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1
Q
What is wellness?
A
A state of being in good health both physically and emotionally
2
Q
Estimated percentage of adults aged 65+ by 2051
A
26%
3
Q
What does CALD stand for?
A
Culturally and linguistically diverse
4
Q
Top 5 countries older adults have migrated from to Australia?
A
1. Italy
2. Greece
3. Germany
4. Netherlands
5. China
5
Q
Estimated percentage of adults aged 65+
A
2.6 million (13%)
6
Q
Life expectancy of females
A
83 years
7
Q
Life expectancy of males
A
78.1 years
8
Q
Estimated percentage of adults aged 85+
A
0.5% in 1971
1.8% in 2011
9
Q
Leading causes of death in older adults
A
Circulatory disease - large cause of death in 75+

Increase in number of death due to falls (males more likely)
10
Q
Ethnicity of older adults
A
36% of older Australians born overseas

Aboriginal and TSI contribute 3% of 0-64 years and 0.7% 65+
11
Q
Risk factors affecting older adults
A
48% of population overweight
10% of 85+ underweight
Exercise reduces with age: 53% over 75 years sedentary
8% of smokers are 64-74 : reduces with age (26% 18-64)
12
Q
Common conditions affecting 65-74 year olds
A
Long sightedness 64%
Arthritis 49%
Hypertension 38%
Short sightedness 36%
13
Q
Common conditions affecting 75+ year olds
A
Long sightedness 59%
Arthritis 50%
Deafness 42%
Hypertension 41%
14
Q
Older adult relationships
A
Primarily care = spouses
Secondary care = adult children (esp. daughters and unmarried children)

Responsible for raising grandchildren in skipped-generation households
15
Q
What has lead to an ageing population worldwide
A
Decline in fertility rates and improvements in health and life expectancy
16
Q
What is the 'Living longer living better' initiative
A
10 year aged care reform package

Provides more choice and control
Easier access to services
Meets social and economic challenges of the ageing population
17
Q
Name four packages of care available for older adults?
(4 Levels of the LLLB initiative)
A
Lvl 1 - support basic care needs
Lvl 2 - support low level care needs
Lvl 3 - intermediate care needs
Lvl 4 - high care needs
18
Q
Financial breakdown of the 'Living longer living better' initiative
A
$955m – help people stay at home
$55m – help carers
$1.2b – strengthen aged care workforce
$268m – tackle to nations dementia epidemic
$194m – support for older adults from diverse backgrounds
$256m – future planning
19
Q
Explain Miller’s functional consequences theory?
A
Effects of actions in relation to risk factors and age related changes that influence their quality of life

role of nurse: use health education interventions to promote optimal health

effects relate to all levels of functioning: mind, body, spirit
20
Q
Why is Health Promotion important for older adults?
A
Improve quality of life
Increase optimal health and functioning
Lower co-morbidities
Increase awareness
Essential for preventing chronic conditions.
21
Q
Explain the Transtheoretical Model of Health Promotion?
A
Addresses disease prevention and health promotion interventions that require a change in health-related behaviours

Pre-contemplation: unaware of the problem, denial of change, no intent to change for next 6 months.

Contemplation: intent to change in foreseeable future. Likely to ask questions.

Preparation: ambivalence regarding unhealthy behaviour, strong desire to change to healthier habits. Change within the next month.

Action: Changes made, less than 6 months. May not see changes yet, likely to revert to unhealthy behaviours.

Maintenance: Continued over 6 months, started experiencing positive effects.
22
Q
Stages of the Transtheoretical Model of Health Promotion?
A
Pre-contemplation
Contemplation
Preparation
Action
Maintenance
23
Q
What happens in the Pre-contemplation stage?
A
Unaware of the problem, denial of change, no intent to change for next 6 months.
24
Q
What happens in the Contemplation stage?
A
Intent to change in foreseeable future. Likely to ask questions.
25
Q
What happens in the Preparation stage?
A
Ambivalence regarding unhealthy behaviour, strong desire to change to healthier habits. Change within the next month.
26
Q
What happens in the Action stage?
A
Changes made, less than 6 months. May not see changes yet, likely to revert to unhealthy behaviours
27
Q
What happens in the Maintenance stage?
A
Continued change over 6 months, started experiencing positive effects.
28
Q
Name the 12 Activities of Living
A
Maintaining safe environment
Communication
Breathing
Eating
Elimination
Wash/dress
Temperature control
Mobilisation
Work/play
Sexuality
Sleep
Death
29
Q
Name 2 tools used to assess function ability in older adults
A
Cognitive Assessment (MMSE)
FRAMPS (falls risk assessment and management plan)
30
Q
What primary prevention education would the nurse give to prevent cancer
A
Stop smoking
Wear sunscreen and avoid excessive periods in sun
Avoid red meat
Exercise
Monitor diet
Don’t drink alcohol in excessive amounts
31
Q
What are functional consequences
A
Observable effects of actions, risk factors, and age related changes that influence quality of life or day-to-day activities. The effects relate to all levels of functioning, including body, mind and spirit.
32
Q
What are negative functional consequences
A
Those that interfere with functioning or quality of life
33
Q
What are positive functional consequences
A
Those that facilitate the highest level of functioning, the least dependency, and the best quality of life
34
Q
What are age related changes
A
Inevitable, progressive, and irreversible changes that occur and are independent of extrinsic or pathological conditions
35
Q
What are risk factors
A
Conditions that increase the vulnerability to negative functional consequences
36
Q
What is health promotion
A
Essential for preventing chronic conditions, reducing mortality and improving quality of life

