Easy Module 4 Textbook

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Questions and Answers

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

30-35%

20-25%

5-10%

12-16% (correct)

What is a common characteristic of individuals that require long-term care?

They are primarily older adults. (correct)

They all live in institutional facilities.

They only require psychological care.

They are all younger than 65.

Which of the following services is NOT considered part of home care?

Meal preparation

Emergency room services (correct)

Laundry assistance

Physical therapy

What is the expected trend regarding the use of home care in the future?

There will be a 120% increase. Signup and view all the answers

Which factor is a barrier to Canadians feeling financially prepared for long-term care costs?

Limited long-term care insurance coverage. Signup and view all the answers

How are most home care hours accounted for in Canada?

By family caregiving. Signup and view all the answers

What does 'aging in place' refer to in the context of long-term care?

Staying at home with adequate services. Signup and view all the answers

What is the role of Alternate Level of Care patients in hospitals?

They are waiting for long-term care beds. Signup and view all the answers

What is the main cause of chronic obstructive pulmonary disease (COPD)?

Smoking Signup and view all the answers

What significant change occurs in the lungs due to chronic emphysema?

Destruction of alveoli Signup and view all the answers

Which of the following is a common symptom of amnesia?

Profound memory loss Signup and view all the answers

How does the ATT gene relate to COPD?

It inhibits elastase Signup and view all the answers

What is an example of a neurocognitive disorder?

Dementia Signup and view all the answers

Which determinant of health refers to conditions that affect people's daily lives, including how they access services?

Physical environments Signup and view all the answers

What is one potential benefit of preventive measures for health in older age?

Reduction in stress on the medical care system Signup and view all the answers

Which of the following is NOT one of the 12 main determinants of health?

Social media usage Signup and view all the answers

What is the nature of good palliative care?

Adapts to the patients' needs and is holistic Signup and view all the answers

Which of the following is a physiological response to bereavement?

Tightness of chest Signup and view all the answers

What is the most devastating form of bereavement?

Losing a child Signup and view all the answers

In the dual process model of coping with bereavement, what does 'restoration' involve?

Taking on new tasks or functions Signup and view all the answers

Which of the following is NOT a behavioral risk factor for chronic disease?

Regular exercise Signup and view all the answers

What condition is characterized by the hardening and thickening of arteries?

Atherosclerosis Signup and view all the answers

Which factor increases the risk for hypertension?

Atherosclerosis Signup and view all the answers

What is the primary contributor to congestive heart failure?

Inadequate blood circulation to the body's organs Signup and view all the answers

What defines a transient ischemic attack?

A temporary blockage in the brain's circulation Signup and view all the answers

Which dietary pattern is associated with a reduced risk for metabolic syndrome?

Mediterranean diet Signup and view all the answers

What is a primary symptom associated with chronic bronchitis?

Coughing with sputum production Signup and view all the answers

What measurement indicates hypertension?

Systolic ≥ 140 mm Hg and diastolic ≥ 90 mm Hg Signup and view all the answers

What is the term for a cluster of symptoms indicating high risk for cardiovascular disease?

Metabolic syndrome Signup and view all the answers

What is the expected replacement cost for long-term care by 2050?

$27 billion Signup and view all the answers

Which of the following is a primary function of adult day programs?

Medication management Signup and view all the answers

What percentage of nursing home residents take 10 or more prescriptions?

61% Signup and view all the answers

What is a key characteristic of the Green House Model?

Individualized long-term care in a home-like setting Signup and view all the answers

What is often a critical issue faced by employees in long-term care facilities?

Burnout and high staff turnover Signup and view all the answers

What is a common psychological effect experienced by individuals relocating to long-term care facilities?

Feelings of regret or guilt Signup and view all the answers

What percentage of Canadians have discussed advance care planning with family or friends?

50% Signup and view all the answers

What stage of the dying process is characterized by high functioning until a terminal illness progresses?

Terminal illness Signup and view all the answers

Which factor is NOT emphasized in person-centered care?

Routine medications Signup and view all the answers

What is a primary goal of hospice palliative care?

