Questions and Answers
What are the effects of ageism on older people? (Select all that apply)
Older adults are projected to outnumber children by 2035 in the US.
True
What is the most common form of income for older adults?
Social Security
For older adults, ____% have at least one chronic health condition.
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Match the following terms with their definitions:
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Which of the following are chronic conditions common in older adults? (Select all that apply)
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What are the 4 Ms that healthcare providers should focus on?
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Atypical presentations of illness are less common in adults over 85.
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What factors contribute to the risk of developing osteoporosis? (Select all that apply)
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What is a common side effect of anticholinergic medications in older adults?
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The prevalence of falls among community-dwelling older adults can be assessed annually using _____.
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Which of the following treatments are considered experimental and may not be covered by insurance? (Select all that apply)
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What is the recommended calcium supplementation for men aged 50-70 years?
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What is the goal serum Vitamin D level to reduce fracture risk?
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Patients should take bisphosphonates on an empty stomach.
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What are some side effects of bisphosphonates?
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What interventions can help prevent falls in older adults? (Select all that apply)
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Match the pharmacological agents with their category:
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Individuals with dementia often experience increased sleep disruption.
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Which medication can contribute to sleep impairment in older adults?
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What is a common risk factor for obstructive sleep apnea?
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What are symptoms of Restless Leg Syndrome? (Select all that apply)
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The preferred treatment for cataracts is __________.
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Glaucoma can be a silent disease.
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What is the effect of aging on the lens of the eye?
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Hearing loss can start as early as a person's 20s.
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Which of the following may contribute to sensorineural hearing loss? (Select all that apply)
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Study Notes
Ageism
- Ageism leads to negative health outcomes for older adults, including shorter lifespan, poorer physical and mental health, and cognitive decline.
- Implicit bias can be addressed through awareness, person-centered care, empathy, and expanding social networks.
- Understanding diverse cultural beliefs and practices enhances care for older patients, advocating for equitable health services.
Aging Trends
- By 2035, older adults in the U.S. are expected to outnumber children for the first time.
- Baby boomers are more educated, are staying in the workforce longer, and are better healthcare consumers.
- 80% of older adults have at least one chronic health condition, with financial challenges like reliance on fixed income and increasing poverty rates among older women and people of color.
Healthy/Successful Aging
- Life review is essential for self-understanding and identity maintenance.
- Erikson's stage of integrity vs. despair focuses on accepting life experiences, with an emphasis on legacy building.
- Quality of Life (QOL) is connected through multiple dimensions: metaphysical, spiritual, biological, interpersonal, environmental, and societal.
General Gerontological Nursing Principles
- Gerontology addresses the physiological, cultural, and advocacy needs of older adults, promoting health and functionality.
- Compassionate acute care should prioritize patient preferences and safety, integrating prevention and education for improved quality of life (QOL).
- The 4 Ms of care: Mobility, Medication, Mentation, and Matters ensure comprehensive and aligned care with older adults’ goals.
OBRA and Nursing Home Standards
- OBRA improved nursing home conditions, established resident rights, and mandated compliance with federal regulations.
- Quality measures include monitoring pain, falls, vaccinations, and pressure injuries to ensure the safety of residents.
Transitional Care
- Designed to improve coordination across care settings, enhancing patient experiences and health outcomes while reducing readmissions.
- Barriers in care transitions often stem from lack of engagement, collaboration, and education among caregivers and healthcare team members.
4 Ms Framework
- Mobility: Vital for maintaining older adults' functional capabilities.
- Medication: Focus on polypharmacy, medication reconciliation, and deprescribing practices.
- Mentation: Regular assessments for cognitive status, using tools like Mini-Cog and CAM.
- Matters: Align care with individual health goals and preferences.
SPICES Framework
- Key areas of focus include Sleep, Eating issues, Incontinence, Confusion, evidence of Falls, and Skin breakdown to identify geriatric syndromes.
Comprehensive Geriatric Assessment (CGA)
- Promotes function and independence, minimizing decline in older adults, and enabling home-based care.
- Geriatric syndromes encompass multifactorial health issues, necessitating holistic interdisciplinary care.
Advance Directives
- Discussions on values and preferences help older adults convey their wishes for end-of-life care.
- Includes Living Wills, DNRs, and Durable Power of Attorney (POA) to ensure decisions align with the individual’s desires.