Major initiatives focus on health promotion
- Screening programs
- Risk reduction interventions
- Environmental modifications
- Health education
37
Q
What age related changes affect hearing in older adults?
A
External Ear
Pinna: no change in conduction of sound
External auditory canal (buildup of cerumen, canal prolapse or collapse)

Middle Ear
Tympanic membrane - less elastic, thinner and stiffer
Calcification of ossicular bones
Muscles and ligaments - thicker and stiffer
Acoustic Reflex

Inner Ear
Changes cause various types of presbycusis (Sensory, Neural, Metabolic or stria, Mechanical)

Auditory Nervous System
Degenerative changes in organ of Corti, auditory meatus and degeneration of arteries to the auditory nerve
38
Q
5 risk factors that affect hearing in older adults?
A
Male gender
Increased age
Genetic predisposition
Exposure to noise
Impacted cerumen
Smoking
39
Q
What percentage of older adults suffer from impacted cerumen?
A
2% to 6% of the general population
19% to 65% of patients over 65 years
40
Q
What is presbycusis?
A
Age-related hearing loss with gradually progressive inability to hear, especially high frequency sounds
41
Q
What is depth perception and how might it affect an older adult?
A
Ability to judge the distance of objects and the spatial relationship of objects at different distances.

Declines with age, can cause falls, difficulty driving, using stairs, pouring drinks, etc
42
Q
What is the difference in nursing care between an arterial leg ulcer and a venous leg ulcer and why?
A
Arterial: inadequate blood supply, dangle legs over bed, allows gravity to aid blood flow to the ulcer

Venous: superficial with irregular edges. Compression
43
Q
What age related changes to the External Ear affect hearing in older adults?
A
Pinna: no change in conduction of sound

External auditory canal: buildup of cerumen, canal prolapse or collapse
44
Q
What age related changes to the Middle Ear affect hearing in older adults?
A
Tympanic membrane - less elastic, thinner and stiffer

Calcification of ossicular bones

Muscles and ligaments - thicker and stiffer
Acoustic Reflex
45
Q
What age related changes to the Inner Ear affect hearing in older adults?
A
Changes cause various types of presbycusis (Sensory, Neural, Metabolic or stria, Mechanical)
46
Q
What age related changes to the Auditory Nervous System affect hearing in older adults?
A
Degenerative changes in organ of Corti, auditory meatus and degeneration of arteries to the auditory nerve
47
Q
What should you assess for hearing loss?
A
Lifestyle and Environmental Factors
- Exposure to noise due to lifestyle, environment or occupation

Impacted Cerumen
- Leading cause of hearing loss, preventable and treatable
48
Q
Intervention for hearing loss?
A
Interventions to prevent noise-induced hearing loss

Education related to ototoxic medications
Smoking cessation
Audiology screening
Prevention of impacted cerumen
49
Q
Age related changes in the Eye
A
Arcus senilis - lipids accumulate in outer area of cornea

Endophthalmos - posterior displacement of eyeball within orbit due to changes in the volume relative to contents or loss of function of the orbitalis muscle

Blepharochalasis - inflammation of eyelid resulting in stretching, leading to formation of folds

Ectropion - lower lid droops and tears can’t drain away

Endotropion - lower lid folds inwards

Dry eyes
Excessive tearing
Visual processing slows
Greater size & density of lens
Iris sclerotic
Atrophy of ciliary body
Less aqueous humour
Vitreous shrinks, proportion of liquid increases
Cones lost in peripheral retina
Rods in central retina decrease
Cones lost from central retina
50
Q
What is Arcus senilis
A
Lipids accumulate in outer area of cornea
51
Q
What is Endophthalmos
A
Posterior displacement of eyeball within orbit due to changes in the volume relative to contents or loss of function of the orbitalis muscle
52
Q
What is Blepharochalasis
A
Inflammation of eyelid resulting in stretching, leading to formation of folds
53
Q
What is Ectropion
A
Lower eyelid droops and tears can’t drain away
54
Q
What is Endotropion
A
Lower eyelid folds inwards
55
Q
Consequences of age related changes to the eye
A
Presbyopia (loss of near vision)
Increase in near point of vision
Lower acuity
Delayed dark/light adaptation
Increased glare sensitivity
Visual field narrows
Decline - depth perception
Altered colour perception
Diminished critical flicker fusion
Visual image processing slower
56
Q
Common conditions affecing the eye
A
Cataracts - lens changes progress to opacity, 25% of 70+

