WGU study guide for care of the older adult c475( 2022 with complete solutions)

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Baby Boomers - ANSWER large group of people born between 1946-1964. Considered more affluent, better educated and healthier. Baby boomers have entered the older age group as of 2011 Baby Boomers un... ique characteristics that make them a challenge for healthcare professionals - ANSWER expect and demand excellence in geriatric care. Health disparities exist among minority elder group. Top five racial groups in United States - ANSWER European African Hispanic Asian Native Americans European Americans 5 health disparities - ANSWER individualistic, stoic (don't want to be a burden to others), elders- lose their sense of self worth. Trust authority- will tend to follow health care advice) smoking by pregnant women drug induced deaths deaths from poisoning deaths from melanoma, and deaths from COPD before age 45. African Americans - ANSWER 2nd larges minority populations. religion/spirituality plays important role in health and wellness. Equate good luck, good fortune, and good health with being right with God. Closer ties with extended families and rely on their close family ties for support. Distrustful of health care personnel African Americans - top five health disparities - ANSWER gonorrhea, congenital syphilis, new cases of AIDS, deaths due to HIV infection. Hispanic Americans - ANSWER high values on family, religion, and community. family interdependence over independence. family first before seeking outside health care. homeopathic remedies in conjunction with religious artifacts before engaging the health care professional. They disagree with silence and noncompliance. May not seek health care because they feel that their illness/disease is a punishment of sins. Many do not seek health care because they do not have access to it (lack of insurance, communication difficulties, or fear of ramifications due to being in country illegally. Diabetes and heart disease are two health problems that have increased within this cultural group Hispanic Americans - top 5 health disparities - ANSWER congenital syphilis TB, AIDS, exposure to particulate matter, cirrhosis deaths Asian Americans - ANSWER still practice holistic (naturalistic) medicine and may incorporate this as an adjunct to Western medicine. Majority of influence comes from Confucianism Follows a naturalistic perspective, defining health and illness as a balance between the individual and the world around the individual. Treatments may involve - acupuncture, moxibustion (burning of herbal leaves on or near the body), cupping (the use of warmed glass jars to create suction on certain parts of the body), massage, herbal remedies, movement and concentration exercises (tai chi) Some elders may forgo life sustaining treatment because of the principles of ren. Ren is the golden rule of Chines decision making "Do not do to others what you do not want done to yourself". Asian Americans - top 5 disparities - ANSWER new cases of TB, congenital syphilis, no pap test among females > 18, exposure to particulate matter, and carbon monoxide exposure Native Americans - ANSWER Insulated from the rest of the country, either literally (by way of land reservation) or in other ways such as linguistically. Follow naturalistic approach, believing that health is a balance of the mind, body, and spirit, and illness occurs when there is an imbalance or disharmony with nature. Health beliefs are blended with religion, carrying a magic facet as well as holistic and naturalistic approaches Native Americans - top 5 health disparities - ANSWER fetal alcohol syndrome, smoking by pregnant women, alcohol related motor vehicle deaths, cirrhosis deaths, and new cases of gonorrhea Age related changes which may affect therapeutic communication - ANSWER Visual acuity Hearing loss Speech and language difficulties ways to communicate/ assist patient with disabilities such as hearing deficits, vision impairments, or aphasia and dysarthria. - ANSWER Hearing deficits - 1. Do not shout. 2)TOUCH or by using a visual cue and wait for patient to visually orient to you before speaking, 3)STAND in front of person in a well lit room (helps the patient lip read), 4) SPEAK TO THE SIDE THAT HAS BETTER HEARING 5) make sure hearing aid is IN and turned ON 5) use gestures or objects for communication. LIMIT BACKGROUND NOISE Allow adequate time for response. Use short sentences and speak clearly May need to write or use a pictogram grid Vision impairments - Position yourself within their vision field. Give verbal indication of the actions you are about to do (avoid startling or scaring them). Label objects or simplify what is in their visual field. Aphasia/Dysarthria (speech impairments) - May be more anxious or self aware. Limit distractions Face patient and maintain