ICB Flashcards
1
Q
What is integrated care?
A
Person centred co-ordinated care which involves MDTs and is for pts with multiple overlapping problems
Treatment, care and support can be tailored to meet patient needs and preferences
2
Q
What are some risk factors for delirium?
A
Advanced age, dementia, polypharmacy, functional or sensory impairment, malnutrition, co-morbidities
3
Q
What tools can be used to assess delirium?
A
CAM, AMT, 4AT
4
Q
What are the sections in the 4AT?g
A
Alertness
AMT4 (age, DOB, name of hospital, current year)
Attention (list months backwards)
Acute change or fluctuating course
5
Q
What are the sections in the CAM?
A
Acute change or fluctuating course of mental state
Inattention
Altered level of consciousness
Disorganised thinking
6
Q
What are some underlying causes of delirium?
A
Trauma, hypoxia, frailty, NOF #, smoker, drugs, ward moves, lack of sleep, electrolyte imbalance, retention, infection
7
Q
How should delirium be managed?
A
Manage pain, orientate (clock, calendar), involve family, ensure pt has glasses and hearing aids, manage constipation/retention, promote oral intake, sleep and mobilisation (PT)
8
Q
What is the characteristic pathology in Alzheimer’s?
A
Amyloid beta plaques and neurofibrillary tangles
9
Q
What are some of the characteristic features in Alzheimer’s?
A
Difficulty remembering recent events but maintain memory of past events
Difficulty recognising people
Repetitive speech
Disorientation
10
Q
What is the pathology in vascular dementia?
A
Arteriosclerosis in BVs supplying brain leading to small vessel disease and infarcts
11
Q
What is the pathology in Lewy-Body dementia?
A
Lewy bodies in cortex and substantia nigra
12
Q
What are some of the characteristic features in Lewy-Body dementia?
A
Fluctuations in degree of cognitive impairment over time Parkinsonism Visual hallucinations Falls REM sleep disorder
13
Q
What are some of the characteristic features in fronto-temporal dementia?
A
Alteration of social behaviour and personality Agitation, depression Impaired judgement and insight Speech output falls Changes in appetite and food eaten
14
Q
What are some of the characteristic features in alcoholic dementia?
A
Deteriorating executive function and assessment of risk
Personality changes
Reduced impulse control
Socially inappropriate behaviour
Attention, concentration and memory problems
15
Q
What is the pathology in alcoholic dementia?
A
A combination of thiamine def., toxic effects of alcohol on nerve cells, head injury and BV damage
16
Q
What is mild cognitive impairment?
A
Memory, problem solving, planning, language problems BUT does not interfere significantly with daily life
17
Q
What is memory clinic?
A
MDT that assesses and diagnoses dementia and may provide psychosocial interventions for dementia
18
Q
What is the aim of memory clinic?
A
Early diagnosis Early treatment Maximising decision-making autonomy Risk reduction Access to care and services
19
Q
What happens at memory clinic?
A
Dementia and subtype diagnosis + explanation
Care coordination
Offering interventions including pharmacological and psychological support
Carer support
20
Q
How are patients in memory clinic assessed?
A
History and collateral, physical exam (neuro + CVS)
MSE, cognitive assessment (ACE, MMSE, MOCA)
Bloods, ECG, CT/MRI
21
Q
How can inattention be assessed as part of the CAM?
A
Squeeze my hand when I say the letter ‘A’
22
Q
How can disorganised thinking be assessed as part of the CAM?
A
Ask questions: will a stone float on water, are there fish in the sea?
Command: hold up this many fingers
23
Q
What are some bedside cognitive screening tests that can used in the investigation of cognitive impairment/dementia?
A
6CIT AMTS10 MMSE MoCA GPCog ACE-III
24
Q
What factors may confound results in cognitive screening tests?
A
Cognitive reserve and adaptability e.g. doctors may perform well even if they have early dementia
Education and IQ
English not first language
Sensory impairment
25
What are some medications used in the management of Alzheimer's?