Comfort and support at the end of life Signup and view all the answers

Which of the following terms refers to the loss of appetite and muscle mass often seen at the end of life?

Anorexia-cachexia syndrome Signup and view all the answers

What is not a recommended method for improving long-term care facilities?

Implementing strict medication schedules Signup and view all the answers

What does the term 'death with dignity' refer to?

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

What psychological result may occur when an individual acknowledges their mortality according to terror management theory?

Enhanced compassion and interpersonal relationships Signup and view all the answers

Study Notes

Long-Term Care

Long-term care is a range of care provided to older adults and disabled individuals, particularly those requiring assistance with daily living activities (ADLs) and instrumental activities of daily living (IADLs).
Long-term care services can be delivered in various settings, including homes, community facilities, and institutions.

Overview of Long-Term Care Costs

Long-term care represents 12-16% of Canada's total healthcare spending, with home care accounting for 10-30% of that cost.
The cost of public and private long-term care is anticipated to triple in the future.
A majority of Canadians express concern about their financial preparedness for long-term care costs, and few Canadians have insurance for long-term care.

Home Care Services

Home care provides assistance to older adults within their own residences, encompassing services like meal delivery, drop-in visits, home assistance (cleaning, laundry, meal preparation), and restorative services (physical and speech therapy).
While people often prefer home care due to its cost-effectiveness, access to appropriate home care services is limited for many, especially those who are older, live alone, are women, are caregivers themselves, or are immigrants.

Family Caregivers

One in four Canadians aged 15 and over provide care to family members or friends.
Approximately 75% of total home care hours are provided by unpaid caregivers, a number projected to increase by 43%.

Types of Community-Based Services

Adult Day Programs: Offer medication management, physical therapy, meals, medical care, counseling, education, and opportunities for socialization.
Supportive or Assisted Living: Provide supportive care services and supervision to individuals who do not need skilled care.
Nursing Homes: Provide medication management, physical therapy, meals, medical care, counseling, education, and socializing opportunities to residents.

Issues in Long-Term Care

Staffing Shortages: Long-term care facilities face challenges with burnout, high staff turnover, and insufficient staff numbers, impacting care quality.
Quality of Care: Despite provincial standards for operation licenses, the quality of care in long-term care facilities varies, with some concerns regarding psychosocial aspects of care.
Medication Use: Antidepressants and antipsychotics are commonly prescribed to residents in long-term care facilities, with rates of antipsychotic use declining in recent years.

Relocating to a Long-Term Care Facility

Relocating to a long-term care facility is a complex process often triggered by significant health events.
The transition can evoke feelings of regret, guilt, depression, and relief.
Although a coordinated placement process exists, individuals are often forced to accept the first available option, which may differ from their preferences.

Psychological Perspectives on Death

The way individuals approach death can influence their perceptions and experiences.
Identity assimilation and legitimization of biography are two mechanisms people might employ to cope with the inevitability of death.

Death Ethos

Death ethos refers to the prevailing societal philosophy concerning death, evident in funeral rituals, treatment of the dying, artistic representations, beliefs about the afterlife, and social conventions surrounding death.
The invisible death ethos characterizes the current practice of dying individuals retreating from family and spending their final days in hospitals, often viewed as a societal shift towards "social death."

End of Life Care

Advance Directives: Documentation of an individual’s wishes regarding their care in case of illness or incapacitation. These directives play a crucial role in empowering patients and ensuring their wishes are respected.
Medical Assistance in Dying (MAID): MAID encompasses two methods: direct administration of a life-ending drug by a physician or nurse (voluntary euthanasia) or the prescription of such a drug by a healthcare professional, allowing the eligible individual to administer it themselves (assisted suicide).
Hospice Palliative Care: A person-centered approach to end-of-life care that prioritizes physical comfort, psychological and social support, and spiritual needs.### End of Life Care
End of life care should be tailored to the individual's needs, rhythms, and circumstances which can change as they progress through the dying process.
Holistic palliative care, in partnership with the patient and family, should be provided at the appropriate level as early as possible, alongside other medical interventions.
Specialized care should be available when needed, in the setting of choice for the patient.

