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NURS4412 Community Health > Older Adults > Flashcards

Older Adults Flashcards

1
Q

Health Status of Older Adults

A

Age Group: 65 years or older

Growth in number and proportion of older adults living in the United States; projected to reach almost 30% of population by 2060

Increased demands on public health system, medical and social services, and health care delivery

Chronic disease contributing to disability, diminished quality of life, and increased health care costs

Globally: # of adults over age 65 expected to reach 1.4 billion by 2050
- Those over age 80 years growing faster than any other group

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2
Q

National Health Status of Older Adults

A

Increased life expectancy (females > males)

Older adults healthier than ever before
Young–old (65–75 years)
Old–old (75–85 years)
Oldest old (85–100 years); approximately 40%

Elite-old (centenarians)

Frail elderly (over age 85 years and need assistance with ADLs)

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3
Q

Common Misconceptions About Older Adults

A

Inability to live independently

Most w/ diminished intellectual capacity or senility

Homogeneity: All alike w/ no individual differences

Inability to learn new things

W/drawn, inactive, nonproductive

Liability: Expensive, drain on economy

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4
Q

Characteristics of Healthy Older Adults

A

Lifetime of healthy habits

Strong social support system

Positive emotional outlook

Affected by
- Personality traits
- Life experiences
- Current physical health
- Current societal supports

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5
Q

Health Needs of Older Adults: Primary Prevention

A

Health education; Follow-through of sound personal health practices;
- Recommended immunizations
- Good Oral Health

Nutrition, oral health, exercise, safety needs, sleep

Economic security needs: Retirement, Social Security

Psychosocial needs
- Maintaining independence
- Social interaction
- Companionship
- Purpose

Spirituality, advance directives

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6
Q

Top 5 Immunizations for Adults

A

COVID-19
Influenza
Pneumococcal
TDAP
Zoster Recombinant

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7
Q

Health Needs of Older Adults: Secondary Prevention

A

Patient is at risk for colon cancer, colorectal cancer, breast cancer, osteoporosis, prostate cancer

Colonoscopy, Mammogram, Prostate-Specific antigen, Dexa Scan,

Focuses on early detection of disease & prompt intervention

Routine screening for HTN, diabetes, cancer

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8
Q

Health Needs of Older Adults: Tertiary Prevention

A

Patient already has a disease
Ex) Treating a patient w/ syphilis using Penicillin

Follow-up & Rehab

Health Issues:
- Alzheimer’s disease
- Arthritis
- Cancer
- Depression
- Diabetes
- Cardiovascular Disease
- Osteoporosis

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9
Q

Common Health Problems of Older Adults

A

Alzheimer’s Disease

Arthritis: Leading cause of disability

Cardiovascular Disease (Leading causes of Death): CHF, prolonged HTN, PVD

Cancer: Age is a significant risk factor
- If history of family history, have them screened for that type of cancer 10 years prior

Depression

Diabetes: Focus on med management, diet change, exercise
- A1C

Hearing Loss

Obesity

Osteoporosis:Dextra Scan

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10
Q

Elder Abuse

A

Intentional or neglectful acts by a caregiver or any other person that causes harm or a serious risk of harm to a vulnerable adult

Tends to go underreported
- No one witnessed it
- Facility’s are reluctant to report due to threat of lawsuit

Physical Abuse
Neglect
Emotional or psychological abuse
Verbal abuse & threats
Financial abuse & exploitation: Most common type
Sexual abuse
Abandonment

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11
Q

Criteria for Effective Health Services

A

Comprehensiveness

Affordable housing options

Adult day and memory care programs

Access to high-quality health care services

Health education (including preparation for retirement)

In-home services

Recreation and activity programs

Specialized transportation services

Safe and outdoor spaces

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12
Q

Services for Healthy Older Adults

A

Goal: Maintenance of Functional Independence

Living arrangements & care options
- Skilled nursing facilities
Intermediate care; assisted living
- Personal care homes

Continuing care retirement communities
Presbyterian Village, Austell
St. George Village, Roswell
Respite care services
Hospice and palliative care

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13
Q

If a patient needs around-the-clock care…

A

…they need to go to a nursing care

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14
Q

Respite Care Services

A

Gives caregivers a break

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15
Q

Palliative Care

A

Consists of comfort & symptom management

Does NOT provide a cure

Primarily intended to relieve the burden of physical & emotional suffering that often accompanies the illness associated w/ aging

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16
Q

Community Health Nursing in an Aging America

A

Case management for resources & referral (MOST IMPORTANT)

Encouragement of healthy lifestyle changes to avoid disease & disability

Development of creative living arrangements & services

Education about immunizations & safety measures including fall prevention

17
Q

Home Health Care

A

Focus is on the 3 levels of prevention

18
Q

Home Health Nursing

A

Focus is on empowerment for highest possible levels of function & health (PICC line, Foleys, PEG tubes)

19
Q

Hospice & Palliative Care

A

Focus is on optimizing quality of life for those experiencing lime-limiting, progressive illness

Prognosis is less than 6 months

20
Q

Home Health

A

Provide care at home
- Help pts & their families achieve improved health & independence in a safe environment

Medicare-certified or Social Security Disability

Recipients have diverse needs
- Most common dx is circulatory disease, followed by neoplasms, & endocrine diseases (especially diabetes)

Skilled Nursing Services
- Wound Care
- Trach Care
- Foley Care
- G-Tube Care: Peg or NG
- Central lines