Age Related Macular Degeneration - drusen develops in macula, 18% of 70+, 47% of 85+, more likely in women
- Dry type: death of photoreceptors, slow, not total, 80-90%
- Wet type: new blood vessels in choroid that bled into sub-retinal space, rapid and severe loss of vision

Glaucoma - ganglion cells of optic nerve damaged by excess aqueous humor, 8% affected,
- Chronic: drainage of aqueous humour gradually blocked
- Acute: sudden blockage
- Normal tension: pressure remains ok but nerve damaged
57
Q
Age-related changes that affect the skin
A
Decreased rate of epidermal proliferation
Thinner dermis, flattened dermal–epidermal junction
Diminished moisture content
Decreased dermal blood supply
Fewer sweat and sebaceous glands
Decreased number of melanocytes and Langerhans cells
Changes in patterns of hair distribution
58
Q
Risks to older adult skin integrity
A
Genetic influence – hair colour and distribution, skin colour
Exposure to ultraviolet radiation – sunlight, tanning light
Adverse medication effects
Personal hygiene practices
Factors that increase the risk for skin breakdown
59
Q
Assessment of skin
A
Abnormal skin conditions
Personal care practices
Skin lesions common in older adults
Risk of skin tears, pressure ulcers and chronic wounds
Skin Tear classification
Chronic wound assessment
Risks for development
Presence of pressure ulcers
Status of current pressure ulcers
Braden scale / Waterlow / Norton
Frequency of assessment
Staging
60
Q
Nurse recommendations to promote cognitive wellness
A
Exercise
Diet - Omega-3 fatty acids, turmeric
Socially and cognitively stimulating and meaningful activities
61
Q
Define dementia
A
An umbrella term for several diseases characterised by progressive cognitive impairment and brain dysfunction not caused by impaired LOC
62
Q
Define delirium
A
An acute transient confusional state of altered LOC, hallucinations and restlessness
63
Q
2 tools used to assess for dementia in older adults?
A
MMSE
ADL's
64
Q
5 most common types of dementia
A
1. Mixed dementia
2. Vascular dementia
3. Alzheimer's dementia
4. Lewy body dementia
5. Frontotemporal dementia
65
Q
7 stages of Alzheimer’s Disease
A
Stage 1: No cognitive decline.
Stage 2: Very mild cognitive decline.
Stage 3: Mild cognitive decline.
Stage 4: Moderate cognitive decline.
Stage 5: Moderately Severe Decline
Stage 6: Severe cognitive decline.
Stage 7: Very severe cognitive decline.
66
Q
What is BPSD?
A
Behavioural and Psychological Symptoms of Dementia
- Agitation 
- Psychiatric symptoms
- Personality changes
- Mood disturbances
67
Q
Explain the PLST Model of Care?
A
Progressively Lowered Stress Threshold

Reference to understand and reduce the challenging behaviours associated with Alzheimer's disease and related dementias
68
Q
2 tools used to assess for depression in older adults?
A
Geriatric Depression Scale
MMSE
69
Q
Age related changes in brain
A
Loss of neurotransmitters and their binding sites (especially dopamine)
Widening of the sulci
Enlarging of the ventricles (15ml in teens - 55ml age 60)
Accumulation of lipofuscin in nerve cell bodies
Large neurons shrink, may be some neuronal loss in frontal and temporal lobes
Some memory functions decline in healthy older adults

Fluid intelligence declines
- Inductive reasoning
- Abstract thinking

Crystallised intelligence improves
- Wisdom
- Judgement
70
Q
Risk factors affecting older adult cognition
A
Physical and Mental Health Factors
- Chronic conditions
- Nutritional status

Medication Effects
- Medications can interfere with cognitive function
- Anticholinergic medications
71
Q
Four types altered cognition older adults may experience
A
Cognitive Decline (minor changes in healthy older adults)
Dementia
Delirium
Depression
72
Q
Dx dementia
A
Diagnosis based on clinical observations, history and available diagnostic data
73
Q
How many people have dementia
A
Within Australia: 245,000 in 2009, 1.1 million in 2050 (4x)

Within WA: 24,000 affected, 125,000 in 2050,138 new cases every week
74
Q
Percentage of people with dementia based on age
A
1-2% at 65 years
5-10% at 75 years
20-30% at 85 years or 50% at 85
40% + at 95 years
75
Q
Types of dementia
A
Alzheimer’s disease
Vascular dementia
Lewy body dementia
Frontotemporal dementia
76
Q
Factors protecting against dementia
A
Exercise
Diet: Omega-3 fatty acids, turmeric
Socially and cognitively stimulating and meaningful activities
77
Q
Global deterioration scale
A
Stage 1: No cognitive decline. Experiences no problems in daily living.

