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49 Cards in this Set
- Front
- Back
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Dementia: Signs & Symptoms
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Increased Difficulty with:
• Learning & Retaining new info • Handling complex tasks • Reasoning ability • Sense of direction • Language • Behavior |
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Dementia: Modes of Onset
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• Abrupt
• Gradual |
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Dementia: Progression
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• Stepwise vs. Continuous
• Worsening vs. Fluctuating or improving |
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• Disturbance of consciousness—reduced awareness
• Reduced ability to focus, sustain, or shift attention • Cognitive changes such as orientation, memory deficit, language disturbances • Fluctuate throughout the day • Develops over a short period |
Delirium
Also known as Acute Confusional State is a reversible disorder of cognitive function and is defined as an acute disturbance of attention and cognition. Delirium affects up to 56% of older people admitted to the hospital. |
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A loss of brain function that occurs with certain diseases. It affects memory, thinking, language, judgment and behavior.
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Dementia
Alzheimer’s disease is the most common dementia-related disorder (50%). Other causes include vascular disease/stroke, other diseases such as Huntington’s, Pick’s and Parkinson’s., ETOH (Alcohol abuse dementia). |
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Age Range for Early-Onset
Alzheimer's |
Before age 60
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Age Range for Late-Onset
Alzheimer's |
Age 60 and above
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Estimates show that ___% of all reported suicides occur with persons 65 and older.
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17-25%
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Older ____ are the highest rates for suicides in the US with older ______ being the second highest risk.
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white males, men of color
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Older white males and older men of color account for ___% of all suicides among American older adults.
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81%
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Risk factors for suicide among older adults
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• serious physical illness
• severe pain • sudden death of a loved one • major loss of independence • financial problems • major loss of interest in activities. |
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A syndrome in later life manifested by weight loss greater than 5% of baseline, decreased appetite, poor nutrition, inactivity, often accompanied by dehydration, depressive symptoms, impaired immune function and low cholesterol levels.
May result from several issues including chronic disease, functional decline. |
GERIATRIC FAILURE TO THRIVE
Adverse outcomes include malnutrition, depression, cognitive impairment and impaired physical function. |
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_____ affects from 5-35% of community dwelling elders and 25-40% of nursing home residents.
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Failure to Thrive
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Syndrome associated with increased rates of infection, incidence of hip fractures, pressure ulcers, surgical mortality, mortality rates and medical costs.
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Failure to Thrive
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Main areas of Assessment
with Older Adults |
• Impaired physical status or function
• Undernutrition or malnutrition (including unintentional or significant weight loss) • Depression or depressive symptoms • Cognitive impairment or decline |
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Effective Treatment of Older Adults is best achieved through...
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a team approach: physician, nurse, dietitian, physical therapist, social worker, mental health professional and/or speech pathologist.
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The excessive loss of muscle associated with aging.
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Sarcopenia
Generally, people start losing muscle at 45 years of age and tend to lose 1% per year. Muscle loss leads to reduced strength and ability to perform everyday tasks. Unsteadiness may result in falls. |
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Highest rates of completed suicide are among:
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elderly age 80 and up
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Leading causes of injury among older adults
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• elder abuse or maltreatment
• falls • driving related accidents • sexual abuse • suicide • traumatic brain injury |
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Types of Elder Abuse
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• Physical
• sexual • financial (undue influence) • abandonment • isolation • neglect • self-neglect |
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Signs of Elder Abuse
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o Sudden changes in financial matters (new gifts, bank accounts, loans)
o Sudden isolation by caregiver o New sources of power & authority o Sudden increase in debt o Altering estate planning o Loss of valuable personal property o Parasitic child/grandchild o Caregiver offer of lifetime care in exchange for $/inheritance |
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the act of making the terminally ill patient more comfortable; to relieve pain
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Palliative Care
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the program which delivers palliative care
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Hospice
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naturally occurring retirement communities
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Aging in Place
