Only $35.99/year

WGU Care of the Older Adult - C475 Adult DPV1

Terms in this set (127)

Acute Care Hospital (ACH) - point of entry into the health care system for older adults.

Acute Rehabilitation (Rehab)- may be found in several settings.
-Uses the interdisciplinary team of nurses, therapists, and physicians.
-Goal: to maximize independence, promote maximal function, prevent complications, & promote quality of life within each person's strengths and limitations.
- Level of intensity depends on setting & patient.

Home Health Care (HHC)- For independent living home-bound adults who require a longer period of observation or care from nurses.
-Can include PT/OT, & speech therapy.

Hospice- holistic, interdisciplinary care that helps the dying person "live until they die."
- Includes palliative care and pain management and comfort care.

Long-term Care Facility (a.k.a. nursing home)- provides 24 hr support care to any age who have lost some or all their capacity for self-care due to illness, disability, or dementia

Skilled Nursing Facilities (SNFs)- subacute or transitional care are for those patients requiring more intensive nursing care than provided in Long-term care.

Alzheimer's Care- dedicated specifically for Alzheimer and Dementia care.

Respite Care- provides time off for family members who are caretakers.
-Care can be at adult daycare center, in the home, or in an assisted living facility or LTC

Continuing care retirement community (CCRC)- group care in independent living to assisted living, LTC, or skilled

Assisted Living- alternative who do NOT feel safe living alone, who wish to live in a community setting, or who need some additional help with ADLs.
-each have their own apartment or room.

Foster care/Group Homes- adults who can do most ADLs but have safety issues and require supervision with some activities.

Green House Concept- new concept of a home environment with 8-10 residents in private rooms with open kitchen and still receive assistance.

Adult Day Care- Adult day services are community based group programs designed to meet the needs of functionally and/or cognitively impaired adults through and individual plan of care.
-< Less than 24 hour care.
• Digestive system fewer digestive enzymes and juices produced. Peristalsis decreased causing constipation/flatulence. Loss of teeth. Liver functions decrease. Dysphagia often occurs. Less saliva and slower gag reflex leads to chocking. Poor appetite due to less taste sensation.
• How to help Good oral hygiene and repair of damaged or lost teeth. Relaxed atmosphere when eating. Avoid dry, fried or fatty foods (difficult to digest) Offer high fiber and high protein foods. Use seasonings to help taste. Increase fluids to help swallowing.

• Endocrine system Increased production of some hormones and decreased production of other hormones. Immune system less effective so get sick easier. Cold, tired, less alert due to metabolic rate decrease. Increased blood glucose levels due to intolerance to glucose due to intolerance to glucose. Usually occurs gradually.
• How to help: Proper exercise, rest and medical care for illness. Balanced diet. Healthy lifestyle to decrease the effects caused by changes in the hormones.

• Nervous system changes here affect other areas. Decrease blood flow causes progressive loss of brain cells. Due to above, interferes w/thinking, reacting, interpreting and remembering. Sense decreases-longer to feel pain, less taste. May have memory loss, especially short term. More prone to cataracts (lens become cloudy) and glaucoma (intraocular pressure increases) Hearing loss usually gradual and more prone to high tones.
• How to help Be patient. Proper eye and hearing care—may need special phones for seeing numbers or hearing tones. Speak slowly and clearly, eliminated background noise. Arrange meals attractively. Environmental safety—smoke detectors, safety bars, etc.

• Integumentary system Most obvious effect seen here sebaceous and sudoriferous glands less active. Circulation decreases. Skin less elastic, itching is common, senile lentigines appear (dark yellow/brown spots). Increased sensitivity to temperature
• How to help: Good hygiene. Frequent use of bath oils/lotions. Decrease showers/baths to weekly. Keep injuries clean and free of infection. Layer clothing to help with cold. No hot water bottles/heating pads.

• Respiratory system Muscles become weaker, rib cage becomes more rigid, Alveoli becomes thinner and less elastic. Chronic conditions: emphysema, bronchitis, dyspnea.
• How to help Alternate activities with periods of rest. Proper body positioning. Sleep in semi-fowlers position. Avoid smoke-filled rooms

• Urinary system Kidneys decrease in size and become less efficient. Loss of ability to concentrate urine causing loss of minerals and electrolytes. Nocturia is common. Enlargement of prostate gland makes urination difficult. Incontinence due to loss of muscle tone. Dehydration can occur because individuals decrease intake thinking they will urinate less.
• How to help: Encourage fluids to decrease kidney infections. Regular trips to the bathroom (bladder training) Drink most fluids prior to 7 pm.

