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HSA 290 Exam 2

Terms in this set (67)

Fluid Intelligence
Skills that are BIOLOGICALLY DETERMINED
-flexibility & abstract thinking
ex. spatial orientation (rubik's cube, puzzles)
Crystallized Intelligence
Knowledge or abilities acquired through EDUCATION & lifelong EXPERIENCES
ex. verbal comprehension (vocabulary)
Is there a decline in fluid intelligence or crystallized intelligence? Why?
There is a decline in FLUID intelligence because there is a slowing down of information processing and response time
Some declines of intelligence after age _____, with significant declines in ages _____+
60, 80
Definition of Learning
acquiring new knowledge
Definition of Memory
storage & retrieval of learned information
What are the five types of memory & their definitions?
1. Primary: instant/immediate (short duration) ex. recalling a 7 digit number immediately

2. Short-Term: temporary processing/holding of information, (ex. memorizing a phone number for 5 minutes)

3. Working memory: Short-term memory while completing a task (ex. recalling the first three steps of a recipe while cooking, or entering the memorized phone number into your phone)

4. Episodic: Retrieval of information acquired in a particular place & time (ate for lunch today)

5. Long-term: Permanent storage
There is a decline in which two types of memory?
Working & Episodic
What stage of Erickson's model is related to gerontology?
9th stage- Gerotranscendence, meaning to move away from early & midlife. **acquire wisdom
Five factor Model by McCrae & Costa
O C E A N
Openness to experience
Conscientiousness
Extroversion
Agreeableness
Neuroticism

*greatest instability ages 17-35
What is Delirium?
Disturbance in consciousness & cognition that is reversible.
*caused by external variables (UTI, etc.)
Personality
a unique pattern of innate and learned behaviors

remains stable with normal aging

influences how we interact with environment and aging
How do older adults learn best?
conducive environment

no time constraint

multi-media and repetition
Depression in older adults
1 in 20
High in institutionalized older adults
Leads to further health problems
More likely to mask/hide symptoms
Symptoms can be easily confused
More likely to seek help from a primary care physician
Suicide & The Elderly
*Older people are at the greatest risk for suicide
Highest suicide rate in older white males
75% who commit suicide have seen a physician in the last month
Treatments for Depression
Psychotherapy (empathy, coping skills)
Pharmacological with caution
Use of Mental Health Services in Older Adults
Significantly underutilized by older people

WHY?
Stigma
Lack of knowledge
Transportation
Payment mechanisms
______ is the biggest risk factor for dementia
Age
Mild Cognitive Impairment
Problems with memory, language, etc. but does NOT interfere with daily life
What percentage of MCI individuals can convert to dementia?
39%
What is dementia?
A general class of disorders that causes IRREVERSIBLE cognitive decline
In general, dementia results in:
Impairments in memory, speech, judgment, problem solving, language problems (aphasia),
inability to carry out requested actions (apraxia, ex. making PB & J), & inability to recognize common objects (agnosia, ex. no idea what a cell phone is)
What is the most common form of dementia?
Alzheimer's Disease (60-80%)
What is a major risk factor for the sudden infarcts / vascular dementia?
Cardiovascular disease
Who first described AD? When?
Alois Alzheimer in 1906
What is early AD? What is late AD?
Early: onset/familial (ages 35-60)
Late: Onset/sporadic (60+) ---MOST PEOPLE
What is the prevalence of AD?
5.4 million Americans, & projected to increase to 16 million by 2050
11% over age 65
32% over age 85
473,000 new cases every year
Someone is diagnosed every 66 seconds
Diagnosis for AD is on the basis of _________
Exclusion
AD is the _____ leading cause of death, and the _____ leading cause of death in older adults
6th in general, 5th for older adults
Caregiving with AD
15.9 million Americans provide unpaid care
(32% spend more than 5 years caregiving)
(25% provide 40+ hours/week of care)

Involves labor intensive personal care tasks:
High levels of emotional stress, depression, and poor health outcomes

The total economic value is $221 billion
Long-term care & AD
Use of LTC increases as the disease progresses

Percent with dementia by setting:
Home care: 37%
Adult day care: 32%
Assisted living: 42%
*Nursing home: 64%*
Costs of AD
$236 billion annually for health and long-term care costs

$36.5 billion to businesses who employ caregivers for people with AD

Medicare spending is 3x higher, Medicaid spending is 19x higher
Sexuality
Includes the ability to be intimate with another person in a mutually satisfying manner

Pleasuring, cuddling, and touching are more important among older adults

Intimacy not restricted to sexual intercourse:
Touching / holding hands
Embracing / hugging
Kissing
Benefits of Sex
Reduces stress/relaxes
Enhances intimacy
Helps form foundation of strong and supportive personal relationships
High Life satisfaction
Health benefits
Self-esteem

