Geriatrics - Special Considerations

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Questions and Answers

What percentage of drivers in the United States are over the age of 65?

  • 40%
  • 30%
  • 10%
  • 20% (correct)

Driving is classified as which type of activity of daily living?

  • Basic Activity of Daily Living (BADL)
  • Essential Activity of Daily Living (EADL)
  • Secondary Activity of Daily Living (SADL)
  • Instrumental Activity of Daily Living (IADL) (correct)

Which of the following is NOT a functional demand of driving?

  • Complex mathematical calculations (correct)
  • Ability to operate a vehicle
  • Higher-order reasoning and decision making
  • Knowledge of road rules

Which screening test is used to assess visuospatial skills relevant to geriatric driving?

<p>Clock drawing test (B)</p> Signup and view all the answers

Reporting an unsafe older driver typically flags them for which of the following?

<p>Medical examination (C)</p> Signup and view all the answers

Unhealthy alcohol use in older adults is best described as:

<p>A whole spectrum from risky use to alcohol use disorder. (B)</p> Signup and view all the answers

For older adults (65 years and older), what is considered 'standard' or 'normal' alcohol use per week?

<p>7 drinks per week (no more than 3 on any day) (C)</p> Signup and view all the answers

According to DSM-5 criteria, a 'mild' alcohol use disorder is characterized by how many symptoms?

<p>2-3 symptoms (C)</p> Signup and view all the answers

Which of the following is NOT identified as a factor influencing unhealthy alcohol use in older adults?

<p>Occupation type (B)</p> Signup and view all the answers

What does AUDIT stand for, in the context of screening for unhealthy alcohol use?

<p>Alcohol Use Disorder Identification Test (B)</p> Signup and view all the answers

If an older patient screens positive on the AUDIT, which of the following is the MOST appropriate next step for a clinician?

<p>Obtain a detailed drinking history timeline and social history. (B)</p> Signup and view all the answers

Which of the following is NOT a recommended component in the treatment of Alcohol Use Disorder in older adults?

<p>Mandatory hospitalization (B)</p> Signup and view all the answers

In the context of cannabis use, when is cannabis considered an 'alternative' therapy?

<p>When used instead of conventional medicine. (D)</p> Signup and view all the answers

Which of the following is a therapeutic benefit of cannabis with sufficient evidence to support its use?

<p>Chemotherapy-induced nausea and vomiting (A)</p> Signup and view all the answers

What is the primary focus of 'integrative medicine' regarding patient care?

<p>Care and research that attends to social, psychological, spiritual, behavioral, environmental, and biological determinants of health. (D)</p> Signup and view all the answers

Which of the following is a profound positive impact of appropriate exercise for older adults?

<p>Chronic disease prevention and improved function (D)</p> Signup and view all the answers

Physical activity is defined as:

<p>Any bodily movement produced by skeletal muscles that results in energy expenditure. (B)</p> Signup and view all the answers

Before starting an exercise program, older adults should be screened for:

<p>Permission or prescription for exercise and conditions requiring activity modifications. (C)</p> Signup and view all the answers

Which type of exercise is specifically recommended for all major muscle groups in older adults?

<p>Strength training (D)</p> Signup and view all the answers

What is a major risk associated with strength training in older adults, if not performed correctly?

<p>Soreness and injury (B)</p> Signup and view all the answers

Historical context and social stigma have significantly impacted the health outcomes of which special population of older adults?

<p>LGBT older adults (C)</p> Signup and view all the answers

Which of the following office practices is recommended to create a welcoming environment for LGBT older adults?

<p>LGBT-friendly symbols and signs visible in the office (A)</p> Signup and view all the answers

Older gay and bisexual men are at increased risk for which type of cancer compared to heterosexual men?

<p>Anal cancer (HPV-related) (A)</p> Signup and view all the answers

Older lesbian and bisexual women may have a higher risk for which of the following health issues?

<p>Moderate psychological distress (B)</p> Signup and view all the answers

What is a significant health concern for older transgender individuals related to sexual health?

