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68 Cards in this Set
- Front
- Back
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Physiologic changes
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cumulative and affect the continuum of biological, psychological, social, and environmental processes of aging
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Most important physiological changes
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loss or decrease in compensatory changes, progressive loss in efficiency of body to repair damaged tissue, decreases immune response
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Ageism
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prejudice or discrimination against a particular age-group and especially elderly
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What are some optimistic views of aging?
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aging is living, education, art, peak experience, spiritual journey, developmental process
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What are some ways to tailor to the patient?
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environment modifications: adequate space, anticipate distraction and minimize it, comfortable temperature and adequate lighting, bathroom facilities, privacy with adequate space
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What do many elderly fear?
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losing independence
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What is a predictor of adverse outcomes for hospitalized patients?
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functional decline
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What is functional assessment?
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evaluation of the physical cognitive abilities required to maintain independence
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ADLs
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basic daily activities
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instrumental activities of daily living
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basic daily activities needed to live independently in the community
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Parts of Katz ADL
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bathing, dressing, toileting, transferring, continuance, feeding
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What does the FIM measure? (functional independence measure)
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motor, communication, and cognition
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Barthel Index
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used widely to examine ADL (does NOT examine communication or cognition)
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FIM Assumption
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level of disability should indicated the burden of care or the cost to the individual or society for that person not to be functionally indepedent
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What is the FIM used for?
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establish criteria for admission, discharge, maintenance of rehabilitation gains
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The FIM measures disability of?
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feeding, grooming, bathing, dressing the upper body, dressing the lower body, bowel management, bed/chair/wheelchair transfer, bladder management, toileting, toilet transfer, tub/shower transfer, locomotion, communication, social cognition, 13 motor items, 5 cognitive items
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FIM Score ranges
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18: maximum dependence
126: complete independence |
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Does the FIM measure the amount of time each activity takes an individual or the hours of care?
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no
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Strengths of the FIM
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short, easy to administer and valid
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Limitations of the FIM
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may take more than one discipline to score, does not incoporate all activities, does not measure number of hours of care
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Barthel Index
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measures performance ability in mobility, self care, and continence
What the person does, NOT what they could do |
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Scoring Barthel Index
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0-100
100: complete independence in all 10 domains 0: complete dependence in all 10 domains |
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Number of domains in Barthel Index
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10
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Lawton IADL
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cooking, cleaning, laundry, shopping, using the telephone, transportation, managing finances
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PULSES
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physical condition
upper limb function lower limb function sensory componenets excretory components support factors |
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SPICES
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sleep disorders
problems with eating or feeding incontinence confusion evidence of falls skin breakdown |
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Promotional strategies for functional assessment
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activity, prevention and early treatment of illness, vaccinations, good nutrtion, mental functioning, independence and productivity, social relationships and support
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AGING GAMES
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Audiovisual
Gait and mobility Insomnia Nutrition GI GU Assistance, ADL/IADL, directives Mood/memory Environment and everyday activities Sexuality |
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Purpose of a mental status exam?
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screen for cognitive abilities and deficits and emotional functioning and intellectual functioning
screening but NOT diagnosis monitoring older adults over time |
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Components of a mental status exam
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consciousness, physical appearance, orientation to person, place and time, speech/language, emotional status
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Components of memory on a mental status exam
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attention, intelligence, judgement, insight, comprehension, perception
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Cognitive function
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encompasses the processes by which an individual perceives, registers, retrieves, and uses information
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Categories of cognitive decline in older adults
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dementias, delirium, impaired thought processes
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Dementias
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chronic, progressive, insidious, and permanent states of cognitive impairment
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Delirium/Acute confusion
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the acute and sudden impairment of cognition, which is considered temporary with an identifiable, biophysical cause
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What are a good indicator of general cognitive loss for older adults?
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declining scores on tests of memory
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A major risk factor for entering a nursing home
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low cognitive functioning
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Folstein MiniMental Status Examination (MMSE) purpose
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quantify cognitive ability, measure change over time and identify presence of organic disease
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Folstein MiniMental Status Examination (MMSE) measures?
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orientation, registration, attention and calculation, recall, language
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Folstein MiniMental Status Examination (MMSE) Scores
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24-30: No impairment
18-23: mild impairment 0-17: severe impairment |
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Strengths of the Folstein MiniMental Status Examination (MMSE)
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valid, reliable tool that takes 5-10 minutes to administer and needs little training to administer
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Limitations of the Folstein MiniMental Status Examination (MMSE)
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influenced by education level: judgment, insight, and remote memory, mood or perceptual disturbance not addressed
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Mini Cog
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Simple test for memory and recall, 3 item recall, clock drawing test, 3-5 minutes
Involves executive function, pre planning for space and hand placement |
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Yesevage Geriatric Depression Scale purpose and scale
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Screen for depression
0= no depression >5= refer for follow up 30= very depressed |
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Strengths of geriatric depression scale
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self rated, no training required, 15 item short version, screens physically healthy, ill, and cognitively impaired
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Limitations of the geriatric depression scale
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limited with severe depression or psychosis, MMSE < 15= questionable reliability, no differentiation between diagnostic categories, not as sensitive to changes over time
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Purpose and scale of the Cornell Depression Scale
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screen for depression
0= no depression 12 and over= refer for follow up 19= severe depression |
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Strengths of the Cornell Depression Scale
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assess for older adults with advanced dementia
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Cornell Depression Scale Limitations
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clinician must rate and longer time than GDS
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Most falls in acute care?
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are in older adults over 65
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How many falls result in injury
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20%
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Falls are responsible for...?
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one in three deaths due to injury
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When do majority of falls occur?
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routine activities
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once they fall....
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they will fall again
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complexity of presentation
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chronic disease, atypical presentation, nutrition, functional status, polypharmacy
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Number one risk factor for falls
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previous falls
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Risks for falls
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previous falls, arrhythmias, TIAs, CVA, PD, the 3 Ds (depression, delirium, dementia), polypharmacy, fear of falling, incontinence, mood, dizziness, environment
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Atypical Presentation of disease
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example: present with falls, caused by hypoxia and the underlying cause may have be CHF
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Geriatric Giants
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Cognitive impairment, falls, incontinence, failure to thrive
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cardiovascular age related changes
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effects of atherosclerosis and arteriosclerosis, previous lifestyle and health, increase in SBP, DBP the same or slightly increased, decrease in cardiac reserve and response to stress
Prone to: CHF, LVH, MI, PVD, CVA, renal insufficiency, arrhthymias |
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Respiratory changes with aging
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changes related to MS system decrease respiratory compliance
Osteoporosis, kyphosis, scoliosis, DJD, decrease in respiratory muscles, decrease in exercise capacity, change in mechanics of breathing, may see exacerbations of chronic disease, increase infections |
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Endocrine age related changes
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increased incidence of hypothyroidism, diabetes
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Musculoskeletal age related changes
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decrease muscle mass, decrease in strength, decrease mobility, joint stiffness, decrease in Height
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Sensory age related changes
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decrease in vision, hearing, reaction time, proprioception, touch
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Neuro/ CNS age related changes
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mental performance, brain: nerve cell loss, more in hippocampus, sensory changes, taste perception, pain perception, sensory changes
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GI age related changes
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decreased motility, decreased taste and saliva, poor dentation, loss of appetite, gas, constipation, GI bleed, cancer
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GU age related changes
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urgency, nocturia, incontinence, renal insufficiency/failure
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Integument age related changes
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wounds, cancer, Herpes Zoster (shingles), pigmented skin lesions
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