Stage 2: Very mild cognitive decline. Forgets names and locations of objects, may have trouble finding words.

Stage 3: Mild cognitive decline. Has difficulty travelling to new locations, has difficulty handling problems at work

Stage 4: Moderate cognitive decline. Has difficulty with complex tasks.

Stage 5: Moderately severe cognitive decline. Needs help to choose clothing and prompting to bathe.

Stage 6: Severe cognitive decline. Needs help putting on clothing, requires assistance bathing, decreased ability to use the toilet

Stage 7: Very severe cognitive decline. Vocabulary becomes limited, eventually declining to single words, loses ability to walk and sit, becomes unable to smile.
78
Q
Risk factors of delirium
A
Advanced age
Pain
Dementia
Surgery
Medications
Physiological disturbances
Pathological conditions
79
Q
Types of depression
A
Major depression
Subclinical depression
Late-life depression
Depression with cognitive impairment
80
Q
Risk factors of depression
A
Demographic factors
Psychosocial influences
Medical conditions
Functional impairments
Effects of medications and alcohol
81
Q
Issues associated with depression
A
Willingness for enhanced coping
Ineffective coping
Hopelessness
Caregiver role strain
Risk for imbalanced nutrition
Risk for compromised resilience
82
Q
Parkinsons disease onset
A
Average age of onset is between 55 and 60 years
83
Q
Parkinsons disease symptoms
A
Asymmetric onset of bradykinesia and rigidity
Tremor (75% of cases)
Characteristic muscle weakness and postural instability
Impaired mobility, speech, swallowing, sleep, and bladder and bowel function
Cognitive dysfunction
Pain and fatigue
Depression
84
Q
Parkinsons disease prevalence
A
Affects 1 in 100 000 but 2% of people aged over 65
85
Q
Parkinsons disease stages
A
Stage 1 - Initial
Stage 2 - Bilateral & Balance
Stage 3 - Slowing
Stage 4 - Severe
Stage 5 – Final
86
Q
Parkinsons disease issues
A
Family coping
Caregiver role strain
Anticipatory grieving
Willingness for enhanced coping as conditions progress
Complications
87
Q
Characteristics of the victim of elder abuse?
A
Mental illness
Codependent
Not financially independent
Burden of care
Weakness or frailty
88
Q
What action would you take if you suspected older adult abuse?
A
Alert facility
Alert family 
Alert appropriate authorities
89
Q
5 types of elder abuse?
A
Emotional or psychosocial
Neglect
Physical
Financial
Sexual
90
Q
Characteristics of the perpetrator of elder abuse?
A
Hostile
Stressed
Shared accommodation
Financial dependence
Mental illness
91
Q
When are people vulnerable to abuse
A
Where people are frail, dependent or under the control of others
92
Q
Factors influencing abuse
A
Functional status and behaviour of residents
Characteristics and attitudes of staff
Philosophy and policies of the agency
Increased dependency
Abuser psychopathology
Family dynamics
Carer stress
93
Q
Signs of Possible Abuse
A
Unexplained injuries
Fearfulness, lack of eye contact, nervousness when caregiver is near
Lost money or sudden inability to pay bills
Over-sedation, evidence of neglected physical needs
94
Q
Six Step Approach to abuse
A
1. Identify Abuse
2. Provide emotional support
3. Assess risk
4. Plan safety
5. Refer
6. Document
95
Q
How to determine pain in patients with cognitive impairment?
A
Reactions to stimulus
Ask
Touch
Facial expressions
Observation
96
Q
Explain the WHO Pain ladder?
A
Pain is present

1. Pain persisting or increasing --> Non opioid +/- adjuvant 
2. Pain persisting or increasing --> Opioid for mild to moderate pain +/- non opioid / adjuvant
3. Freedom from pain --> +/- non-opioid and adjuvant
97
Q
What is nociceptive pain
A
Damage to body tissue, usually described as a sharp, aching or throbbing pain.
98
Q
Two types of nociceptive pain
A
Somatic pain: pain receptors in skin, tissues activated.