eye contact May need to use multiple forms of communication (body language, written or pictorial information) Use short uncomplicated sentences with simple choices. Summarize message for accuracy. Take time and do not correct every error and respect the elder's limitations. Be patient!! Communication with a delirious elder - ANSWER discussions simple and questions concise. Use large print calendars and clocks to assist with orientation. Pictures of family may assist in reorienting. Well lit room. Offer frequent reassurance. Avoid physical restraints Use distraction and soothing conversation. Communication with DEMENTIA - ANSWER Make sure the person is attending to you prior to beginning the conversation. Face the person Speak slowly and clearly. Eye level Reduce or limit background noise. Break tasks into small manageable steps and provide simple and clear directions ( one step at a time may be needed ) Praise efforts. Use concrete terms and familiar words. Offer simple choices. Allow adequate time to respond. Do not argue or attempt to reason with someone regarding delusions or hallucinations. Encourage discussion of life events, traditions, memories. Use large print calendards Label items Establish a familiar environment Hearing aids are one of the most common and economical devices used by a person with hearing deficits. Consider the types that would best suit the older adult - ANSWER BTE (Behind the ear) - worn behind the outer ear. Has an adjustable volume and is battery powered. IT IS THE MOST COMMON. Suitable for the entire range of hearing loss. OTE (over the ear) - very small and sits on top of the outer ear. ITE (in the ear) - custom fitted, adjustable volume and battery powered. Much smaller and some may have difficulty using. Used for mild to moderate hearing loss. ITC (in the canal) - tiny that fit in the ear canal and barely visible. Customized fit. May be too small for some to use. CIC (completely in canal) - smallest type. Difficulty handling and positioning the device. Most expensive. Some patients have several deficits that affect communication abilities. Consider patients who are post CVA, TBI, or paralysis and what technology could be utilized to assist them with effective communication - ANSWER Broca's aphasia is a nonfluent, agrammatic expressive aphasia. They have good auditory comprehension and are able to understand but have difficulty producing intelligible speech. Communication - patience!!! Wernicke's aphasia is a fluent aphasia. They are able to speak, although the speech may contain odd words/sounds. They have impaired auditory comprehension and has great difficulty understanding what is said. Rely on nonverbal gestures. NEED SPEECH THERAPY Dysarthria - may be difficult to understand when they are speaking. Patience !!! May use assistive technology to augment or replace vocal communication. Encourage to speak slowly and use simple sentences or single words. Allow time for patient to respond. If there is no speech - assess the patient's yes/no reliability; use a picture board or eye blink. May use writing, typing or communication board. Deaf - use qualified sign language interpreters Paralysis - depending on the type, but communication is difficult. ALS(as it progresses) or a pontine stroke - they can not produce speech or use their hands to express. They are aware of the environment but with no motor function below the level of the eyes, it is difficult to effectively communicate to others. Use of electronic form of communication, either by blink of eye or use of reflector dot (worn on forehead) and they can move the mouse around to type words. recommended approaches for tobacco cessation and alcoholism identification and prevention - ANSWER Willing to quit smoking- "5 A's" ask about smoking status, advise them to quit, assess their willingness, assist in an attempt to quit (counseling and pharmacotherapy) arrange for follow up contact to prevent relapse. Not willing to quit smoking - "5 R's" - Relevance (why quitting would personally relevant to him/her); Risks (patient to identify them); Rewards (patient to set up reward system) Roadblocks (patient to identify them) Repetition (repeat with each clinic visit) SMOKING CESSATION MEDS - Chantix, Zyban, Nicotine patch, Nicotine gum, Nicotine lozenge, Nictorol Inhaler, Nicotrol NS ALCOHOLISM TREATMENT - Identify ones that require treatment, determine one's readiness to discuss treatment; assess one's need for detox; plan for post detox treatment in coordination with other professionals. Treatment consists of benzodiazepines, as well as thiamine and other vitamin supplements. Preventive vaccines - ANSWER Pneumococcal - >65. followed with dose at least one year after the most recent dose. Influenza -yearly by October Zostavax >60 Tetanus -every 10 years Elder abuse - ANSWER May include physical, sexual, psychological, and financial exploitation, neglect, and violation of rights. Reporting to adult protective services agency is MANDATORY . In nursing homes and assisted living facilities must be reported to the Long-Term Care Ombudsman Program in most states. Compare Healthy people initiative 2000 and 2010 - ANSWER Healthy People Initiative 2000 - initiated by the U.S. Public Health Service to reduce preventable death and disability for Americans. Healthy People Initiative 2010 - health care objectives designed to increase the quality and quantity of years of healthy life of Americans and to eliminate health disparities. 