Atypical Presentations of Illness
- Older adults often present vague or atypical symptoms due to comorbidities or polypharmacy, leading to missed diagnoses and increased morbidity.
- Common presentations include subtle behavioral changes, confusion, and decreased appetite, necessitating vigilant monitoring and timely identification.
Medication Safety and Polypharmacy
- Age-related changes in drug sensitivity and metabolism raise risks for older adults, exacerbating adverse drug events (ADEs).
- Polypharmacy is defined by the use of five or more medications, correlating with higher hospitalization rates and geriatric syndromes.
- Strategies for adherence should include individualized support, simplifying regimens, and ensuring clear communication.
Musculoskeletal Changes
- Aging leads to decreased muscle mass (sarcopenia), reduced functional capacity, increased body fat, and fluid volume loss, heightening fall risk.
- Skeletal changes include diminished calcium absorption and reduced bone density, contributing to frailty and impaired mobility.
Assessment of Mobility
- Initial assessments establish baselines for mobility and impact on quality of life, utilizing comprehensive health histories and functional evaluations.### Falls Efficacy Scale and Tests
- A score above 70 on the Falls Efficacy Scale indicates a fear of falling in older adults.
- The 30-second chair stand test evaluates strength and endurance; below-average scores correlate with an increased risk of falls.
- The Timed Up and Go test (TUG) measures balance and walking ability; longer times indicate greater assistance needed and a higher fall risk.
Physical Consequences of Impaired Mobility
- Untreated mobility issues can lead to skin breakdown, pressure injuries, and infections.
- Loss of calcium and muscle mass, as well as joint pain and contractures, are common.
- Reduced circulation and increased risk for constipation also occur.
Fall Assessment and Management
- Community-dwelling adults require annual fall assessments (STEADI).
- At hospital admission, conduct a facility fall assessment.
- For acute falls: do not move the patient initially, assess for injuries, take vital signs, and notify the rapid response team if needed.
- Write detailed descriptions of fall incidents for medical records.
Frailty Indicators
- Multiple screening tools are used to identify frailty, such as the Frailty Index, which includes criteria like unintentional weight loss, weakness, slowness, exhaustion, and low physical activity.
- Assess frailty in both outpatient and inpatient settings, requiring interdisciplinary care.
- Frailty can lead to delirium, emphasizing the need for close monitoring.
Osteoarthritis Overview
- Characterized by persistent joint pain, morning stiffness, and pain with activity, often accompanied by crepitus and decreased range of motion.
- Common in postmenopausal women, those with obesity, and after previous joint injuries.
- Diagnosed through radiographs showing joint-space narrowing and osteophytes.
Osteoporosis Risk Factors
- Key genetic factors include age (over 50), gender (females more affected), race (Caucasian and Asian higher risk), and family history.
- Lifestyle factors such as sedentary behavior, smoking, and excessive alcohol consumption contribute to osteoporotic risk.
- Medications like long-term corticosteroid therapy and certain antiepileptics can increase the likelihood of osteoporosis.
Osteoporosis Development Factors
- Development linked to failure to achieve peak bone mass, increased bone resorption, and decreased bone formation.
- A Bone Health Risk Assessment focuses on identifying and managing these risk factors with an emphasis on prevention.
- Dual-Energy X-Ray Absorptiometry (DXA) scans measure bone mineral density; performed on women over 65 and men over 70 or younger individuals with risk factors.
Hip Fracture Characteristics and Management
- Commonly presents as the patient found on the floor with a shortened and externally rotated injured leg.
- Coordinated hospital care is crucial for expediting treatment and reducing complications.
- Risks for hip fractures include excessive substance use, sedentary lifestyle, cognitive impairment, and medications increasing fall risk.
- Prevention strategies involve addressing modifiable risk factors and promoting physical activity.
Intervention Strategies
- Early mobility initiatives and consistent physical activity, including resistance training, improve strength and promote anti-inflammatory effects.
- Nutrition focused on caloric and protein intake supports frailty management.
- Nonpharmacological treatments for osteoarthritis include low-impact exercises, weight loss, and physical/occupational therapy.
- Pharmacological treatments involve a range of analgesics and anti-inflammatory medications, with careful attention to side effects.
Specifics on Osteoporosis Prevention and Treatment
- Recommended calcium (1000mg men, 1200mg women) and vitamin D (600-1000 IU/day) supplementation to maintain bone health.