Visceral pain: internal organs injured or inflamed.
99
Q
What factors worsen pain in older adults?
A
Lack of exercise
Mental status
Chronic conditions
100
Q
What is osteoporosis and why is it a problem in older adults?
A
Condition which makes bones weak and brittle

Increased chance of fractures and falls
101
Q
What are the risk factors for falls in older adults?
A
Pathological conditions
Medications
Environmental factors
Functional impairment
102
Q
What is osteoarthritis?
A
Type of arthritis that occurs when flexible tissue at the ends of bones wears down.
103
Q
What factors affect behaviours related to taking medications in older adults?
A
Motivation
Cultural and psychosocial influences
Knowledge
Physical capabilities
104
Q
What age related changes affect musculoskeletal wellness in older adults?
A
Decrease size and number of muscle fibres
Fibres deteriorate and replaced by connective tissue and fat
Muscle membrane fails and cells loose fluid and K
Bone thins
Minerals leave bone quicker
105
Q
Nursing assessment when promoting safe use of medication?
A
Cognitive capacity
Barrier to compliance
Side effects
Cultural considerations
106
Q
What age related changes affect medication use in older adults?
A
Altered Absorption
Altered Distribution
Altered Metabolism
Changes to pharmacokinetics and pharmacodynamics 
Changes to physiology and cognition
Social factors
Compliance issues
Increased vulnerability to adverse effects
Impaired ability to swallow medications
107
Q
Age related changes to muscles
A
Decrease in size and number of muscle fibres

Fibres deteriorate and eventually replaced by connective tissue and then fat

Muscle membrane starts to fail and cells loose fluid and K
108
Q
Age related changes to joints
A
Thinning of synovial fluid

Collagen and elastin degenerate

Cartilage outgrowths and fragmentation of fibrous structures

Scar tissue and calcification

Fraying and cracking of cartilage – pitting of the surface
109
Q
Mobility limitations
A
People who are active and healthy have less adverse consequences

Those whose mobility is restricted suffer more
Experience muscle fatigue after little exercise
Decreased movement affecting ADLs
Increased dependency and social isolation
Diminished pleasure in leisure activities
Falls, pressure sores and malnutrition
110
Q
Prevalence of osteoporosis
A
Affects 3.4% of Australian population

82% are women
84% are over 55 years
111
Q
Prevalence of osteoarthritis
A
Affects 15% of the overall population
Prevalence increases with age

Radiographic changes indicating OA in over 80% of 55+
112
Q
What is the leading cause of disability in older adults
A
osteoarthritis
113
Q
Pathology of osteoarthritis
A
Articular cartilage thins and tears
Lack of protection leads to ulceration
Bony deformity results (including spurs)
Synovitis
Capsule hypertrophy
Periarticular muscle wasting
114
Q
Prevalence of pain in older adults
A
Back pain 21%-49.5%
Joint pain, 20.5% - 71%
Substantial pain 45% to 80%
Cancer pain
Neuropathic pain
115
Q
Categories of pain
A
Nociceptive
Neuropathic
Mixed
Psychological pain disorders
Chronic pain (3-6 months)
116
Q
What are the pain scales
A
Multi-dimensional

Uni-dimensional - also reliable for those with mild-moderate cognitive impairment
117
Q
Effect of Unresolved Pain
A
Depression
Anxiety
Decreased socialisation
Sleep disturbance
Impaired mobility
118
Q
What is medication absorption altered by
A
Increased gastric acidity
Altered gastric emptying
Decrease in hepatic first pass metabolism of some drugs
119
Q
What is medication distribution altered by
A
Less lean body mass and more fat
Less water in the body
Less plasma albumin
120
Q
What is medication metabolism altered by
A
Decreased oxidative metabolism
Decreased hepatic blood flow
121
Q
What does altered medication absorption cause
A
Unpredictable timing and extent of drug effects
Increased risk of stomach irritation
122
Q
What does altered medication distribution cause
A
Fat soluble medications have less intense immediate effects and an erratic but prolonged action

Greater proportion of unbound (active) drugs in the bloodstream

Increase in time taken for drug to reach target
123
Q
What does altered medication metabolism cause
A
Significant changes in half life with serious implications
124
Q
Issues with medication due to changes in physiology and cognition
A
Sight and hearing – distinguishing which medications are due when

Problems understanding requirements

Problems remembering requirements and if medications have been taken

Problems removing packaging
125
Q
What age related changes affect digestive, nutrition and hydration wellness in older adults?
A
Less effective chewing
Low sense of smell and taste
Low daily intake
Tooth loss
Absorption of some nutrients is impaired
126
Q
What factors increase the risk of dehydration in older adults?
A
Health conditions
Intake behaviours
Medications
127
Q
What 6 areas are assessed when using Mini Nutritional Assessment Tool?
A
1. Food intake
2. Weight loss
3. Mobility
4. Psychological stress 
5. Neuropsychological problems
6. BMI
128
Q
5 age related changes that affect urinary wellness in older adults?
A
1. Cognitive ability
2. Functional status
3. Mobility
4. Postural sway
5. Medications
129
Q
How much urine can older adults store in their bladder?
A
Usually 300-450ml, maximum 500
130
Q
What environmental factors contribute to incontinence in older adults?
A
Cognition
Accessibility
Ability to voluntarily control 
Urge to void
Accessibility to toilets
131
Q
5 categories of urinary incontinence?
A
Overflow - urethral blockage, bladder unable to empty properly