3 types of assessments: Physical , Cognitive and Functional - ANSWER Physical - assess physical health. It includes VS, assess for pain, BP problems, irregular heartbeat, abnormal breath sounds, etc. Functional - assessing what the older adult can still do for him or herself. Bathing, eating, dressing, etc. Cognitive - addresses thought processing, thinking and reasoning skills. Normal cognitive changes - Decline in information processing speed, divided attention, sustained attention, ability to perform visuospatial tasks, and short-term memory. Difference between delirium and dementia - ANSWER delirium as: • 1. Disturbance of consciousness with reduced ability to focus, sustain, or shift attention • 2. A change in cognition (such as memory deficit, disorientation, language disturbance) or the development of a perceptual disturbance that is not better accounted for by a preexisting, established or evolving dementia • 3. The disturbance develops over a short period of time (usually hours to days) and tends to fluctuate over the course of the day • 4. There is evidence from the history, physical examination or laboratory findings that the disturbance is caused by several different possible events including general medical conditions (cancer, AIDS), metabolic disturbances (including electrolyte disturbances as occurs with dehydration, drug intoxication, drug withdrawal, drug side effects, and multiple etiologies). dementia as: • 1. Development of cognitive deficits: o • The person cannot recall new or previously learned information. o • Memory problems must be present. • 2. One or more of the following: o a. Apraxia: Impaired motor activities due to damage to motor cortex (e.g., the person cannot use a key) o b. Aphasia: Language disturbance (e.g., cannot find words or put sentences together) o c. Agnosia: Failure to recognize or identify objects (e.g., the person may see something but cannot label it or tell what it is used for) o d. Disturbed executive functioning: Planning, organizing, sequencing, and abstracting problems due to frontal lobe damage Describe the use and purpose of the various special tools that have been proven to produce accurate results for assessment of the older adult. - ANSWER Confusion Assessment Method (CAM), to assist nurses and others to identify delirium quickly and accurately using the four basic features of delirium: 1) acute onset or fluctuating course, 2) inattention, 3) disorganized thinking, 4) altered level of consciousness. A diagnosis of delirium is made if both features 1 and 2 are present along with either of features 3 or 4. Mini Mental State Examination (MMSE): A brief series of questions to help determine the presence of cognitive impairment. Test the elder's orientation, registration, attention and calculation, recall and visouspatial skills. If the score is <20, it indicates cognitive impairment. The Clock Drawing Test (CDT) component of the Mini-Cog TM allows clinicians to quickly assess numerous cognitive domains including cognitive function, memory, language comprehension, visual-motor skills, and executive function and provides a visible record of both normal and impaired performance that can be tracked over time. SPICES is an acronym for the common syndromes of the elderly requiring nursing intervention: S is for Sleep Disorders P is for Problems with Eating or Feeding I is for Incontinence C is for Confusion E is for Evidence of Falls S is for Skin Breakdown HELPS TO IDENTIFY HEALTH ALTERATIONS Describe the pain assessment tools, and explain how unrelieved pain can lead to prolonged hospitalization. - ANSWER A pain assessment, such as a 0-10 scale OR faces pain rating scale, used to determine pain intensity. impaired clients, - assess for crying, moaning, groaning, NONverbal - Agitation, Increased confusion, Decreased mobility, Combativeness, Resistance to care, Guarding, Grimacing, Restlessness, Changes in eating and sleeping habits, Withdrawal, Aggression, Rubbing/holding a particular area of the body, Rapid breathing Pain in the elderly is particularly problematic. "Unrelieved pain can contribute to unnecessary suffering, as evidenced by sleep disturbance, hopelessness, loss of control and impaired social interactions. Pain may actually hasten