Donepezil, rivastigmine and galantamine
| Memantine
26
What is a medication used in the management of Lewy-Body dementia?
Rivastigmine
27
What are the side effects of acetylcholinesterase inhibitors?
GI disturbance, reduced appetite, arrhythmias, dizziness, drowsiness, falls, headache, GI bleed
28
What are some side effects of memantine?
Constipation, dizziness, drowsiness, headache, seizures
29
In which conditions should caution be taken when prescribing acetylcholinesterase inhibitors?
Peptic ulcers, bladder obstruction, asthma/COPD, heart block, syncope, seizures
30
What are some behavioural and psychological symptoms of dementia (BPSD)?
Agitation, aggression, wandering, sexual disinhibition
Sundowning
Sleep disturbance
Depression, anxiety, psychosis (hallucinations and delusions)
31
What non-pharmacological management should be considered for behavioural and psychological symptoms of dementia (BPSD)?
ABC charts (antecedent-behaviour-consequence), Distraction/re-direction
Activity scheduling, reminiscence therapy, aromatherapy
Orientation, hearing aids + glasses
32
What pharmacological management may be considered for behavioural and psychological symptoms of dementia (BPSD)?
```
Antidepressants
AChEi/memantine
Analgesia
Benzos
Mood stabilisers/anticonvulsants
Antipsychotics
```
33
When might a vulnerable adult risk management (VARM) be used?
When working with adults deemed to have capacity to make decisions for themselves, but who are at risk of serious harm or death through: self-neglect, risk taking behaviour or refusal of services
34
What is the Abbey Pain Scale?
Standardised pain assessment tool developed for use in demented non-verbal patients
35
How is pain assessed using the Abbey Pain Scale?
```
Vocalisation
Facial expression
Body language
Physiological changes
Physical changes
```
36
Why can it be difficult to manage physical health issues on psych wards?
```
Lack of specialist nursing care
Lack of senior physical health support
Risks to pts
Non-compliance
Difficulty in recognising or communicating physical health problems
```
37
What are the key points to consider when asking about social + functional history in an older person?
Where they live (home, residential home etc.)
How they mobilise and with what aids
Who performs tasks such as cleaning and shopping
Adaptations or safety features within the home Package of care, support and by whom
38
Why should comprehensive geriatric assessment be done?
```
Reduced readmissions
Reduced unnecessary deaths
Reduced long-term care
Greater patient satisfaction
Lower costs
```
39
What are the domains of the comprehensive geriatric assessment?
```
Problem list
Medication review
Nutritional status
Mental health
Functional capacity
Social circumstances
Environment
```
40
What should be considered in the problem list of the CGA?
Current co-morbidities and past
Physical symptoms: pain, continence, sensory impairment
MSK and skin assessment
41
What should be considered in the functional capacity domain of the CGA?
Basic activities of daily living
Gait and balance
Activity/exercise status
Instrumental activities of daily living
42
What should be considered in the social circumstances domain of the CGA?
Informal support available from family or friends
Social network such a visitors or daytime activities Eligibility for being offered care resources
Finances
43
What should be considered in the environment domain of the CGA?
Home environment
Facilities and safety within the home
Toilet + transport facilities
Accessibility to local resources
44
What is frailty?
State of increased vulnerability to stressors due to age-related declines in physiologic reserve across neuromuscular, metabolic, and immune systems
45
What are the complications of frailty?
Dehydration, delirium, inadequate nutrition, skin breakdown, pressure ulcers, lowered resistance to infection, falling, worsening mobility
All leading to increased hospitalisation, care home admissions and death
46
Describe the Rockwood clinical frailty scale:
Scale ranging from very fit to terminally ill that is used to estimate frailty of an individual and therefore their prognosis
47
How can frailty be prevented?
Electronic frailty index to identify frail adults
Good nutrition, low alcohol intake, staying physically active
CGA, falls assessment + intervention, med review
48
What is multimorbidity?
