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What is aging in place?

Allowing older adults to remain in their own homes and communities for as long as possible, thus minimizing traumatic uprooting moves to other residential and care settings.


What are some services that may foster "aging in place"?

Personal Care
  • assistance with ADL’s (caregiver)    
  • home health care          
  • meal preparation
  • nutrition sites
  • home delivered meals or groceries
Home Maintenance
  • home repair &/or modifications
  • housekeeping
  • yardwork
  • shopping, medical appointments, etc.
Emergency call/response systems
  • Life line


What are design features that increase safety and foster aging in place?

  • Ramps
  • Side rails


What are potential reasons for the elderly moving?

  • Income
  • Health hazards
  • Not able to walk
  • To move closer to the family
  • Chronic illness
  • Disability


What is a least restrictive living envrionment?

A living arrangement which maximizes choice and minimizes lifestyle disruption.


What is a single-family residence?

Home that is owned or rented by an elder who lives alone, with a spouse,  significant other, or other family members. 


What are "seniors only" apartments?

  • Individual apartments within a specially designed, multi-unit dwelling.
  • Apartments restricted to seniors.
  • Some older adults sell their homes of many years and move to an apartment.
  • Pros: You are around people their age
  • Cons: The're around only people their age, restricted only to seniors


What are retirement communiities?

  • Residential development designed for independent, active elders.
  • Owned or rented units.
  • Offer amenities, recreational activities, and services that cater to residents e.g., meals, transportation, housekeeping, golf, tennis, swimming pool, spa,  and a variety of clubs and interest groups.
  • Services purchased
  • Pros: Great activities for the elders
  • Cons: Cost might be an issue


What are continuing care retirement communities?

  • Offers “life care”; provide a full range of services & accommodations to meet each resident’s needs as they change.
  • Provide multiple levels of care including independent, assisted living, & skilled nursing.
  • May require buy-in or entry fee followed by monthly payments covering rent, services, amenities, and medical assistance. Entry fee may be refundable in part, or not at all.
  • Pros: Provides long term care
  • Cons: Very expensive


What is ECHO Housing/Granny Flat?

  • Second family living unit or apartment with a separate entrance located on a single family lot.
  • May be a pre-fabricated housing unit.
  • Fosters affordable housing.
  • Aids families with elderly parents unable to live completely alone.
  • Pros:
  • Cons:


Describe shared housing

  • Group residence with shared common areas.
  • Each person has a private bedroom & shares rest of house, as well as expenses & chores.
  • Professional organizations which specialize in these arrangements match the two parties based on needs and abilities.
  • Pros:
  • Cons:


Describe HUD or federally funded housing

  • Government subsidized apartments architecturally designed for elders and may include disabled individuals including younger age groups.
  • Monthly rents vary according to income (sliding scale), apartment size, and services received.  Income and expenses are verified.
  • Pros: Cheap
  • Cons: Could be suspecible to crime


What are assisted living facilities?

  • Private apartments – residents receive assistance with non-medical aspects of daily activities (e.g. meals, personal care, housekeeping, laundry, transportation, & medication supervision prn).
  • 1 or 2 rooms & bathroom; share common areas for meals and social activities.
  • May be a part of CCRC, N.H., or stand alone.
  • Licensure required in TX  (Agency: DADS) and nursing homes
  • Pros:
  • Cons:


What are personal care homes?

  • Provides board and care and supervision for 4-10 residents in a  homelike setting. 
  • Designed for individuals who do not require professional nursing care, but need considerable personal care and assistance.
  • Often a home is renovated or converted for this purpose.
  • Licensure required in TX  (Agency: DADS)
  • Pros:
  • Cons


What is Skilled Nursing/Long Term Care Facility (N.H.)?

  • Provide round the clock personal care (skilled care also for some facilities).
  • May specialize in short-term or acute nursing care, intermediate care or long-term skilled nursing care, & rehab.
  • May be freestanding or part of a seniors community.
  • Licensure required in TX (Agency – DADS)


What did the social security act pass?

}provided additional funds for purchase of services.

Some facilities opened, offered room & board, &  personal care services.


What does the Omnibus Budget Reconciliation Act require?