death by increasing physiological stress, decreasing mobility, contributing to pneumonia and thromboemboli". Explain CDT (Clock Drawing Test)--commonly done with the Mini-Cog evaluation. - ANSWER The clock-drawing test, in which the client is asked to draw a clock face and indicate a particular time, screens for mild cognitive impairment - Five Rights of Medication Administration - ANSWER right patient, right drug ,right dose, right route, right time drugs that alter lab results - ANSWER Isoniazid, levodopa, morphine, vitamin C, and penicillin G may lead to false-positive urine glucose results. Levodopa may produce an increase in serum bilirubin and uric acid why is the older adult more apt to polypharmacy? - ANSWER Many older patients are prescribed multiple drugs, take OTC medications, and are often prescribed additional drugs to treat the side effects of the medications that they are already taking. They may see several different health providers BEER's List of Inappropriate drugs to use in older adults - ANSWER Benzodiazepines are mentioned quite a bit. Amitriptyline (Elavil), chlordiazepoxide-amitriptyline (Limbitrol), and perphenazine-amytriptyline (Triavil) Strong anticholinergic and sedation effects Diphenhydramine (Benadryl) May cause confusion and sedation; All barbiturates, except when used to control seizures Highly addictive, Meperidine (Demerol) May cause confusion Short-acting nifedipine (Procardia and Adalat) Potential hypotension and constipation Clonidine (Catapres) Potential for orthostatic hypotension and CNS adverse effects Mineral oil Potential for aspiration and adverse effects; Methocarbamol (Robaxin), carisoprodol (Soma), chlorzoxaxone (Paraflex), cyclobenzaprine (Flexeril), oxybutynin (Ditropan) Anticholinergic effects, sedation, weakness Short-acting dipyridamole (Persantine) Orthostatic hypotension Methyldopa (Aldomet) and methyldopa-hydrochlorothiazide (Aldoril) May cause bradycardia and exacerbate depression in older adults MAP - ANSWER medication assistance program is a choice you can offer your patient who cannot pay for their medication. Define autonomy and self-determination. - ANSWER Autonomy: self-governing, having moral independence.the concept that each person has a right to make independent choices and decisions. Self-determination - Patient has right to decide. What is frailty? What are the characteristics? - ANSWER General decline in the physical function of older adults. Defining characteristics include - unintentional weight loss of more than 10% in the prior year, - feelings of exhaustion, -grip strength in the weakest 20% for age, -walking speed in the lowest 20% for age -low caloric expenditure (<270 kcal) per week on physical activity. What is the Kohlman Evaluation of Living Skills (KELS)? - ANSWER It is an occupational therapy evaluation that is designed to determine a person's ability to function in basic living skills. The evaluation assesses 17 daily living skills under five categories—self-care, safety and health, money management, transportation and telephone use, and work and leisure. The administration of the evaluation combines questions and tasks. What are the factors that influence the quality of life of an older adult? - ANSWER influenced by health status, nutrition well being, spirituality, living arrangements, physical activity, social interactions, physical, mental, emotional function, disease management, independence. They are influenced by emotional, physical, economic, and social needs. Quality of life is enhanced by prevention and management of chronic disease through preventive care, support for healthy lifestyle choices, education, and home evaluations to reduce risk of injury. Maintaining maximum independence while maintaining maximum quality of life is a balance sought by the elderly, their caregivers, and society in general. Any evaluation of quality of life should include the perceptions of the person being evaluated. Even those with dementia are able to identify mood state, at times with more accuracy than their caregivers. What is the one of the most common role changes faced by the aging person? List all. - ANSWER Retirement is perhaps one of the most common role changes faced by the aging person. Loss of a spouse causes a profound role change, with numerous transitions. The transition from health to illness involves changes in lifestyle, self-concept, and perhaps a lost sense of value and relationships. divorce can force a change in roles. What is role reversal for the older adult? - ANSWER elder moves from care provider to care recipient through the course of aging. List and describe the care options for the older adult? - ANSWER • • Independent living with help: Cooks, companions, homemaker/cleaning service—formal or informal. • • Family: Usually informal; may live in patient's or family member's home. • • Adult daycare