Presence of 2 or more long-term health conditions
49
When does polypharmacy become problematic?
No evidence-based indication for medication
Medication fails to achieve the therapeutic objectives
Cause unacceptable ADRs, or put the pt at high risk of ADRs
Pt is not willing or able to take one or more medicines as intended
50
What is the STOPP START tool?
Screening tool that can be used to identify potentially inappropriate prescriptions that may result in hospitalisation, and alert doctors to potential prescriptions for commonly encountered diseases in older people
51
What are some common medications that may be started using the STOPP START tool?
Anticoag in AF
Antihypertensives, statins
ACEi, beta blockers (angina), metformin
52
What are some common problematic drugs in the elderly?
Anticholinergics
| Opioids, benzos, NSAIDs, warfarin, digoxin, bendroflumethiazide, TCAs
53
What are some causes of falls?
```
Trips/slips
Acute illness
Faint, postural hypotension
Vertigo, chronic vestibular hypofunction
Sensory neuropathies
Subdural
Multiple factors (polypharmacy, frailty)
```
54
How should a lying/standing BP be completed?
Best measured in morning
| Lie flat for 5min, check BP then again within 1min of standing and after 3min of standing
55
How is postural hypotension defined?
Drop of more than 20/10mmHg with symptoms or drop to <90 systolic
56
Describe the domains of a multi-factorial falls risk assessment:
Falls history
Assessment of gait, balance and mobility, and muscle weakness (timed up and go test)
Osteoporosis risk
Person’s perceived functional ability and fear of failing
Assessment of visual impairment
Assessment of cognitive impairment and neuro exam
Assessment of urinary incontinence
Home hazards
CVS exam, postural BP, ECG and med review
57
How can falls be prevented?
Strength and balance training (Otago or postural stability)
Med review
Postural hypotension correction
Home hazard assessment, transfer safely (including to toilet), sensory aids and good footwear
58
What are some consequences of falling?
```
Injury
Fear of falling, loss of mobility, increased dependency
Hypothermia
Long lie (AKI, rhabdo)
Infection (UTI, pneumonia)
Thrombosis
```
59
How can bone health be assessed?
Bloods, DEXA scan and FRAX score
60
What is carer strain?
When caregiver feels overwhelmed and unable to perform their role to the best of their ability
61
What is a package of care?
Combination of services put together to meet a person’s assessed need
62
What is the focus of the integrated community services team?
Providing short term support at home when one is discharged from hospital and/or to avoid an unnecessarily prolonged hospital admission
63
What is a home first form?
Individuals are medically fit for discharge but still require ongoing home support, work towards restoration of daily routine
64
What is a SALT assessment?
Assesses ability to communicate, take fluids and food, take medication
Recommend how to feed, what consistencies are safe, communication chart
65
What is feed at risk?
Person continues to eat and drink despite significant risk of aspiration and/or choking
Used to maintain QoL in advanced stage of illness
66
What is a nursing home?
Staffed at all times by registered nurses supported by care assistants
Residents need nursing intervention
67
What is a residential home?
Staff are trained but not in nursing care
68
What is discharge planning?
Process by which hospital team considers what support might be required by pt in community, refers pt to and liaises with these services to manage pt discharge
69
What factors need to be considered before discharge?
Destination of discharge, rehab and medical management plans
DNAR needed?
Pt choice as part of MDT
Continuing healthcare checklist: funding (100%, funded nursing care, mainstream, fasttrack)
TTOs + discharge letters
70
What questions should be asked as part of a continence history?
How pt voids, frequency, symptoms
Oral intake and types of drinks consumed
Bowel habit-including stool type and frequency
Drug history
71
What examinations should be performed as part of investigation into incontinence?
Review of bladder and bowel diary
Abdominal examination
PR examination (prostate in males)
External genitalia review
72
What investigations should be performed as part of investigation into incontinence?
```
Urine dipstick and MSU
Frequency/volume charts (72h period)
Check residual volume post micturition
Urodynamics
Cystoscopy and US imaging
```
73
What is functional incontinence?
