in the terminal bronchioles hinders airway expansion during inhalation and complete emptying during exhalation, causing shortness of breath.
Smoking: The primary cause of COPD. Cigarette smoke triggers the release of the enzyme elastase, which breaks down elastin.
Heredity: The ATT gene can inhibit elastase production, making some individuals more susceptible to COPD.

Prevention of COPD

Medications and treatments: Inhalers to facilitate oxygen intake and reduce inflammation, lung surgery to remove damaged tissue, and spirotiger devices to stimulate respiratory muscles.

Neurocognitive Disorders

Neurocognitive disorder: Significant impairment in cognitive function affecting daily activities and social interactions.
Dementia: Often used to describe the loss of cognitive abilities.
Mild cognitive impairment: A type of neurocognitive disorder indicating potential risk for developing Alzheimer's disease.
Amnesia: Characterized by severe memory loss.
- Anterograde amnesia: Loss of memory for events after the onset of amnesia.
- Retrograde amnesia: Loss of memory for events before the onset of amnesia.

Alzheimer's Disease

Prevalence: The prevalence of Alzheimer's disease is not specified in the provided text.
Psychological symptoms: The psychological symptoms of Alzheimer's disease are not mentioned in the text.
Biological causes: The biological causes of Alzheimer's disease are not discussed within the provided text.
Proposed Cause: The text does not provide any information about a proposed cause for Alzheimer's disease.
Diagnosis: The text does not go into detail about the diagnosis of Alzheimer's disease.
Medical treatments: The text does not mention any medical treatments available for Alzheimer's disease.
Psychosocial treatments: The text does not mention any psychosocial treatments available for Alzheimer's disease.

The text identifies 12 main determinants of health:
- Income and social status
- Employment and working conditions
- Education and literacy
- Childhood experiences
- Physical environments
- Social supports and coping skills
- Health behaviors
- Access to health services
- Biology and genetic endowment
- Culture
- Race and racism
Prevention: Starting preventive measures even in older age can have a positive impact on health, reducing the burden on the healthcare system.
Promotion: Supporting healthy aging across eight domains:
- Outdoor spaces and buildings
- Transportation
- Housing
- Social participation
- Respect and social inclusion
- Civic participation and deployment
- Communication and information
- Community support and health services

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Description

This quiz explores the various aspects of long-term care, including its types, services, and the challenges faced by older adults. It highlights issues like financial preparedness and the increasing demand for home care. Test your knowledge on how long-term care works and its significance in supporting senior citizens.