at a facility: Part-time temporary assistance, frequently for respite or while a family caregiver works; often used for persons with dementia or for the frail elderly needing assistance or at risk for social isolation. Usual discharge is to assisted living or death. • • Adult daycare at home: Part-time respite, as above. • • Senior living complexes/continuing care/supported care retirement communities: Full range or limited services, depending on the community and level of assistance needed; can be progressive as needs increase. • • Assisted living: Homelike setting with more physical and medical care available than in senior complexes. • • Paid caregiver homes (licensed or unlicensed): Caregivers accept one or several nonrelatives into their home to receive 24-hour assistance, especially with BADLs, usually on a private-pay basis. In some states, public subsidies may cover adult group/foster home care. • • Extended care facilities: Skilled or intermediate care nursing home facilities for rehabilitation or ongoing care; can be paid by Medicare, Medicaid, or private pay, depending on financial resources. Preadmission screening is usually required by the state regulatory agency. What is the Borg Category Rating Scale? - ANSWER Strength (defined as the ability to exert force) is less of a predictor of positive outcomes than muscle power (defined as the ability to exert force quickly). Allows persons to rate their own level of exercise and target their desired level of activity. Describe the Framingham Heart Study. What did it look at and what were the findings - ANSWER A 50-year, longitudinal study designed to identify factors that cause and prevent cardiovascular disease. the following risk factors have been identified: • • Age greater than or equal to 50 for men and 60 for women • • Hypertension • • Smoking • • Obesity • • Family history of premature CHD • • Diabetes (considered to be a CHD risk-equivalent, i.e., carries the same risk of a coronary event as known CHD) • • Sedentary lifestyle • • Abnormal lipid levels • The risk factors included in the Framingham calculation of 10-year risk are age, total cholesterol, HDL cholesterol, systolic blood pressure, treatment for hypertension, and cigarette smoking. What are the risk factors for stroke? Describe the statistical data in regards to strokes and the older adult. - ANSWER increased age, hypertension, smoking, diabetes, coronary artery disease, heavy alcohol use, cigarette smoking, sedentary lifestyle, and a high-fat diet, atrial fibrillation and asymptomatic carotid stenosis third leading cause of death in the United States, with more than two-thirds of stroke occurring in persons age 65 years or older. estimated that 36% of strokes suffered by clients 80-89 years of age are as a result of nonvalvular atrial fibrillation. What are other disease processes the older adult is at risk for? Explain the prevalence and how to prevent or control the illness - ANSWER Thyroid dysfunction -Older adults are far more susceptible to thyroid dysfunction than younger adults. Overt disease affects 5% of American adults, but the prevalence of subclinical hypothyroidism (elevated thyroid-stimulating hormone [TSH] with normal levels of thyroid hormone) is 17.4% among women older than age 75 and 6.2% among men over age 65. The goal of screening would be to decrease the negative effects of overt thyroid disease. Osteoporosis -The risk for the development of osteoporosis markedly increases with age, and osteoporosis is responsible for 70% of the fractures that occur in older adults. Women ages 65-69 have 6 times the risk of osteoporosis than younger postmenopausal women, and that rate increases to 14 times in women ages 75-79. Age, Bone density testing gold standard screening tool, Hearing and visual impairment -The prevalence of hearing and visual impairment increases with age and has been correlated with social and emotional isolation, clinical depression, and functional impairment. An objective hearing loss can be identified in over one-third of persons age 65 years or older and in up to half of patients age 85 years or older. High-frequency loss is the most important contributor to this increase in hearing loss, though up to 30% of cases may be caused or compounded by cerumen impaction or otitis media, which are easily treated. About 4% of adults ages 65-74 and 16% of those 80-84 years of age have bilateral visual acuity worse than 20/40. Macular degeneration is the most common cause of visual loss in elderly whites, whereas African Americans are more likely to lose vision as a result of cataracts, glaucoma, and diabetes. Visual impairment has been correlated with falls and hip fractures in the elderly. The Snellen eye chart is a useful tool for vision screening. Ophthalmology referral may be useful for clients whose corrected vision is worse than 20/40, or who