Older people can have satisfying relationships without active sex life

Satisfaction with sexual behavior is not associated with age but with health
Sexual activity decreases after age _____
74
Physical changes in MEN
Decline in testosterone

Abbreviated Ejaculation

Erectile Dysfunction is common
(treatment: Viagra and Levitra)
Physical changes in WOMEN
Decline in estrogen and progesterone = menopause

Reduction of elasticity and lubrication of the vagina
(treatment: Lubrications)
Older lesbians and gay men
Older lesbian and gay cohorts have had to manage heterosexism for the greater part of their lives

Fear discrimination by health care professionals and not being treated respectfully

Face ageism added onto homophobia
Sex is an ADL: True or False
TRUE
_____% of HIV cases are in people 50+
25%
What is the #1 cause of malnutrition?
Depression
What is undernutrition? In what age group is it common?
Inadequate dietary intake, loss of appetite, muscle atrophy. Common in ages 65+
What is overnutrition? What percentage of the elderly are considered overweight?
Excess nutrient & energy intake.
11-40% of the elderly
Undernutrition happens in what percentage of older adults who are institutionalized?
50-80%
Assessing Nutritional Status- "Malnutrition" 2/6 of the following
Insufficient energy intake
Weight loss
Loss of muscle mass
Loss of subcutaneous fat
Localized/generalized fluid accumulation
Diminished functional status, measured by handgrip strength
Assessing Nutritional status
Detailed H&P
Anthropometric data
Weight loss/gain, appetite
Diet/intake history
Difficulty chewing/swallowing
Physical/medical changes
Living situation/social
Medicines
MNA (Mini Nutritional Assessment Tool)
Anthropometrics
General assessment
Dietary assessment
Self assessment
Treatment of Malnutrition
Weight loss: increase high kcal/pro foods, add fats if tolerated, small frequent meals, supplements

Vitamin/mineral: supplement; B12, Vitamin D, Calcium, Iron

GI problems: lactose intolerant, constipation, decreased appetite (treat with food if possible)

Meds: Drug/nutrient interactions

Treat underlying illness: decrease anorexia, improve immune function

Environment important: LTC residents eat together as much as possible, sitting upright, enhance food palatability, encourage family visits

Ethical issues: tube feedings
Costs of health care
$2.6 Trillion per year

18% of GDP

Older adults consume 34% of the total health care expenditures
Population aging has contributed to increased health care expenditures but it is not sole reason. What are the others?
Expansion of government programs
Medical inflation
More expensive treatments/technologies
Medicare
Federal program that provides acute care (hospital, physician, and drugs) for:

Older adults (45 million)
Disabled people < 65 (9 million)
Social insurance program
Benefits and eligibility are defined by law and funded through taxes from participants
How is medicare financed?
Payroll taxes (1.45% x 2)

Beneficiaries pay annual premiums, deductibles, co-payments, and coinsurance

General tax revenues
Medicare Part A
Hospital inpatient
Skilled nursing facility (acute) (3-night stay in hospital)
Hospice benefits
Limited home health
Medicare Part B
Unlimited physician care
Outpatient services
Ambulance and ER services
Limited home health care

Requires beneficiaries to pay a monthly premium of $104.90/month but higher for those earning $85,000+

Annual deductible of $166

Coinsurance of 20% for services
Medicare Part C
Optional program that provides Part A&B services under a private managed care plan

May pay wider range of preventive care and/or lower OOP costs
What percentage of people select part C?
25%
Medicare Part D
Voluntary prescription drug benefit through private plans

Beneficiaries pay monthly premium and annual deductible (varies by plan)

Donut hole
Medicare and the ACA
The donut hole will be gradually eliminated by 2020

Preventive care covered with no-cost sharing beginning in 2011

Cuts payments to Part C plans
Medicare (limitations) DOES NOT cover:
Vision care and eyeglasses
Hearing aids
Dental care
Experimental treatments
Long-term care
Medicare costs
Older adults pay 4x as much on health care

About 20-30% of their income goes to uncovered health care costs

No limit on out-of-pocket spending
Medigap Insurance
Private insurance plans that cover the difference between Medicare coverage and the cost of treatment

only 30% of beneficiaries have it
Future proposals to reduce medicare costs
Require older people to pay more OOP

Reduce covered services

Pay providers less

Raise eligibility age from 65 to 67

Privatize Medicare
What did Callahan propose about Medicare?
We should not use medical technology/advancements to prolong life past the natural life expectancy
Medicaid
Federal-state public assistance program to provide health care to the poor and other needy groups.

States determine eligibility requirement

Must provide certain medically necessary services with additional services being optional by each
state

Medicare beneficiaries may also qualify ("dual eligibles)
Older persons account for only _____% of Medicaid users, but _____% of the Medicaid budget
12% of users, 75% of budget
Medicaid and the ACA
Optional for statues to expand coverage to all individuals with incomes up to 138% of FPL (state dependent)

Shift in funding for alternatives to nursing home care
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