No problems with urogenital tract but circumstances mean voiding of urine happens in a socially unacceptable way for pt e.g. older lady in hospital bed having to wait for someone to come and help her to toilet
74
What are some non-pharmacological management options for incontinence?
```
Switching to decaffeinated drinks
Regular toileting
Pelvic floor exercises (8x TDS), bladder retraining
Good bowel habit
Improving oral intake
Weight loss
```
75
What are some drugs that cause urinary retention?
TCAs, antihistamines, antipsychotics, calcium channel blockers, benzos, anticholinergics
76
What are some causes of faecal incontinence?
Faecal impaction with overflow diarrhoea (50%)
Neurogenic dysfunction
Chronic diarrhoea
Spinal cord pathology
77
How should faecal incontinence be investigated?
PR – assessment of rectum, prostate, anal tone and sensation + visual inspection around the anus
Stool type should be assessed if in the rectum
78
How should faecal impaction with overflow diarrhoea be managed?
Enemas for rectal loading, stool softeners and stimulants
| Manual evacuation may be done in difficult cases
79
How should chronic diarrhoea be managed?
Regular toileting, dietary review, low dose of loperamide then constipating and enema regimes
80
Where do pressure ulcers typically occur?
Over a bony prominence, such as the sacrum, ischial tuberosity and heels
Tissue compression, such as under a plaster cast, splint, arm sling, crutches, under glasses
81
What causes pressure ulcers to form?
Compression of soft tissue occludes blood supply, leading to ischaemia and tissue death
82
What scoring system assesses patient risk for pressure damage?
Waterlow
83
Which patients are at risk of developing pressure ulcers?
Altered mobility (inc. major surgery/trauma), poor nutritional status, medication, age, underlying medical conditions, neurological deficit
84
How can pressure injuries be prevented?
Frequent repositioning
| Dressings over wounds, dynamic mattresses, good nutrition, debridement
85
What is advanced care planning?
Recognition that pt is approaching EoL
Communication of this with pt and family members
Exploration of wishes of pt
86
In which patients is advanced care planning particularly important?
People at risk of losing mental capacity e.g. progressive illness
People whose mental capacity varies at different times e.g. mental illness
87
What are advance statements and advance decisions?
AS - statement of wishes and preferences
| AD - advanced decisions to refuse treatment
88
What is ceiling of care?
How much intervention is appropriate
89
In which patients may it not be in best interest to resuscitate?
Co-morbidities, frailty
Unlikely to be successful
If successful may have significant effect on QoL and functional ability
90
What are the benefits of advanced care planning?
Enables greater autonomy, choice and control
Improves the quality of end of life care
Greater concordance with pt’s wishes if they have been discussed
Reduced unwanted or futile invasive interventions, treatments or hospital admissions
Reduces later burden on family, relieves anxiety
91
What is the purpose of the ReSPECT form?
Creates a summary of personalised recommendations for a person’s clinical care in a future emergency in which they do not have capacity to make or express choices
Looks at whether focus of care is more towards life-sustaining treatments or more towards prioritising comfort
92
What are some general indicators of poor or deteriorating health?
```
Unplanned hospital admissions
Deteriorating performance status
Dependence on others for care
Weight loss
Asks for palliative care
```
93
What are some consequences of poor nutrition?
Increased susceptibility to disease
Impaired physical and mental development
Higher risk of skin breakdown
Reduced productivity
94
What are some risk factors for malnutrition?
Illness
Swallowing difficulty
Living alone
LD, MH issues
95
How can malnutrition be assessed?
MUST score
Weight, height, BMI
Mid upper arm circumference
96
Describe the 3 domains used when calculating the MUST score:
BMI
Unplanned weight loss in past 3-6m
Pt acutely ill and likely to be no nutritional intake for >5d
97
What is the management for those that score low risk of MUST score?
Repeat screening
Weekly in hospital
Monthly in care home
Annually in community if >75y
98
What is the management for those that score medium risk of MUST score?