report visual problems that limit activities such as reading or driving. Many expert panels, including the American Academy of Ophthalmology, the American Optometric Association, and Prevent Blindness America, recommend regular ophthalmologic exams for adults over 65 years of age (40 years of age for African Americans) based on the fact that effective glaucoma screening should be performed by eye specialists with specialized equipment to evaluate the optic disc and measure visual fields. The optimal frequency for glaucoma screening has not yet been determined. Prostate cancer is both the second most common form of cancer among U.S. men and the second leading cause of cancer death in U.S. men. The risk of developing prostate cancer increases with age and is the second leading cause of death in American men. The disease is most prevalent in African Americans and least prevalent among Asian Americans. Two tests are commonly used in prostate cancer screening: the digital rectal exam (DRE) and the prostate-specific antigen (PSA) blood test. Breast cancer is the most common cancer among U.S. women, and the prevalence of the disease increases with age. According to the CDC (2008), 3-4% of women who are 60 years old today will get breast cancer by the age of 70. Other risk factors for the disease include family history of breast cancer, atypical hyperplasia in breast tissue, and birth of a first child when a woman is over 30 years of age. The USPSTF examined whether breast cancer screening, by mammography, was beneficial in older women. Colorectal cancer is both the third most common cancer in the United States and the third leading cause of cancer death in the United States. The prevalence of the disease increases with age, and over 90% of colorectal cancer is diagnosed in clients over the age of 50. There are several good screening methodologies to detect early colon cancer: fecal occult blood testing (FOBT), sigmoidoscopy, and colonoscopy. Choice of screening test is determined based on client risk factors and preference. Patients who have a history of adenomatous polyps or inflammatory bowel disease, or a family history of colorectal cancer or adenomatous polyps, should receive colonoscopy. Screening for these high-risk clients is begun before age 50. Commonly used screening strategies for clients of average risk include annual FOBT, sigmoidoscopy performed every 5 years, or a combination of FOBT performed annually with sigmoidoscopy every 5 years when FOBT testing is negative. If the results of this test are positive, clients are sent for colonoscopy or double contrast barium enema combined with sigmoidoscopy, in cases where colonoscopy is not available. The best methodology for FOBT is the three consecutive stool samples that are collected at home by the patient on an annual basis. These tests should be examined without rehydration due to the decreased specificity of the test that is associated with rehydration of the samples. A single guiaic test, performed in the office with DRE, is not recommended as an adequate screening test What is the definition of a fall? And what can happen to an older adult after a fall? What are the risks for falls? (Past history of falls is a major risk factor!) - ANSWER A fall is defined as "an event which results in a person unintentionally coming to rest on the ground or another lower level; not as a result of a major intrinsic event (such as a stroke) or overwhelming hazard". Falls can result in injury, loss of independence, reduced quality of life, and death in the elderly. Fractures are the most serious health consequence of falls. Of those who fall, 20-30% suffer moderate to severe injuries such as hip fractures or hip traumas. 87% of all fractures among older adults are due to falls. The most common fractures are of the vertebrae, hip, forearm, leg, ankle, pelvis, upper arm, and hand. What are intrinsic risk factors? What are extrinsic risk factors? - ANSWER InTrInSiCs-changes associated with aging and with disorders of physical functions needed to maintain balance. :) vestibular, :) proprioceptive, :) visual function, as well as cognition and musculoskeletal function. :) LE weakness, dizziness Elderly persons who fall in institutions are usually more physically and/or cognitively impaired, and therefore intrinsic factors contribute most to falls and fall-related injuries. EXTRINSIC related to environmental hazards >> poor lighting, >>stairs, >>clutter, >>throw rugs >> poor shoes >> cluttered enviroment Extrinsic factors are implicated in up to 50% of all falls in the elderly in community settings. Among older adults living in the community, when and where do most falls occur? - ANSWER most falls occur during usual activities such as walking. Indoor falls occur most often in the bathroom, bedroom, and kitchen. Explain what you can do to prevent falls. - ANSWER