Stress - relaxed pelvic floor, increased abdominal pressure

Urge - bladder oversensitivity from infection, neurological disorders

Detrusor over - activity incontinence

Functional incontinence
132
Q
Prevalence of Type II diabetes in older adults in Australia?
A
1/6 over 65 are diabetics. Of diabetics 43% are 65+
133
Q
What may lead you to suspect an older adult may have developed type II diabetes?
A
Blurred vision
Itching 
Skin infections
Cuts that heal slowly
Tired and lethargic
134
Q
6 interventions in a health promotion plan for an older adult with type II diabetes?
A
Quit smoking
Exercise
Nutrition 
Medication
No alcohol
Education
135
Q
Changes to Taste & Smell
A
Sense of smell declines from 30
Sense of taste less intense in older adults
Taste discrimination decreases (sweetness unchanged)
136
Q
Changes to Mouth & Oesophagus
A
Teeth cusps flatten
Tooth fracture and loss more likely
30% have diminished saliva
Oral mucosa more likely to ulcerate
Swallowing ability slower and more feeble
Oesophageal transit time slows
137
Q
Changes to Stomach & Intestine
A
Gastric emptying slows
Muscle fibres and mucosa of small intestine atrophy, lymphatic follicles decrease, villi shorten and widen.
Absorption of some nutrients is impaired and immune function diminished
138
Q
Changes to Liver
A
Shrinkage
Fibrosis occurs
Lipofuscin is deposited
Blood flow diminishes
139
Q
Changes to Pancreas
A
Shrinkage
Ductal hyperplasia
Lobal fibrosis
Decreased responsiveness of beta cells to glucose (reduced insulin secretion > glucose intolerance > T2 diabetes)
140
Q
Changes to Gall Bladder
A
Increased cholecystokinin
Decreased bile acid synthesis
Widened common bile duct

Leads to biliary stasis, increased flora, increased likelihood of cholelithiasis and poorer appetite
141
Q
Changes to Large Bowel
A
Reduced mucous
Decreased elasticity
Poorer perception of rectal distension
Constipation more likely
142
Q
Risk Factors affecting digestion and nutrition
A
Medication effects
- Digestion, eating patterns, and utilisation of nutrients

Lifestyle factors
- Alcohol intake and smoking

Psychosocial factors
- Companionship, support resources, anxiety and stress
143
Q
Risk factors for diabetes
A
Obesity
Hypertension
Family history
Physical inactivity
High cholesterol levels
144
Q
Diabetes leads to
A
Renal failurer
Retinopathy
Neuropathy
Stroke
Sypertension
MI
145
Q
Issues assiciated with diabetes
A
Causing changes to BGL: Infections, arthritis, medications (steroids)

Challenging ability to self care diabetes: Finance, cognitive changes, nutritional changes
146
Q
Dx of diabetes
A
Any one of the following 3:

Fasting BG > or = 7.0mmol/L (after an 8 hour fast)

Symptoms of hyperglycaemia (polyuria, polydipsia, weight loss and a random BGL of > 11.1mmol/L during the day

2 hour blood glucose value during oral GTT > 11.1mmol/L with glucose load of 75g
147
Q
Changes to Bladder
A
Storage capacity decreases
Connective tissue replaces some bladder & urethral muscle
Diminished sphincter tone

Changes due to cerebral cortex
- Sensation of bladder fullness occurs late
- Bladder emptying incomplete

Changes due to oestrogen
- Loss of tone and strength in bladder and urethra -> decreased urethral closure pressure
- Bladder more irritable
148
Q
Changes to Urinary function
A
Functioning nephrons decline from early adulthood
Glomeruli deteriorate
Decline in renal function likely to be disease related
149
Q
What causes changes in urine concentration
A
Renal tubules less efficient in:

Substance exchange
Water retention
Suppression of ADH secretion in hypo-osmolality
Ability to conserve sodium when salt depleted
150
Q
Causes of urinary incontinence
A
Delirium and dementia
Gastrointestinal conditions
Diabetes mellitus
Obesity
Alcoholism
COPD
Metabolic disturbances
Hip fractures
151
Q
Nursing interventions for urinary incontinence
A
Urinalysis
Pelvic floor muscle training
Pelvic floor electrical stimulation
Pessaries
Continence training
Environmental modifications
Medications
Surgical and minimally invasive procedures
Management of incontinence
152
Q
What percentage of older adults over the age of 85 years do not have coronary heart disease?
A
12.6%
153
Q
7 risk factors for cardiovascular disease in older adults?
A
1. Race
2. Diet/nutrition
3. Depression
4. Hypertension
5. Increased age
6. Gender
7. Physical inactivity
154
Q
What is post prandial hypotension?
A
Hypotension that occurs within 75 mins of eating a meal. Often meal high in carbs.
155
Q
Prevalence of post prandial hypotension?
A
Affects 20-40%
156
Q
What is orthostatic hypotension?
A
Postural hypotension. A reduction of 20mmHg (S) and 10mmHg (D) within 1-4 mins on standing after lying for 5 minutes
157
Q
Negative functional consequences of the respiratory age related changes?
A
Hypoxia
Hypercapnia
158
Q
Top 3 actions included in a health promotion plan for an older adult with COPD?
A
Smoking cessation
Elimination exposure to environmental pollutions 
Subtle exercise
159
Q
What activities of daily living would be affected by an older adult with severe COPD?
A
Breathing
Sleep
Eating
Work
Sex
160
Q
Changes affecting the nose
A
Tip rotates down
Septum deviates (contributes to mouth breathing, snoring and obstructive apnoea)
Blood flow decreases
Turbinates decrease in size
161
Q
Changes affecting the tracheal cartilage
A
Calcifies
Trachea becomes stiffer
162
Q
Changes to cough reflex
A
Diminishes
163
Q
Changes to gag reflex
A
Less efficient
164
Q
Changes to chest wall
A
Ribs and vertebrae subject to osteoporosis
Costal cartilage calcifies
Respiratory muscles weaken

Increase dependence in accessory muscles especially diaphragm
Sensitivity to intra-abdominal pressure changes
165
Q
Changes to lungs
A
Decrease in size and weight and become flabbier
Mucosal bed thickens
Blood supply to lungs diminishes
Elastic recoil diminishes -> early airway closure

Age 20-30 alveoli enlarge and walls become thinner
4% loss in SA every 10 years
166
Q
Response to Hypoxia and Hypercapnia
A
When mechanisms work properly the response to either is increased respiratory rate and depth

This response is reduced by 40%-50% between 30 and 80
167
Q
Risk factors that affect respiratory wellness
A
Smoking
Second hand smoking
Occupational exposure
Environmental factors
Additional Risk Factors
168
Q
Nursing Assessment for respiratory function
A
Identifying opportunities for health promotion
- Assess for risk factors
- Vaccinations

Detecting and preventing lower respiratory infections

Physical assessment findings

Promoting health for respiratory wellness
- Smoking cessation
- Disease prevention
- Eliminate exposure to environmental pollutants

Eliminating the risk from smoking
169
Q
Prevalence of CHD
A
36% of men
39% of women
170
Q
Disease related changes in the heart
A
Amyloid deposits
Liopofuscin accumulation
Degeneration of basophils
171
Q
Age related changes in the heart
A
Slight increase in left ventricular wall thickness
Enlargement of left atrium
Thickening of atrial endocardium
Thickening of atrioventricular valves
Calcification in the aortic valve
Decrease in pacemaker cells and irregularity in their shape
Increased deposits of fat, collagen, and elastic fibres at sinoatrial node
172
Q
Consequences of Changes in the Heart
A
Changes results in:
Heart less able to fully contract
Longer diastolic filling and systolic emptying
Myocardium more irritable and less responsive to SNS
Stress adaptation less efficient
173
Q
Changes in arteries
A
Tunica intima - thicken, endothelial cells become irregular, elongate