<p>Higher rates of HIV (B)</p> Signup and view all the answers

In what year was gay marriage recognized nationally in the United States?

<p>2015 (B)</p> Signup and view all the answers

Limited health literacy is best defined as:

<p>The degree to which individuals have the capacity to obtain, process, and understand basic health information and services to make appropriate health decisions. (C)</p> Signup and view all the answers

What percentage of caregivers may have limited health literacy?

<p>Up to 53% (B)</p> Signup and view all the answers

Which of the following is NOT a consideration related to health literacy in older adults?

<p>Access to transportation (B)</p> Signup and view all the answers

REALM and TOFHLA are examples of:

<p>Formal screening tools for limited health literacy. (B)</p> Signup and view all the answers

Homelessness and housing instability in older adults is:

<p>Common in the US and increasingly affecting older adults. (D)</p> Signup and view all the answers

Homelessness is defined as lacking:

<p>A fixed, regular, and adequate nighttime residence. (A)</p> Signup and view all the answers

Clinicians play an important role in addressing homelessness by:

<p>Recognizing patients at risk and preventing first episodes of homelessness. (D)</p> Signup and view all the answers

Which of the following is a significant risk factor for becoming homeless for older patients?

<p>Death of a relative or close friend (C)</p> Signup and view all the answers

Rapid rehousing is a resource for homeless older patients that focuses on:

<p>Quickly moving individuals from homelessness to permanent housing. (C)</p> Signup and view all the answers

Older adults are the fastest-growing segment of which population?

<p>Criminal justice population (B)</p> Signup and view all the answers

The increase in older adults in the criminal justice system is partly a result of:

<p>Strict sentencing policies from the 1980s and 1990s. (A)</p> Signup and view all the answers

Compared to their chronological age, incarcerated older adults often appear:

<p>10-15 years older due to 'accelerated aging'. (C)</p> Signup and view all the answers

Which of the following health conditions is NOT commonly seen at higher rates in older adults within the criminal justice system?

<p>Appendicitis (A)</p> Signup and view all the answers

Older travelers face barriers to safe travel primarily due to:

<p>Multimorbidity, functional issues, cognitive impairment, or medication management difficulties. (C)</p> Signup and view all the answers

What is an essential aspect of preparing older patients for travel?

<p>Preparing patients for travel and providing anticipatory guidance. (C)</p> Signup and view all the answers

What is a significant social determinant of health for older immigrants?

<p>Immigrant status itself, leading to health inequities and disparities. (D)</p> Signup and view all the answers

Which of the following legal statuses is NOT mentioned in the context of older immigrants in the US?

<p>Refugee (D)</p> Signup and view all the answers

What percentage of the US population is comprised of immigrants?

<p>13.5% (D)</p> Signup and view all the answers

What is cited as the major barrier to healthcare for older immigrants?

<p>Lack of health insurance. (C)</p> Signup and view all the answers

Beyond knowledge of road rules and ability to operate a vehicle, what cognitive function is MOST critical for driving?

<p>Hidden coordination between eyes, brain, and body (D)</p> Signup and view all the answers

What specific visuospatial skill is assessed using the clock drawing test in the context of geriatric driving?

<p>Ability to represent numerical and spatial relationships (A)</p> Signup and view all the answers

What information is MOST crucial to obtain if an older patient screens positive on the Alcohol Use Disorders Identification Test (AUDIT)?

<p>Drinking history timeline (C)</p> Signup and view all the answers

What is a key consideration when using cannabis as a 'complementary' therapy in older adults?

<p>Combining it with conventional medicine (D)</p> Signup and view all the answers

What is the MOST emphasized aspect of integrative medicine regarding patient care?

<p>The clinician-patient relationship (B)</p> Signup and view all the answers

Besides soreness and injury, what is another major risk associated with strength training in older adults?

<p>Improper technique leading to musculoskeletal issues (B)</p> Signup and view all the answers

What is the MOST important initial step a clinician can take to create a welcoming environment for LGBT older adults?