Suggestions of possible changes to the environment, facilitation of modifications, and training in the use of adaptive equipment were helpful in reducing the number of falls in a group of frail elderly with a history of falls. However, modifications to the environment alone were not sufficient to make the difference. Compliance with the physical changes as well as with the suggested behavioral changes was also important. Identify the types of restraints used - ANSWER Types of Physical Restraints Wrist and leg restraints; Wheelchair safety bars; Vest restraints; Mitts; Chairs with lapboards; Beds with side rails; Bedsheets; Lap belts Chemical restraints - Medication Explain the effects of restraint use on the elderly - ANSWER The use of physical restraints increases the risk for falls, confusion, death by strangulation, and complications of immobility (e.g., contractures, pressure ulcers, pneumonia, UI, and learned helplessness). Physical restraints are not recommended, because they may increase fear and agitation. Distraction and soothing conversation should be tried instead. Identify alternatives techniques (instead of restraints) to deal with wandering, combative or confused patients. - ANSWER • • Personal strengthening and rehabilitation program • • Use of personal assistance devices such as hearing aids, visual aids, and mobility devices • • Use of positioning devices such as body and seat cushions or padded furniture • • Safer physical environment design, including removal of obstacles that impede movement, placement of objects and furniture in familiar places, lower beds, and adequate lighting • • Regular attention to physical and personal needs, including toileting, thirst, hunger, socialization, and activities adapted to current ability and former interests • • Design of physical environment for close observation by staff • • Efforts to increase staff awareness of a person's individual needs, including assignment of staff particularly to the person, in an effort to improve function and decrease difficult behaviors • • Living environment designed to promote relaxation and comfort, minimize noise, provide soothing music, and maintain appropriate lighting • • Provision of massage, art, movement activities, and complementary therapies (e.g., Healing Touch, energy work) • • Use of bed, chair, and door alarms to alert to the need for assistance Identify ways to promote healthy living among the elderly - ANSWER Social interactions, proper nutrition, and physical activity have been found to help maintain healthy behaviors and thus promote optimal aging. Identify the two most widely publicized components of health promotion - ANSWER Exercise and nutrition Describe some of the preventive care services covered under Medicare. - ANSWER One-Time "Welcome to Medicare Physical" within 6 months of initial enrollment; no deductible or copayment. Physician takes history of modifiable risk factors (coverage makes special mention of depression, functional ability, home safety, falls risk, hearing, vision), height and weight, blood pressure, EKG. Cardiovascular screening Every 5 years; no deductible or copayment;Ratio between total cholesterol and HDL, triglycerides. Cervical cancer Covered every 2 years; no deductible, copayment applies.Pap smear and pelvic exam. Colorectal cancer Covered annually for fecal occult blood test; no deductible or copayment. Covered every 4 years for sigmoidoscopy or barium enema; deductible and copayment apply. Covered every 10 years for colonoscopy; deductible and copayment apply. Densitometry Covered every 2 years; deductible and copayment apply. Diabetes screening Annually, those with prediabetes every 6 months; no deductible or copayment. Not covered routinely, but includes most people age 65+ (if overweight, family history, fasting glucose of 100-125 mg/dl [prediabetes], hypertension, dyslipidemia). Mammogram Covered annually; no deductible, copayment applies. Prostate cancer Covered annually; no deductible or copayment. Digital rectal examination and PSA test. Smoking Cessation Two quit attempts annually, each consisting of up to four counseling sessions. Limited to those with tobacco-related diseases (heart disease, cancer, stroke) or drug regimens that are adversely affected by smoking (insulin, hypertension, seizure, blood clots, depression). Clinicians are encouraged to become credentialed in smoking cessation. Immunization No deductible or copayment. Influenza vaccination covered annually; pneumococcal vaccination covered one time, revaccination after 5 years dependent on risk. Other Coverage Diabetes outpatient self-management training (blood glucose monitors, test strips, lancets; nutrition and exercise education; self-management skills: 9 hours of group training, plus 1 hour of individual training). Medical nutrition therapy for persons with diabetes or a renal