Tunica media - increase in collagen, thinning and calcification of elastin (stiffening)
174
Q
Changes in veins
A
Become thicker
More dilated
Less elastic
Valves in leg veins become less efficient in returning blood
175
Q
Consequences of Changes in Blood vessels
A
Arteries more vulnerable to atherosclerosis
Aorta dilates to compensate for stiffness
Increased peripheral resistance
Slight increase in systolic BP
Impaired baroreceptor function in large arteries – especially during postural changes
Diminished ability to increase blood flow to vital organs
Left ventricle forced to work harder
Arteries stiffen and responsiveness to adrenaline stimulation diminishes -> HR fails to increase or decrease as efficiently
176
Q
Risks for Cardiovascular Disease
A
Race
Increased age
Diabetes mellitus
Heredity
Hypertension
Social Class
Gender
Depression
Diet / nutrition
Alcohol / smoking
Hypertension
Obesity
Physical inactivity
Hyperlipidemia
Anxiety
Stress
Isolation
Post menopausal
177
Q
Explain Palliative Care?
A
An approach that improves the quality of life of patients and their families facing the problem associated with life threatening illness, through the prevention and relief of suffering by means of early identifications and impeccable assessment and treatment of pain and other problems, physical, psychological and spiritual.
178
Q
What to say to patients and families during final stages of life?
A
Tell me more about …
What questions do you have?
What are you most concerned about?
How are you today?
179
Q
Name 9 medications commonly use during end of life care and their purpose?
A
1. Morphine - pain relief, respiratory depression
2. Hydromorphine - pain relief
3. Haloperidol - antipsychotic, calming, reduce restlessness
4. Midazolam - produce drowsiness, alleviate anxiety
5. Metoclopramide - alleviate nausea
6. Hyoscine - reduces spasms
7. Clonazepam -  antiepileptic, treat panic attacks
8. Hyosine butylbromide - relieve smooth muscle spasms
9. Fentayle - pain relief
180
Q
Name common symptoms that often need to be managed during Palliative Care?
A
1. Pain
2. Breathlessness
3. Anxiety
4. Agitation/restlessness
5. Hallucinations
6. Dysphagia
7. Nausea
8. Vomiting
9. Respiratory symptoms
181
Q
What physiological changes would lead you to believe death was imminent?
A
1. Changes in respiration (cheyne stoking)
2. Hypotension and tachycardia 
3. Change in responsiveness
4. Uncharacteristic restlessness
5. Peripheral shutdown and cyanosis
6. Retained airway secretions - suction, positioning
182
Q
Name 7 supportive interventions for relationship building during end of life care?
A
1. Presence
2. Touch
3. Recognition of autonomy
4. Compassion
5. Honesty
6. Expert communication
7. Assisting in transcendence
183
Q
What is the Liverpool Care Pathway? What benefits does it offer?
A
Pathway covering palliative care options for patients in the final days or hours of life
Supporting quality care in the last hours or days of life
184
Q
Benefits of palliative care
A
Provides relief from distressing symptoms
Affirms life and supports active living for as long as possible
Enhances quality of life
Regards dying as a normal process
Intends neither to hasten nor delay death
Includes psychological and spiritual care
Supports the family, during the trajectory and after the death
Uses a team approach
185
Q
What is the palliative care approach
A
Should be on a needs basis
Should involve discussion with the older person, family, and health care team
Should involve the consideration of advance care directives

A palliative approach:
- May be relevant over a long period of time
- May be concurrent with active treatment
186
Q
What is end of life
A
An umbrella term to denote that part of life, where a person is living with, and impaired by, an eventually fatal or terminal condition, even if the prognosis is ambiguous or unknown

Often focuses on final days or weeks of life
187
Q
What are advance health directives
A
Legal statements that say what sort of medical treatment you want to have or not have after you are no longer able to make these decisions for yourself
188
Q
What is important for people who are dying
A
To know what to expect
To maintain control and choice
To maintain dignity and privacy
To avoid symptom distress
To have access to information and to spiritual and emotional support
To have time to say goodbye
To have excellent care
189
Q
Signs used to anticipate death
A
Peripheral shutdown and cyanosis
Changes in respiration - cheyne stoking (laboured)
A change in responsiveness
Uncharacteristic restlessness
Retained airway secretions - suction, positioning
Hypotension and tachycardia
190
Q
Recognition of approaching death should prompt ...
A
Review of medications
Review of comfort care strategies
Communication with the family
Rituals
191
Q
Bereavement care
A
Regards family

May want time to say goodbye
Need to know what happens next
Need to know that the person is still respected
Need to know that cultural and family wishes will be respected
192
Q
West Australian End of Life and Palliative Care Learning Continuum
A
Provides structure and guidance in education and training for all health care professionals delivering end-of-life care in health and aged care settings in Western Australia

The goal is to support health care professionals to deliver safe, effective quality care for patients, their families and carers throughout the end-of-life continuum
193
Q
Core Principles of palliative care
A
1. Person, carer and family centred care
2. Safety, quality and risk management
3. Effective communication
4. Building capacity
194
Q
Symptoms in the terminal phase
A
Pain
Breathlessness
Anxiety
Agitation and restlessness
Hallucinations
Dysphagia
Nausea
Vomiting
Respiratory secretions
195
Q
How long for constipation symptoms to develop
A
7-10 days
196
Q
Bristol stool chart
A
1-3 Constipation
4 Aim
5-7 Diarrhoea (or constipation, overflow)
197
Q
Rome III classification for constipation
A
2+ symptoms

Staining
Lumpy or hard stool
Sensation of incomplete evacuation
Sensation of anorectal obstruction
Manual maneuvers
<3 bowel movements per week
198
Q
Primary causes of constipation
A
Slow transit
Difficult defication
199
Q
Secondary causes of constipation
A
Lifestyle
Medical conditions
Meds
Mechanical abnormalities
200
Q
Risk factors for constipation
A
Female
Dementia
Low privacy
Increase length of stay
201
Q
Types of laxative agents
A
Bulking agents
Softening agents
Osmotic agents
Stimulant agents