Bereavement

Bereavement is the process of coping with the death of another.
It is more likely in older adulthood due to the increased likelihood of experiencing loss.
Physiological effects can include chest tightness, shortness of breath, loss of energy, sleep problems, digestive issues, and a weakened immune system.
Emotional effects may include anger, depression, anxiety, emptiness, and preoccupation with the deceased.
Cognitive effects can involve impaired attention and memory, social withdrawal, and an increased risk of accidents.
Sociocultural impacts can involve changes in family or community position, loss of status, and financial burden.
Losing a child is the most devastating form of bereavement.
Parental bereavement increases the likelihood of the bereaved parent dying for up to 20 years, with mothers experiencing a greater impact than fathers.
The Attachment view of bereavement suggests that maintaining emotional bonds with the deceased is beneficial.
The Dual process model of coping with bereavement highlights two dimensions: restoration and loss, which involve taking on new roles and coping with emotional consequences respectively.
Individuals adapt to bereavement by alternating between these dimensions, with their approach influenced by their attachment style.
According to Mancini and Bonanno, flexible adaptation is key to coping with loss.
Repressive coping, where one forgets the painful event, can be beneficial at times and aligns with identity process theory, where individuals choose to continue identifying with roles associated with the bereaved person.

Key Concepts in Health & Prevention

Health is defined as a state of complete physical, mental, and social well-being, not just the absence of disability or illness.
Activities of daily living (ADLs) include bathing, dressing, transferring, using the toilet, and eating.
Instrumental activities of daily living (IADLs) include using the phone, shopping, meal preparation, housework, laundry, and transportation.
General behavioral risk factors for chronic disease include tobacco use, alcohol use, unhealthy diet, sedentary lifestyle, and obesity.
Chronic diseases are responsible for 41 million deaths worldwide annually (2018), disproportionately affecting low- and middle-income countries and individuals under the age of 70.

Diseases of the Cardiovascular System

Cardiac and Cerebrovascular Conditions
- Fat and other substances naturally accumulate in artery walls as we age.
- Atherosclerosis is the build-up of fatty deposits in artery walls, significantly narrowing the passage and limiting blood circulation.
- Arteriosclerosis is a general term for the thickening and hardening of arteries, a natural process that everyone experiences to some extent.
- Coronary (Ischemic) Heart Disease occurs when atherosclerosis leads to blockage of blood flow to a part of the body, potentially damaging organs and tissues.
- Myocardial Infarction is a blockage of blood flow to the heart muscle caused by significant build-up of plaque in a coronary artery.
- Hypertension (High Blood Pressure) is chronically elevated blood pressure.
  - Systolic pressure: Pressure exerted by blood during heart contraction.
  - Diastolic pressure: Pressure when the heart relaxes between beats.
  - Hypertension is diagnosed when blood pressure is consistently at or above 140 mmHg systolic or 90 mmHg diastolic.
  - Atherosclerosis contributes to hypertension as plaque buildup forces the blood through narrower passages, increasing pressure.
  - High pressure also strains the artery walls.
  - Hypertension increases workload on the heart.
- Congestive Heart Failure occurs when the heart cannot pump enough blood to meet the body's needs, leading to congestion of tissues with fluid.
- Cerebrovascular Disease involves disorders of circulation to the brain, potentially resulting in a stroke.
  - Stroke is an acute condition where an artery leading to the brain is blocked or bursts by a clot or other particle.
  - Transient Ischemic Attack (TIA) is caused by temporary clots in cerebral arteries.
    - It is often called a 'mini-stroke' and, despite being temporary, increases the risk of a full stroke.

Incidence

Cardiovascular diseases were the leading cause of death in Canada, accounting for approximately 25% of all deaths.
Heart attacks and heart failure are the top 5 reasons for hospitalization.
Cardiovascular disease is the leading cause of death globally, with the highest rates in Eastern Europe, Central Asia, and Central Europe.