disease: 3 hours of individual training first year, 2 hours subsequent years. Glaucoma screening annually for those with diabetes, family history, or African American descent. Persons with cardiovascular disease may be eligible for comprehensive prevention programs by Drs. Dean Ornish and Herbert Benson: coverage 36 sessions within 18 weeks, possible extension to 72 sessions within 36 weeks. Frequency and Duration These are estimates of what researchers recommend, relying most heavily on the U.S. Preventive Services Task Force recommendations, but not exclusively on them. Blood pressure: Begin early adulthood, annually, ending around age 80. Cholesterol: Begin early adulthood, every 2-3 years, ending around age 80. Colorectal cancer: Begin age 50, every 5-10 years for colonoscopy, ending around age 80. Mammogram: Begin age 40, every year or two; begin age 50 annually; begin age 65 every 2 years; ending around age 80. Osteoporosis: Begin early adulthood for women (no frequency recommended); every 2-3 years after age 65 for women, less frequently for men. Pap test: Begin with female sexual activity, two normal consecutive annual screenings, followed by every 3 years; two normal consecutive annual screenings around age 65, then discontinue. Prostate cancer: Do not do routinely, except if there is a family history or African American heritage. Describe a health contract - ANSWER The health contract/calendar relies on the self-management capability of a client, after initial assistance is provided by a clinician or health educator. The client is helped to choose an appropriate behavior change goal and to create and implement a plan to accomplish that goal. The statement of the goal and the plan of action are then written into a contract format. A health contract is alleged to have several advantages over verbal communication alone, especially when the communication tends to be limited in direction (i.e., mostly from health professional to client). The alleged advantages of a contract, which still need additional empirical testing, are that it is a formal commitment that not only enhances the therapeutic relationship between provider and client, but also requires the active participation of the client. The contract also: • • Identifies and enhances motivation • • Clarifies measurable and modest goals • • Suggests tips to remember new behaviors • • Provides a planned way to involve support persons such as family and friends Explain Bailey's Bull's eyes. - ANSWER The goal of the bull's-eye is for people to consume the nutritious foods that are listed in the center of it. These foods are low in saturated fat, sugar, and sodium, and high in fiber. They include skim milk, nonfat yogurt, most fruits and vegetables, whole grains, beans and legumes, and water-packed tuna. As you move to the foods listed in the rings farther away from the bull's-eye, you eat more saturated fat, sugar, sodium, and low-fiber foods. In the outer ring of the bull's-eye, therefore, are most cheeses, ice cream, butter, whole milk, beef, cake, cookies, potato chips, and mayonnaise. Discuss Healthy People 2010 and 2000. - ANSWER Healthy People 2010 is an initiative of the U.S. Department of Health and Human Services that utilized the skills and knowledge of an alliance of more than 350 national organizations and 250 state public health, mental health, substance abuse, and environmental agencies to develop a set of health care objectives designed to increase the quality and quantity of years of healthy life of Americans and to eliminate health disparities. Healthy People 2000, was initiated by the U.S. Public Health Service in another effort to reduce preventable death and disability for Americans. Define health promotion vs. health screening. - ANSWER Model health promotion programs: Programs that have received federal funding and foundation support to evaluate their effectiveness, and to encourage their replication. Health screening are tests that look for diseased before you have symptoms. Screening can find diseases early. Identify the three types of prevention and provide an explanation and example of each. - ANSWER Senior Services of Seattle/King County began the Senior Wellness Project (later renamed Project Enhance) in 1997 at the North Shore Senior Center in Bothell, Washington. It was a research-based health promotion program that included a component of chronic care self-management that was modeled after Kate Lorig's program. Project Enhance is currently divided into two components: Enhance Fitness and Enhance Wellness. Enhance Fitness is an exercise program that focuses on stretching, flexibility, balance, low impact aerobics, and strength training. Certified instructors have undergone special training in fitness for older adults. Classes last an hour, involve [Show More]

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