<p>Displaying LGBT-friendly symbols and signs in the office (D)</p> Signup and view all the answers

What is a potential sexual health concern that should be addressed when providing care for older transgender individuals?

<p>Increased rates of HIV (C)</p> Signup and view all the answers

An older LGBT individual presents with concerns about accessing social security benefits and Medicare. What policy issue is MOST likely affecting this patient?

<p>Social security and Medicare recognition (B)</p> Signup and view all the answers

An 80-year-old immigrant patient, otherwise eligible for Medicare, is denied coverage. What legal circumstance MOST likely explains this?

<p>The patient resides temporarily with temporary visas. (D)</p> Signup and view all the answers

A 78-year-old man presents with his daughter, who is concerned about his driving. She reports multiple near-misses and confusion at intersections. Which of the following tests is most appropriate to assess his visuospatial abilities?

<p>Clock drawing test (A)</p> Signup and view all the answers

A 72-year-old woman reports having 2-3 glasses of wine every evening. She lives alone and reports feeling "a little down lately." What is the most appropriate next step in evaluating her alcohol use?

<p>Administer the AUDIT questionnaire (D)</p> Signup and view all the answers

A 70-year-old man with chronic neuropathic pain is interested in alternative treatments. He is asking about cannabis. Which of the following is an evidence-supported indication for medical cannabis?

<p>Chemotherapy-induced nausea (C)</p> Signup and view all the answers

A 69-year-old lesbian woman presents for a wellness visit. Which of the following is true regarding her preventive care?

<p>She may have lower screening rates for cervical cancer (B)</p> Signup and view all the answers

A 75-year-old man is brought in by his case manager from a transitional shelter. He recently lost his housing after the death of his spouse. Which of the following is a major risk factor for homelessness in this population?

<p>Death of a close relative (C)</p> Signup and view all the answers

An 80-year-old man who was recently released from prison appears frail and has poor dentition, chronic pain, and urinary incontinence. What concept best explains his presentation?

<p>Accelerated aging due to incarceration (B)</p> Signup and view all the answers

A 68-year-old woman is preparing for a trip to Southeast Asia. She takes medications for hypertension and diabetes. Which of the following should be discussed in anticipatory guidance?

<p>Anticipated exacerbation of chronic illness during travel (D)</p> Signup and view all the answers

A 70-year-old immigrant woman with limited English proficiency presents to your clinic. She has difficulty understanding instructions and completing forms. Which of the following is the best screening tool for her health literacy?

<p>Rapid Estimate of Adult Literacy in Medicine (REALM) (D)</p> Signup and view all the answers

A 74-year-old immigrant with limited English proficiency and no insurance presents to the clinic with uncontrolled diabetes. Which of the following is the greatest barrier to care in this population?

<p>Health insurance status (D)</p> Signup and view all the answers

A 66-year-old lawful permanent resident recently arrived in the U.S. He is unsure if he qualifies for Medicare. Which of the following best describes his eligibility?

<p>Lawful permanent residents are eligible for Medicare (A)</p> Signup and view all the answers

A 70-year-old woman with multiple comorbidities wants to begin an exercise program. What is the most appropriate first step?

<p>Perform a pre-participation history and physical exam (A)</p> Signup and view all the answers

A 73-year-old man asks about the best types of exercise to prevent falls and maintain mobility. Which of the following is most appropriate?

<p>Strength, flexibility, and balance training (C)</p> Signup and view all the answers

A 75-year-old woman has difficulty understanding medication instructions, completing forms, and asks, "Can I take these with food?" Which of the following tools would most appropriately screen her health literacy?

<p>TOFHLA (D)</p> Signup and view all the answers

A 76-year-old man presents with frequent ER visits and confusion about his medication regimen. Which of the following findings would most strongly suggest limited health literacy?

<p>Inability to explain the purpose of his medications (C)</p> Signup and view all the answers

A 79-year-old woman who recently lost her husband reports falling behind on rent. She's worried about losing her apartment. What is the most appropriate resource to recommend?