Document dietary intake for 3d
If adequate, repeats screening as in low risk
If inadequate, improve and increase nutritional intake, monitor and review care plan
99
What is the management for those that score high risk of MUST score?
Refer to dietitian
Increase nutritional intake
Monitor and review care plan often
100
What are some hospital related issues that can lead to poor nutrition?
Recumbent position
Difficulty accessing food and drink
Co-existing conditions – constipation, delirium, pain
Lack of oral routine and suboptimal mouthcare
101
What are some early interventions to support optimal nutrition?
Mouth care
| High contrast plate colour, small dining rooms, enhanced menus, screening, sensory aids, access, little and often
102
What are some later interventions to support optimal nutrition?
Finger food (high calories) and food fortification - porridge, build-up drinks
High protein oral nutritional supplements
Enteral support with feeding (i.e. an NG tube)
103
What are some causes of reduced oral intake in dementia?
```
Olfactory and taste dysfunction
Attention deficit
Executive function deficit (shopping, preparing food)
Dysphagia
Refusal to eat
```
104
What are the characteristics of community hospitals?
Small local hospital (aka hub or a unit), typically rural
Focus on intermediate care/rehabilitation
Medical service sessional (not onsite 24/7), typically provided by local GPs often with consultant support
105
Describe a classic community hospital:
Local hospital, unit or centre providing a range and format of accessible health care facilities and resources for the defined community
106
Describe community hospital hubs:
Local hospitals providing a range of community-based health and social care services (including well-being + health promotion)
Do not include inpatient beds
107
Describe intermediate care/rehabilitation units:
Local facility providing beds and associated clinics and therapy in order to promote independence, avoid admission to a DGH and reduce stays in a DGH
108
What is hospital at home?
Community-based provision of services usually associated with acute inpatient care
109
What is intermediate care?
Services provided to pts, usually older people, after leaving hospital or when they are at risk of being sent to hospital
110
What is OPAT?
Outpatient parenteral antibiotic therapy
111
What are the benefits of community based interventions compared to hospital admission?
Strong patient satisfaction positive impact on quality of patient care
More personal style of care
Staying at home considered more therapeutic
112
What are the key points in the NHS Long Term Plan?
Patients get properly joined-up care at the right time in the optimal care setting
Prevention programmes and assessing health inequalities
NHS’s priorities for care quality and outcomes
How current workforce pressures will be tackled, and staff supported
Upgrade technology and digitally enabled care
Sustainable financial path using new funding
113
What is NHS Continuing Healthcare?
Some people with long-term complex health needs qualify for free social care arranged and funded solely by the NHS
114
What is the process for obtaining a support package through NHS Continuing Healthcare?
Initial checklist assessment
Full assessments by MDT
Care needs assessed and weighted to decide if eligible
115
What is the NHS continuing healthcare fast-track pathway?
If health is deteriorating quickly and pt is nearing the EoL, care and support package within 48h
116
What criteria rule people out from obtaining funding from the local council to help with the cost of care?
Savings worth more than £23,250
| Own your own property (if moving into care home)
117
What is a carer?
A person of any age who provides unpaid support to a partner, child, relative or friend who wouldn’t manage to live independently or whose health or wellbeing would deteriorate without this help
118
Why may someone need a carer?
Frailty, disability, serious health condition, mental ill health or substance misuse
119
What are some roles of a carer?
Organisation of person’s life inc. finances
Understanding medical background, take to appts
Food prep
Stress management
Help with movement around home
120
What are some support services/systems in place for carers?
```
Carers Centre – CLASP
Age UK
Carers assessment
Carers allowance - £67.25/w (benefit if caring for >35h/w)
Disability Living Allowance
```
121
What are some barriers to carers accessing support?
Lack of awareness, not feeling worthy, cost, physical access
122
What is a crisis in terms of carers?
When a carer can no longer cope
123
What some physical demands placed on carers?