- Both weight-bearing and strength exercises preserve bone density and decrease fall risk.
- Pharmacological options include bisphosphonates like Risedronate and Alendronate, SERMs for postmenopausal women, and anabolic agents that promote bone formation.
Other Treatments and Considerations
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Emerging therapies like glucosamine/chondroitin and CBD oil, along with intra-articular steroid injections, may provide pain relief but lack robust evidence.
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Persistent pain or significant functional loss warrants referrals to specialists for advanced interventions, including potential surgical options.### Hip Fracture Management
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Surgical intervention is optimal within 24 hours if patient is medically stable.
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Aims to provide rapid pain control and improve mobility post-surgery.
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Spinal anesthesia is preferred over general anesthesia to mitigate post-operative complications.
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Pressure injuries should be prevented by padding bony prominences during surgery.
Post-Operative Care
- Older patients often experience unmanageable postoperative pain.
- Utilize scheduled low-dose opioids alongside non-opioids for effective pain relief.
- Conduct neurovascular assessments using the 6Ps: Pain, Pallor, Paralysis, Paresthesia, Pulses, and Poikilothermia.
- Increased risk for DVT/PE necessitates preventative measures like compression devices and early mobilization.
- Implement pain management strategies, and encourage incentive spirometry to prevent pneumonia.
- Oxygen support is recommended at 2L NC while in bed for 3-4 days post-op to reduce pneumonia risk.
- Early mobilization is crucial, within 24 hours post-surgery, to limit muscle strength loss.
- Establish mobility goals tailored to the individual, considering barriers like pain and fatigue.
- Continuous patient orientation can help prevent delirium post-surgery.
Nutrition and Discharge Planning
- Maintain nutritional support and skin integrity management post-op.
- Educate patients and engage family caregivers in discharge and rehabilitation processes.
- Advise against movements involving flexion greater than 90 degrees, adduction, and internal rotation post-surgery.
- Promote the use of an abductor pillow and discourage crossing legs or lying on the operated side.
Age-Related Changes and Sleep Disturbances
- Aging leads to a decline in CNS neuropeptides impacting sleep cycles.
- Flattened circadian rhythms decrease deep sleep (Stage 3) and shorten REM episodes.
- Aging correlates with increased daytime fatigue and greater sleep disruption, impacting overall health.
Sleep Impairment Connections
- Sleep issues may indicate underlying mood, cognitive, or neurodegenerative disorders.
- Fragmented sleep patterns can be early indicators of Alzheimer's or Parkinson's diseases.
- Common medications such as antihistamines and opioids can contribute to sleep disturbance.
Obstructive Sleep Apnea and Restless Leg Syndrome
- Obstructive sleep apnea risk is heightened for individuals who are obese or male, and exhibit decreased airway stability.
- Characteristic symptoms include snoring, gasps, and daytime sleepiness.
- Management options include weight loss, CPAP, or surgical interventions.
- Restless leg syndrome affects 10-35% of older adults, with symptoms increasing at rest and alleviated by movement.
- Treatment focuses on correcting underlying conditions, lifestyle modifications, and medications.
Chronic Insomnia and Treatment Principles
- Chronic insomnia affects 25-51% of older adults, characterized by difficulty falling/staying asleep and early awakening.
- Establish a history and evidence-based sleep scales for better assessment.
- Treatment should target underlying causes and use medications conservatively ("start low, go slow").
Age-Related Sensory Changes
- Visual changes include lens thickening, decreased pliability, increased light sensitivity, and reduced tear production, leading to dry eyes.
- Cataracts impact vision by forming opacities, with treatment typically requiring surgery as corrective lenses lose effectiveness.
- Glaucoma can result in optic nerve damage from increased intraocular pressure; early screening in older adults is critical.
- Macular degeneration leads to loss of central vision, with characteristic symptoms of blurred vision and distorted lines.
Management and Prevention
- Regular eye exams and lifestyle changes (quitting smoking, dietary improvements) are essential preventive measures.
- Education on medication safety, lighting, and home modifications is vital for reducing fall risks in older adults.
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Description
This quiz explores the concept of ageism, its effects on older individuals, and strategies to address implicit bias. Learn about the importance of person-centered care and how empathy and awareness can help combat ageism in various environments. Engage with the content to enhance your understanding and approach to this critical social issue.