<p>Rapid rehousing services (D)</p> Signup and view all the answers

A 77-year-old transgender woman on long-term estrogen therapy presents for routine care. Which of the following health concerns is most appropriate to monitor?

<p>Prostate cancer (D)</p> Signup and view all the answers

A 71-year-old gay man is concerned about anal cancer risk. Which of the following conditions increases his risk the most?

<p>HPV infection (A)</p> Signup and view all the answers

A 68-year-old woman asks about the difference between complementary and alternative medicine. Which of the following correctly defines complementary therapy?

<p>Is used alongside conventional medicine (A)</p> Signup and view all the answers

Flashcards

Instrumental Activities of Daily Living (IADLs)

Difficulty or inability to perform activities related to independent community living.

Screening Tests for Geriatric Driving

Visual acuity, visual fields, contrast sensitivity, visuospatial skill, maze test, trail making, rapid pace walk, joint ROM, muscle strength.

Unhealthy Alcohol Use

Defined as a spectrum from risky use (co-morbidities) or Alcohol Use Disorder

Classifying Alcohol Use Disorder (DSM-5)

Mild (2-3 symptoms), Moderate (4-5 symptoms), Severe (6 or more symptoms)

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Cannabis Use in Older Adults

Symptom management, disease prevention, wellness, forestalling aging, and treatment of chronic conditions

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Integrative Medicine

Care and research that considers social, psychological, spiritual, behavioral, and environmental factors; emphasizes the patient-clinician relationship, patient empowerment and patient wellness.

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Nonmainstream therapies in Integrated medicine

Conventional+ Mainstream therapies; "Alternative"is used instead of conventional medicine/ "Complementary" when used with conventional medicine

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Physical Activity for Older Adults

Physical activity is any bodily movement via skeletal muscles that results in energy expenditure, is planned structured and repetitive bodily movement, and is done to improve or maintain physical fitness.

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Types of Exercise for Older Adults

Aerobic (jogging/walking), strength (muscle groups), flexibility and balance exercises.

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LGBT- Friendly Environment

Friendly symbols, privacy, inclusive forms, language and stance, requested names/pronouns, inclusive bathrooms

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Transgender Medicine

Four steps: diagnosis, lifestyle assumption, hormonal and drug therapy, surgical treatment

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Limited Health Literacy

Individuals have the capacity to obtain, process, and understand basic health information and services to make health decisions

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Health Literacy Considerations for Geriatrics

Consideration for older adults includes hearing/vision impairment, stress, cognitive impairment, caregivers may have limited literacy

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Homelessness

Lacking a fixed, regular, and adequate nighttime residence; often have a preceding period of housing instability.

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Risk Factors: Homelessness

Death/breakdown of relationships, disputes, domestic abuse, lack of social support, job loss, difficulty paying housing, mental illness, cognitive impairment

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Resources for Homeless Patients

Rapid rehousing, Rental assistance/supportive housing. Medical respite Medically oriented supportive services, intensive case management

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Fastest growing segment of criminal justice population

Due to waves of Strict sentencing policies in the 1980's and 1990's.

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Older traveler-Preparing patients

Providing anticipatory guidance to help travelers prepare, focus on chronic exacerbated illness during travel, patient limitations

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New Immigrants

A migrant who has moved across an international border, regardless of legal status or whether the move is voluntary or involuntary

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Immigrants Barriers

Barriers include immigration policies, insurance access, interpreter-Bilingual, language proficiency

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Clock Drawing Test

Clock drawing assesses visuospatial abilities, coordination, and motor planning affected by age-related cognitive decline.

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AUDIT Questionnaire

A validated screening tool used to assess risky or unhealthy alcohol use, especially in older adults. Helps in stratifying severity and need.

Signup and view all the flashcards

Medical cannabis use

Medical cannabis has strong evidence for use in chemotherapy-induced nausea, HIV-related wasting, neuropathic pain, and MS spasticity.