Diet (often busy)
Weight (poor diet, lack of exercise)
Sleep disturbance (stress, night-time care)
124
What some financial demands placed on carers?
Benefits system (understand entitlements, how to apply)
Transport
Equipment
Formal support
125
What some emotional demands placed on carers?
Feel invisible (no-one asks how they are), anxiety, guilt, anger
126
What some social demands placed on carers?
Isolation, no time for socialising, change in priorities
127
How can carers access information?
GP, social media groups, websites, local groups, lawyers
128
What is the difference in life expectancy between LD population and general population?
Women with LDs have life expectancy 18y shorter than average and men 14y shorter than average
129
What is normal IQ?
100 ± 15
130
What is borderline IQ?
70-84
131
What is the IQ cut off for mild LD?
50-69
132
What is the IQ cut off for moderate LD?
35-49
133
What is the IQ cut off for severe LD?
20-34
134
What is the IQ cut off for profound LD?
<20
135
What are some causes of learning disabilities?
Unknown in most cases (70%)
Fragile X, Down’s, malnutrition
Peri and postnatal infections
136
What are some physical health issues seen in LDs?
Hypothyroidism, epilepsy, visual/hearing impairment, cerebral palsy
Constipation, incontinence
137
What is STOMP in regards to LDs?
Stop overprescribing of meds to people with LD
| Encouraging regular check ups and focus on non-drug therapies
138
How can communication with those with LDs be improved?
Ensure environment is appropriate, involve family and carers
Simplify language, may use some sign language
Communication passports – what the pt likes to talk about e.g. football
Longer appts
139
What are health inequities?
Avoidable inequalities in health between groups of people within countries and between countries
140
What is poverty?
When one cannot afford the basic needs of life – food, clothing, shelter
141
How many people and children are in poverty in the UK?
14.3 million people (22%)
| 34% of children
142
What are some examples of adverse childhood experiences?
```
Verbal, physical, sexual abuse
Physical and emotional neglect
Parental separation
Household mental illness
Household domestic violence
Exposure to substance misuse
Homelessness
```
143
What are the consequences in future life for children with multiple adverse childhood experiences?
Substance misuse, MH problems, cardio-resp + diabetes, crime/violence
144
What are some of the consequences of poor housing/homelessness?
```
Exacerbates poverty
MH problems or substance misuse
Delayed hospital discharge
Impact on chronic conditions (asthma, dementia, CV disease)
Lower life expectancy
```
145
What is income distribution theory?
Relative income within the country matters more than gross national product with regards to inequalities
146
What are the points in Marmot: fair society?
Give every child best start
Enable all children, young people and adults to maximise capabilities and control lives
Create fair employment and good work for all
Ensure healthy standard of living
Create and develop healthy and sustainable places and communities
Strengthen role and impact of health prevention
147
What is the inverse care law?
Those who need medical care the most, are the least likely to receive it and vice versa
148
What are some sociological factors impacting on health inequalities?
Income and social status
Education
Physical environment - safe water and clean air, healthy workplaces, safe houses
Social support networks
149
What are the 5 core principles of the Mental Capacity Act?
Assume capacity unless it is established that they lack capacity
A person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success
Able to make unwise decisions
Decisions under the Act made in pts’ best interest
Any decision made must be the least restrictive option available to the person
150
What is the two-stage process for assessing capacity to make decisions?
Diagnostic Test – is there a disorder of brain or mind influencing ability to make decision?
Capacity Test – can pt understand the information, weigh up the risks, retain the info long enough to make a decision and communicate that decision back to you
151
What is Lasting Power of Attorney?
Person legally appointed to make decisions on another person’s behalf in the event that they lose capacity to make decisions for themselves
152
What is an independent mental capacity advocate (IMCA)?
People trained to represent adults who lack capacity to make decisions for themselves
153
What is Deprivation of Liberty Safeguards (DOLS)?
Allows restraint and restrictions to be used but only if they are in the person’s best interests
Designed to safeguard adults who lack capacity to make the decision as to where their care and treatment should take place
154
What are some examples of situations depriving people of liberty?