• Musculoskeletal system muscles lose tone, volume and strength. Osteoporosis occurs from mineral loss. Joints become stiff, less flexible and sometimes painful. Movement is slower. Fine motor movements become more difficult.
• How to help: Encourage exercise to keep muscles active (range of motion). Diet high in protein, calcium and vitamins to slow mineral loss and help muscle strength. Enviromental safety-grab bars, canes, etc. Well fitting shoes. Consult w/ therapy for latest tx.

• Circulatory system Heart muscle less efficient. Vessels narrow and less elastic. Blood flow to brain decreases due to efficieny. Blood pressure may increase.
• How to help: Avoid strenuous activities. Moderate exercise, low impact. Support hose to prevent blood clots. Range-of-motion exercise. Diet low in salt/fat.

• Changes in Cognitive Decline in information processing speed, divided attention, sustained attention, ability to perform visuospatial tasks, and short-term memory

• Changes in Hearing Conductive problems Sensorineural problems. Presbycusis. Results in loss in sensitivity to pitch with high-frequency consonants, poor word recognition

• Changes in Touch Reduction in number of receptors. Reduction in blood flow. Results in a reduction in tactile and vibration sensations, decreased sensitivity to warm or cold stimuli

• Changes in Vision Changes in lens, pupil, and iris. Results in poor visual acuity, Presbyopia, increased sensitivity to light and glare.
Make sure you are familiar with this. Benzodiazepines are mentioned quite a bit. It is estimated that 1/5 of clients are prescribed medications that are not

BEERS List of Medications to Avoid in the Elderly
Medication Effect
Propoxyphene (Darvon) and combination products (Darvon with ASA, Darvon-N, and Darvocet-N) Offers few advantages over acetaminophen, yet has the same adverse effects as other narcotic medications
Amitriptyline (Elavil), chlordiazepoxide-amitriptyline (Limbitrol), and perphenazine-amytriptyline (Triavil) Strong anticholinergic and sedation effects
Diphenhydramine (Benadryl) May cause confusion and sedation; use in smallest possible dose for emergency allergic reactions
All barbiturates, except when used to control seizures Highly addictive, more adverse effects in the older adult
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; other options readily available
Estrogens only Lack of cardioprotective effect in older women; evidence of carcinogenic potential
Nitrofurantoin (Macrodantin) Potential for renal impairment; other alternatives available
Cimetadine (Tagamet) CNS effects including confusion
Indomethacin (Indocin and Indocin SR) CNS adverse effects; other NSAIDs available with fewer 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
• Osteoporosis Age, low BMI, and failure to use estrogen replacement are the strongest risk factors for osteoporosis development. The risk associated with agae alone was high enough that the USPSTF recommends routine screening for all women over the age of 65. If risk factors, especially weight less than 70 kg ( about 154 lbs) and no estrogen therapy, are present, the task force suggest screening women at age 60.
• Prostate Cancer Two tests are commonly used in prostate screening: the digital rectal exam (DRE) and the prostate-specific antigen (PSA) blood test.
• Decreased Metabolism with age, hepatic mass and blood flow decrease. Therefore, the hepatic metabolism of medications is reduced. Also with age, the renal mass and renal blood flow are reduced. This physiologic change will decrease the amount of drug that goes through renal excretion. This can result in higher, and potentially toxic, levels of drug in the body of the older adult
• Cardiovascular Structural changes with age: Decreased myocardial cells, decreased aortic dispensability, decreased vascular tone. Increased myocardial cell size, increased left ventricle wall thickness, increased artery stiffness, increased elastin levels, increased collagen levels, increased left atrium sized. Functional changes: Decreased diastolic pressure (during initial filling), decreased diastolic filling, decreased reaction to B-adrenergic stimulus. Increased systolic pressure, increased arterial pressure, increased wave velocity, increased left ventricular end-diastolic pressure, elongation of muscle contraction phase, elongation of muscle relaxation phase, elongation of ventricle relaxation. No change with age: Ejection fraction, stroke volume, overall systolic function