National & state regulations in place

21
Q

OASIS (Home Health Outcome & Assessment Information Set)

A

Contains data items developed to measure patient outcomes & to improve home health care

OASIS Assessments are required of ALL home health agencies certified to accept Medicare & Medicaid Payments

Very detailed & time consuming but thorough assessment that sets up what care the client needs & effective case management

22
Q

Practice Linkages

A

Outcome and Assessment Information Set (OASIS)
- Designed to demonstrate improved, cost-effective client outcomes

Two key OASIS target areas
1) Medication management
2) Infection prevention

OASIS-> Outcome eval-> Outcome management-> Resource Management-> Cost-effective, quality care

23
Q

Home Health Clients

A

Clients include individual, family, significant others

Individuals are predominantly: Older than 65 years, but not exclusively

Individuals tend to:
- Have chronic health needs (e.g., diabetes, COPD, CHF)
- Rely on care from family members (who may exhibit signs of compassion fatigue)

24
Q

Home Health Interdisciplinary Team

A

Home health care nurses: RNs, LPNs
- RNs: Initial assessment
- LPNs: Follow-up and do nursing skills

Home care aides and personal care attendants

Physical therapists and staff: Gross Motor Skills
- Walking

Occupational therapists and staff: Fine Motor Skills
- Eating
- Writing

Social workers: Obtain resources

Administrative personnel

25
Q

Reimbursement for Home Health Care

A

Corporate: Insurance companies, HMOs, PPOs, and case management programs

Government 3 rd Party Payers: Medicare, Medicaid, Military Health System, & Veterans’ admin
- Large payout

Individual clients & families

26
Q

Medicare Home Health Criteria & Reimbursement

A

The patient must:
- Be confined to home or homebound
- Need skilled services (from a nurse or therapist)
- Be under care of a physician
- Receive services under a home health plan of care established and periodically reviewed by a physician
- Have had a face-to-face encounter related to home health condition with a physician or NP

Episode of care: 60 days

Admission: assessment using Outcome and Assessment Information Set (OASIS)

Medicare documentation: OASIS, Medicare plan of care, recertify every 60 days

27
Q

Medicare-Reimbursed Home Health Care

A

Prospective payment system
- Episode of care: 60 days
- Payment determined by clinical and functional status at start of care and projected service needs

Start of Care

Referral from physician

Assessment using Outcome and Assessment Information Set (OASIS)

Develop plan of care

28
Q

Nursing Practice During Home Visits

A

Contacting patient and/or family to schedule visit

Locating the home

Assessment begins at the curb

Promoting self-management

Collaborating, mobilizing, strengthening, teaching, and solving problems

If it ever becomes unsafe, terminate the visit
- Let someone know
- Also terminate visit if family conflict arises

29
Q

Selected Nursing Challenges in the Home

A

Infection control
- Clients
- Home health care team

Medication safety

Risk for falls

Technology at home

Nurse safety

30
Q

Home Health Nursing Case Management

A

Nurse as a case manager for each client

Coordinating other professionals and paraprofessionals involved in the client’s care
- PT/OT

Serving as primary contact with client’s physician

Case conferencing with team members (Medicare mandate—every 60 days)

Supervising paraprofessionals

31
Q

Hospice & Palliative Care

A

Four types of care:
1) Routine home care with intermittent visits
2) Continuous home care when condition is acute and death is near
3) General inpatient/hospital care for symptom relief
4) Respite care in nursing home of no more than 5 days at a time to relieve family members

Four categories of hospice providers:
1) Home health agencies
2) Hospital-based facilities
3) Skilled nursing facilities
4) Freestanding facilities

32
Q

Four Foci of Hospice

A

1) Attention to body, mind, & spirit

2) Death is not a taboo topic

3) Health care tech used w/ discretion

4) Client have a right to truthful discussion & participation in treatment decisions

33
Q

Medicare Hospice Benefit Requirements

A

Client must:
- Have a prognosis of 6 months or less to live

  • Acknowledge a terminal prognosis
  • Choose comfort care instead of life-extending care
  • Sign up for comfort-focused hospice benefit
  • Waive regular Medicare health services
34
Q

Hospice Services & Reimbursements

A

Services
- Coordination of care in all settings
- Clinical and financial case management

Four payment levels
1) Routine home care with intermittent visits
2) Continuous home care for acute condition, imminent death
3) Inpatient hospital care for symptom relief
4) Respite care in a nursing home to relieve family members

35
Q

When is Hospice Care Appropriate?

A

When the patient chooses to receive palliative care instead of curative care for a life-limiting or terminal illness
When the physician determines that the patient has a life-expectancy of six months or less if the disease runs its normal course
Can be any age, any illness, as long as above conditions are met

36
Q

Palliative vs Hospice

A

Palliative Care
- Symptom Team approach
- Enhance quality of live
- Provided along w/ life-prolonging treatments

Hospice
- Symptom management
- Holistic care
- Team approach
- Enhance quality of life
- Provided in lieu of life-prolonging treatments
- Included as part of Medicare (Hospice Benefit- under Medicare Part A)

37
Q

Goals of Hospice Care

A

Provide comfort and relief of physical, emotional, social and spiritual suffering

Promote dignity

Prepare patient/family for death
- Provide a peaceful “good” death as defined by the patient and family
- Empower patient/family to make decisions relating to life closure

38
Q
A

NURS4412 Community Health (7 decks)

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