Confined to a restricted place for a non-negligible period of time
Subject to ‘continuous and complete supervision and control’
Person is not free to leave
Does not have the capacity to consent to their care and treatment in these circumstances
155
What are the key considerations of biomedical ethics?
```
Respect for autonomy
Non-maleficence
Beneficence
Justice
Confidentiality, informed consent, capacity
```
156
Who is at risk of abuse or neglect?
Older people or people with disabilities
157
What are some examples of types of physical abuse?
Assault,biting, rough handling, scalding and burning, making someone purposefully uncomfortable, confinement
158
What are some indicators of physical abuse?
Inconsistency with the account of what happened Bruising, burns, frequent injuries
Changed behaviour in the presence of a particular person
Failure to seek medical treatment
159
What are some indicators of domestic violence?
Low self-esteem, guilt, physical evidence of violence, verbal abuse in front of others, isolation, limited access to money
160
What are some examples of types of sexual abuse?
Rape, sexual assault, non-consensual sexual activity, sexual photography, indecent exposure
161
What are some indicators of sexual abuse?
Bruising, bleeding, pain or itching in the genital
STIs
Pregnancy in a woman who is unable to consent
Excessive fear
162
What are some examples of types of emotional abuse?
Enforced social isolation, preventing religious/cultural needs, preventing expression of choice, intimidation, coercion, harassment, cyber bullying
163
What are some indicators of emotional abuse?
Withdrawal, low self-esteem, uncooperative behaviour, weight loss/gain, tearfulness, anger
164
What are some examples of types of modern slavery?
Human trafficking, forced labour, sexual exploitation, debt bondage
165
What are some indicators of modern slavery?
Malnourished, isolation from the community, seeming under control of others, overcrowded accommodation, lack of ID, always wearing the same clothes, fear of law enforcers
166
What are some examples of types of financial abuse?
Theft, fraud, scamming, preventing access to money/benefits, misuse of personal allowance or benefits, false representation, exploitation, misuse of a power of attorney
167
What are some indicators of financial abuse?
Unexplained lack of money, unexplained withdrawal of funds from accounts, family show unusual interest in the assets of the person, disparity between the person’s living conditions and their financial resources
168
What are some examples of types of institutional abuse?
Overcrowded establishment, rigid regimes, insufficient staff, abusive and disrespectful attitudes towards people using the service, not offering choice, failure to respond to complaints
169
What are some indicators of institutional abuse?
People being hungry or dehydrated, poor standards of care, poor record-keeping, absence of visitors, absence of individual care plans
170
What are some examples of types of neglect?
Failure to provide or allow access to food, shelter, clothing, heating, stimulation and activity, personal or medical care
Refusal of access to visitors, failure to ensure privacy and dignity
171
What are some indicators of neglect?
Poor physical condition, pressure sores, malnutrition, untreated injuries and medical problems, uncharacteristic failure to engage in social interaction, inadequate clothing
172
What are some examples of types of self-neglect?
Lack of self-care to an extent that it threatens personal health and safety, inability to avoid self-harm, failure to seek help or access services to meet health and social care needs
173
What are some indicators of self-neglect?
Very poor personal hygiene, unkempt, malnutrition, dehydration, living in squalid conditions, hoarding, inability or unwillingness to take medication or treat illness or injury
174
What are some examples of different types of abuse?
```
Physical
Domestic violence
Sexual
Emotional
Modern slavery
Financial
Institutional
Neglect
Self-neglect
Discriminatory
```
175
What is the prognosis for mild cognitive impairment?
10-15% go on to develop dementia
176
What percentage of >65y fall each year?
28-35%
177
What are some examples of basic activities of daily living?
Walking, feeding, dressing, grooming, toileting, bathing, transferring
178
What are some examples of instrumental activities of daily living?
```
Managing finances
Managing transportation
Shopping, meal preparation
Cleaning and home maintenance
Communication (telephone and mail)
Managing meds
```