  • Use of a standardized assessment tool (MDS);
  • - Timely development of a written care plan.
  • - Reduction in use of restraints & psychotopic drugs
  • -Increase in staffing
  • -Protection of residents’ rights.
  • -Training for nursing assistants
  • -Deficient nursing homes could receive sanctions


What are the bill of rights for LTC/NH residents?

The right to:

  • Voice grievances and have them remedied.
  • Information about health conditions & treatments and to participate in one’s own care.
  • Choose one’s own health care providers & to speak privately  with him/her.
  • Consent to or refuse all aspects of care & treatment.
  • Manage one’s own finances if capable.
  • Be transferred or discharged only for appropriate reasons.   
}Be free from all forms of abuse.
  • }Be free from all forms of restraint to the extent compatible with safety.
  • }Privacy & confidentiality concerning one’s person, personal information, & medical information.
  • }Be treated with dignity, consideration, & respect in keeping with one’s individuality. 
  • Immediate visitation & access at any time for family, healthcare providers, & legal advisors


What are alzheimer's facilities?


What is an adult day care?

  • Provides supervision, meals, medication administration, and social & recreational activities during day hours. Some provide health-related  services and transportation.
  • Provide respite for caregivers.
  • Convenient for families who work during the day.
  • Reimbursed by Medicaid.


What are ACE (acute care for elderly) units?

  • Geriatric unit in the hospital staffed by a multidisciplinary team.
  • Designed to address acute care needs of older adults.
  • Research –Outcomes:
  • Improved functional status
  • Fewer discharges to NH
  • Better 1 yr. survival rate compared to elders receiving usual hosp. care.
  • Major focus on rehab. & prevention of disability. 


What are some problems with medication absorption with the elderly?

  • Decreased salivary secretion
  • Diminished esophageal motility
  • Slowed intestinal motility
  • Decreased gastric acid output
  • Decreased gastric pH
  • Outcome:
  • No significant change in quantity absorbed.
  • Time to onset or peak may be delayed.


What are some changes with distribution of drugs in the elderly?

  • ¨Systemic circulation transports drug through the body
  • ¨High blood flow organs receive highest concentration brain, kidney, liver, lungs
  • ¨Low blood flow organs receive lowest
  • ¨Fat-soluble drugs
  • ¨Water-soluble drugs
  • ¨Plasma proteins


What are common anticholinergic side effects that occur with older adults?

  • Constipation
  • Dry mouth


Why is polypharmacy?

  • ¨Use of multiple medications for the same problem
  • ¨Very common in older adults
  • ¨Can occur intentionally or unintentionally
  • ¨Commonly occurs with multiple specialists and lack of communication
  • ¨Two major concerns:
    • ¡Increased risk for drug interactions
    • ¡Increased risk for AE’s


Wht are appropriate and inappropriate examples of polupharmacy?

ú All drugs in the regimen address recognized indications
¨  Inappropriate
úMore drugs prescribed than necessary, drugs with unacceptable adverse effects or toxicity prescribed (alone or combined with other drugs), or redundant drugs prescribed


What are some adverse dug reactions from polypharmacy? 

  • ¨Noxious response to a drug
  • ¨Common cause of hospitalization
  • ¨Some can be predicted
  • ¨Some can’t be predicted
  • ¨“Start low, go slow, but go”
  • ¨Beer’s list
  • ¨ADE
    • ¡Report to US Food and Drug Administration


What is the problems with medications and older adults?

A given dose of a given medication produces a different, and sometimes unexpected, response in an elderly patient compared to a younger patient of the same gender and similar body weight.



What are some nursing interventions to reduce adverse drug events in the elderly?

  • ¨Give lowest dose possible
  • ¨Discontinue unnecessary therapy
  • ¨Attempt nondrug approaches first
  • ¨Give the safest drug possible
  • ¨Assess renal function
  • ¨Always consider the risk-to-benefit ratio when adding drugs
  • ¨Assess for new interactions with any new prescription
  • ¨Avoid the prescribing cascade
  • ¨Avoid inappropriate medications


What are the risk factors for adverse drug events?

  • More than 6 chronic concurrent illnesses
  • More than 12 doses of medications/day
  • More than 9 medications
  • History of prior drug reaction
  • Low body mass index
  • Age over 85
  • Creatinine clearance less than 50