Behavioural Risk Factors

Tobacco Smoking: Smoking damages arteries, making them vulnerable to plaque formation and accelerates the aging process through changes to DNA methylation.
Sedentary Lifestyle: Individuals aged 65+ have the highest risk for heart disease but are the least likely to meet the recommended 150 minutes of exercise per week (only 37% achieve this).
Diet: High BMI and obesity, affecting 1 in 4 Canadians with the highest prevalence among those aged 35-39 and 50-64.
Alcohol Intake: It is high in calories and damages the cardiovascular system and brain.
Metabolic Syndrome: This occurs when individuals experience a cluster of symptoms associated with cardiovascular disease risk.
- Criteria include abdominal obesity, high triglycerides, low HDL (good cholesterol), high LDL (bad cholesterol), and high glucose levels.
- Individuals must meet at least 3 of these criteria.
A study on Indigenous communities revealed 85% of participants were at moderate-high risk for cardiovascular disease.
- This may be attributed to barriers in accessing routine healthcare, affordability of medications, and prescription compliance.

Prevention of Heart Disease and Stroke

Diet: A high intake of vegetables and fruits, following a Mediterranean diet, is crucial for reducing the risk of metabolic syndrome and cardiovascular disease, and is considered the most important preventative measure.
Relaxation Training: This can help manage stress, which is a risk factor for cardiovascular disease.
Challenges: People may find it difficult to make necessary lifestyle changes,

Respiratory Diseases

COPD (Chronic Obstructive Pulmonary Disease)
- This group of diseases involves airflow obstruction in the respiratory system.
- It often involves two related diseases:
  - Chronic Bronchitis:
    - Long-standing inflammation of the bronchi, leading to increased mucus production, and a greater likelihood of respiratory infections.
    - Causes narrowing and plugging of bronchi, making breathing difficult.
  - Chronic Emphysema:
    - Permanent destruction of the alveoli.
    - Elastin in the terminal bronchioles is destroyed, preventing airways from enlarging during inhalation and emptying completely on exhalation.
    - Causes shortness of breath.
- Smoking: Smoking is the main cause of COPD, as cigarette smoke releases elastase which breaks down elastin.
- Heredity: The ATT gene, which inhibits elastase, also plays a role in susceptibility to COPD.
Prevention of COPD:
- Medications and Treatments: Inhalers, lung surgery, and the SpiroTiger device can be used to improve oxygen levels, reduce inflammation, and strengthen respiratory muscles.

Neurocognitive Disorders

Neurocognitive Disorder: Characterized by significant cognitive decline impacting daily activities and social interactions.
Dementia: Often used synonymously with neurocognitive disorder, signifying a loss of cognitive abilities.
Mild Cognitive Impairment: A form of Neurocognitive Disorder that indicates a potential risk for developing Alzheimer's disease.
Amnesia: Profound memory loss, classified as:
- Anterograde amnesia: Difficulty forming new memories.
- Retrograde amnesia: Difficulty retrieving past memories.

Alzheimer's Disease

Prevalence, Psychological Symptoms, Biological Causes, Proposed Causes, Diagnosis, Medical Treatments, and Psychosocial Treatments are all complex components of Alzheimer's disease.

12 Major Determinants of Health:
- Income and social status, employment and working conditions, education and literacy, childhood experiences, physical environment, social support and coping skills, health behaviors, access to health services, biology and genetic endowment, culture, and race/racism.
- Prevention: Prevention efforts, even when initiated in older age, have significant benefits and reduce strain on the medical care system.
- Promotion: Supporting healthy aging through:
  - Outdoor spaces and buildings: Accessible and inviting outdoor spaces.
  - Transportation: Safe and available transportation options.
  - Housing: Affordable and safe housing options.
  - Social participation: Opportunities for social interaction and engagement.
  - Respect and social inclusion: Respectful and inclusive community attitudes.
  - Civic participation and deployment: Opportunities for community involvement.
  - Communication and information: Access to clear communication and relevant information.
  - Community support and health services: Accessible and comprehensive community and health services.

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