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Cancer Screening in Older Lesbian Women

Older lesbian and bisexual women often have reduced rates of cancer screening due to stigma, healthcare avoidance, or provider assumptions.

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Accelerated aging in incarcerated adults

Older incarcerated adults often exhibit 'accelerated aging,' appearing 10-15 years older than their biological age due to poor healthcare, nutrition, and stress.

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Travel Considerations for Older Adults

Travel in older adults may worsen chronic conditions due to time zone changes, medication disruptions or physical strain.

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Rapid Estimate of Adult Literacy in Medicine (REALM)

REALM is a quick, validated tool that screens for functional health literacy in clinical settings.

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Health insurance and older immigrants

Lack of health insurance is the single greatest barrier to care among older immigrants; only lawful permanent residents are eligible for Medicare.

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Medicare eligibility

Lawful permanent residents (green card holders) can qualify for Medicare after meeting residency and work requirements.

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Exercise program and older adults

Before initiating an exercise program, older adults should be screened for safety with a focused history and physical.

Signup and view all the flashcards

Test of Functional Health Literacy in Adults (TOFHLA)

Test of Functional Health Literacy in Adults (TOFHLA) is a validated tool that assesses reading comprehension and numerical skills in a health context.

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Medication management

Difficulty understanding and managing medications is a hallmark of limited health literacy.

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Balance exercises and mobility

A well-rounded regimen that includes balance, flexibility, and strength training helps prevent falls and maintain function in older adults.

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Rapid Rehousing

Rapid rehousing offers rental assistance and support services to prevent first-time homelessness or help older adults recover from recent housing loss.

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Prostate Cancer

Transgender women retain their prostate and remain at risk for prostate cancer.

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HPV and Anal Cancer

HPV is the leading risk factor for anal cancer, particularly in older gay and bisexual men.

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Complementary medicine defined

Complementary therapies are used in addition to conventional medicine

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Study Notes

Special Populations and Health Policies for an Aging Society

  • Common physical examination requirements for geriatric populations should be identified.
  • Specific geriatric findings/abnormalities during physical examinations

Driving and Older Adults

  • 20% of US drivers are older than 65.
  • Caregivers are important when determining a patient's medical fitness to drive.
  • Knowledge of road rules and operating the vehicle, hidden coordination between the eyes, brain, and body, higher-order reasoning, decision-making, visual acuity, visual fields, contrast sensitivity, and visuospatial skill are all needed for driving.
  • The clock drawing test assesses visuospatial abilities, which are crucial for driving safety and evaluates higher-order coordination between vision, motor planning, and cognition.
  • Driving performance tests can be done.
  • The state decides if it's unsafe to drive.

Unhealthy Alcohol Use

  • Covers a whole spectrum, from risky use with co-morbidities to Alcohol Use Disorder (AUD).
  • Moderate AUD involves 4-5 symptoms from the DSM-5.
  • Factors include genetics, environment, demographics.
  • The Alcohol Use Disorders Identification Test (AUDIT) is a validated screening tool to assess risky or unhealthy alcohol use and helps stratify severity and determine the need for further intervention.
  • Willing patients should be treated with medication and counseling while giving attention to social circumstances.

Cannabis Use

  • Symptoms can be managed using cannabis.
  • It can aid in disease prevention and wellness.
  • It can forestall aging and treat chronic conditions.
  • Integrative medicine attends to social, psychological, spiritual, behavioral, and environmental factors.
  • Nonmainstream therapies are "Alternative" when conventional medicine is not used.
  • Complementary therapies are used alongside conventional medicine (e.g., acupuncture with physical therapy).

Therapeutic Benefits Of Cannabis Use

  • Chemotherapy-induced nausea and vomiting can be treated.
  • HIV-induced wasting can be treated.
  • Neuropathic pain and pain and spasticity of multiple sclerosis can be treated.