• Older adults remain in their homes being around family and friends • Elder cohousing communities or Green Houses—neighborhood based retirement programs. |
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Average Monthly Cost
for Assisted Living |
Approx $3000
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Psychological Affects of Stroke
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• Depression
• Apathy • Memory Loss • Dysphasia/Aphasia • Frustration • Apraxia • Dependency Issues |
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Focal Seizure Psychosis
Symptoms by Brain Region |
• Frontal: depersonalization, olfactory hallucinations
• Parietal: perceptual distortions • Temporal: hyper-religiosity, hyper-orality • Occipital: visual distortions |
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Common Causes of Delirium
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• ETOH withdrawal
• Infections, including UTI • Pulmonary Diseases • Cardiovascular Diseases • Neuro. Diseases • Medications • Environmental: lead/insecticide |
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Medication Problems in Elderly
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• Multiple healthcare providers
• OTC meds, friend's meds, herbal • Non-compliance b/c side effects, cost, memory loss • Guarded re: disclosing info about self-directed med changes • Hoarding of medications • Synergistic effects: 8-12 meds/day |
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Sundowning
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In Alzheimer's patients, increase in delirious/psychotic Sx occurring late in the day due to sensory deprivation
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Types of Dementia
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• Vascular dementia
• Alzheimer's • Parkinson's • Creutzfeldt-Jacob • Pick's disease • Brain Infection (AIDS, meningitis, syphilis) • Lewy-Body • Fronto-temporal |
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Features of Vascular Dementia
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• 20% of all dementias
• rapid onset, stepwise decline • some recovery of function • often with history of Hypertension |
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Features of Lewy-Body Dementia
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• diffuse Lewy-Body disease
• hallucinations • parkinsonian movements |
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Features of Fronto-temporal Dementia
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• marked personality changes
• impaired executive function |
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Six Domains of Potentially Limited Civil Capacity
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• Medical Consent
• Sexual Consent • Financial • Testamentary • Driving • Independent Living |
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A brief neurocognitive battery with alternate forms, measuring immediate and delayed memory, attention, language, and visuospatial skills.
Used primarily for detection and characterization of dementia in elderly and other disorders. Can be used for repeat evaluations when an alternative form is desirable to control for practice effects. |
Repeatable Battery for the Assessment of Neuropsychological Status (RBANS)
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Test of mild cognitive impairment (MCI) and dementia, developed by Z. Nasreddine MD
Measures exec. function, visuoconstructional skills, language, memory, attention, conceptual thinking, orientation, calculations |
Montreal Cognitive Assessment Test (MOCA)
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Assessment Tools Used
with Elderly Persons |
• RBANS
• MOCA • Clock Drawing |
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A quick screening test for cognitive dysfunction secondary to mild cognitive impairment, dementia, delirium, or a range of neurological and psychiatric illnesses
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Clock Drawing Test
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Potential Errors in Clock Drawing
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• Impaired spacing of numbers
• Perseveration • Organizational problems • Etc. |
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Services offered by APS
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• Home visit to assess & follow patient/family
• Case Management • Tx recommendations, coordination of services • Interface with police/DA services |
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Legal Issues: Capacity
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ability to make intelligent choices, understand the nature and effects of one's decisions
psychological evaluation is one method of determining capacity |
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term used to describe the strategic use of manipulation through fraud, misrepresentation, or physical intimidation for the purpose of taking advantage of an elderly person's vulnerability
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Undue Influence
REPORT MANDATED! |
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Factors that set the stage for Undue Influence
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• Isolation: manipulator controls all communication
• Dependency: perpetrator convinces pt. that they cannot survive alone • Stockholm Syndrome: patient bonds to abuser b/c dependent |
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Gives directions for how an individual wants to be treated in the event of a catastrophic illness or accident
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Advance Directive
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Healthcare providers including paramedics are mandated to try and resuscitate you and use all measures to keep you alive without this document
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Do Not Resuscitate (DNR)
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Examples of IADLs
(Instrumental Acts of Daily Living) |
transportation, banking, taking meds, shopping, cooking, housekeeping
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Examples of ADLs
(Acts of Daily Living) |
bathing, grooming, dressing, feeding, continence, ambulation/transfers
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Time-frame for reporting elder abuse to APS
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Phone call: ASAP
Written: 48 hrs. |