Appropriate Exercise for Older Adults

  • Helps health, chronic disease prevention, function, and fall prevention.
  • Defined as any bodily movement produced by skeletal muscles.
  • Exercise results in energy expenditure.
  • Exercise is planned, structured, and repetitive bodily movement.
  • Before initiating exercise, older adults should be screened for safety with a focused history and physical to guide appropriate modifications and identify contraindications.
  • Aerobic exercise like running, jogging, walking, biking, and swimming are appropriate.
  • Flexibility and balance training are good exercises for older adults, and strength training helps prevent falls and maintain function in older adults.

Meeting the Unique Needs of LGBT Older Adults

  • Impact of social stigma on medical, psychological, and social outcomes.
  • LGBT-friendly symbols, signs, and fliers should be present in offices.
  • Providers should use inclusive language to accommodate.

Health Issues For Older Gay And Bisexual Men and Lesbian And Bisexual Women

  • Important to understand Sexual health.
  • Understand Cardiovascular Health and encourage no smoking.
  • Older lesbian and bisexual women may have reduced rates of cancer screening due to stigma, healthcare avoidance, or provider assumptions.
  • Screen for potential Cancers
  • HPV is the leading risk factor for anal cancer, particularly in older gay and bisexual men, where vaccination and screening are essential preventive strategies.

Older Transgender Health

  • Four steps.
  • Diagnosis
  • Lifestyle assumption
  • Hormonal and drug therapy
  • Surgical treatment
  • Screen for Cardiovascular disease Screen for cancer
  • Transgender women retain their prostate and remain at risk for prostate cancer, so screen appropriately because hormone therapy can alter its presentation. Discuss Hormone Use

Policy Issues Affecting LGBT Older Adults

  • Gay marriage has been legal since 2015. LGBT health disparities.

Limited Health Literacy

  • The degree to which people can obtain, process, and understand basic health information.

  • Vision and hearing impairment are important.

  • Cognitive impairment can limit health literacy.

  • Polypharmacy and emotional stress may also be involved.

  • Caregivers may have limited health literacy.

  • Consider social history.

  • Consider highest level of education and non-compliance with medical instructions.

  • The Rapid Estimate of Adult Literacy in Medicine (REALM) is a quick, validated tool that screens for functional health literacy, especially in patients with communication barriers and difficulty following medical instructions.

  • The Test of Functional Health Literacy in Adults (TOFHLA) is a validated tool that assesses reading comprehension and numerical skills in a health context

  • Difficulty understanding and managing medications is common with limited health literacy

Homelessness and Housing Instability

  • Lacking a fixed, regular, and adequate nighttime residence can make someone homeless.
  • Risk factors: Death of a relative or friend and Disputes with a landlord, cotenant, neighbor, or coworker.
  • Social disruptions, such as the death of a spouse, a breakdown of relationships, and a lack of support systems, are major risk factors for homelessness among older adults.
  • Rapid rehousing offers rental assistance and support services to prevent first-time homelessness or help older adults recover from recent housing loss.
  • Help can be given with medical respite with services delivered by highly trained professionals.

Older Adults and The Criminal Justice System

  • The population grew 300% between 1993 and 2016.
  • Premature or "accelerated" aging results from incarceration.
  • Older incarcerated adults often exhibit accelerated aging, appearing 10-15 years older than their biological age due to poor healthcare access, inadequate nutrition, and stressful environments.
  • Health issues include high rates of multimorbidity, geriatric syndromes, and functional impairments.

The Older Traveler

  • Face barriers to safe travel due to multimorbidity, functional issues, cognitive impairment, or medication management difficulties.
  • Travel in older adults may worsen chronic conditions due to time zone changes, medication disruptions, or physical strain.
  • Preparing patients for travel is essential.

Unique Needs of Older Immigrants

  • Many lawful permanent residents over 65 y/o are eligible for Medicare in the US.
  • Lawful permanent residents (green card holders) can qualify for Medicare after meeting residency and work requirements
  • Extrinsic barriers include Immigration policies and Insurance access.
  • Lack of health insurance is the single greatest barrier to care among older immigrants, and many remain uninsured.
  • Intrinsic barriers include language proficiency.

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