Module 2 - Geriatric Nutrition, Hydration, and Mental Health Flashcards
(181 cards)
1
Q
The ABC’s of Nutrition for the Elderly
A
Aim for fitness
Build a healthy body
Choose sensibly
(We use these to help the elderly to stay in good nutrition)
2
Q
What is a very important factor for later ability to recover from disease and illness?
A
Lifelong eating habits
3
Q
What are the important congressional acts to know relating to elder nutrition?
A
Omnibus Budget Reconciliation Act of 1987 (OMBRA)
Balanced Budget Act of 1997
4
Q
What was the main purpose of the OMBRA and Balanced Budget Acts?
A
To impact nutritional standards in LTC facilities regarding BMI, weight, I/O, hydration, pressure injuries
If you cannot follow these standards there will be monetary fines and government benefits can be removed - LTC can lose their normal reimbursement amount
5
Q
Factors that contribute to malnutrition in the elderly?
A
Normal Physiologic Changes
Oral and GI Changes - motility slows with age and they may be edentulous or using dentures
Sensory Changes - may not hear as good or smell/taste as well
Social and Economic Changes - SS reliance –> tough decisions on rent v food, etc
6
Q
Sarcopenia (Sarcopenia Obesity)
A
Decreased lean muscle mass
7
Q
How can sarcopenia come about?
A
Decreased Physical Activity
Sedentary Lifestyle
Decreased Nutrition
Decreased Anabolic Hormones
8
Q
Can obesity occur alongside sarcopenia?
A
YES
9
Q
What does the vicious cycle of Sarcopenia occur?
A
Sarcopenia –> Functional Decline –> Loss of Strength –> Additional Loss –> Increase in Morbidity and Mortality –> REPEATS FROM SARCOPENIA
10
Q
Oral and GI Changes that contribute to Malnutrition in the Elderly
A
Xerostomia
Dysphagia
Decreased Thirst Perception
Altered Dentition
Altered Taste and Smell
Decreased Gag Reflex
Decreased Peristalsis, Gastric Secretion and Motility (Constipation)
Altered Appetite - Anorexia of the Aging
11
Q
What contributes to Altered Appetite / Anorexia of the Aging?
A
Increase cholecystokinin and early satiety
Stomach decreases in size
12
Q
Xerostomia
A
dry mouth
try to encourage fluids with this
13
Q
Dysphagia
A
Difficulty swallowing
could be from something like stroke or another illness
14
Q
Signs and Symptoms of Dysphagia in the Elderly?
A
Ask the family if they have noticed anything?
Drooling
Facial Droop, Open Mouth
Dementia, Confusion, LOC
Increased nasal or oral secretions
Weak voice; cough
Slurred speech
Recurrent Respiratory Infections
Pocketing of Food
15
Q
What are some causes of Dysphagia in the Elderly
A
Neurologic Disorders
Muscular Disorders
Anatomical Abnormalities (like tumors)
16
Q
What happens to intestinal absorption, motility, and blood flow with age?
A
Decreases
17
Q
What happens to pancreas size with age and what causes it?
A
Decrease
Duct Hyperplasia and Lobular Fibrosis
18
Q
What happens to the incidence of cholelithiasis and amount of bile with aging?
A
Cholelithiasis incidence increases but bile decreases
19
Q
Cholelithiasis
A
Gallstones
20
Q
What happens to liver size and flow with age?
A
Decreases
21
Q
What happens with medication use and adverse drug reactions in the elderly?
A
Use of medication increases, and the poly-pharmacy increases the possibility of adverse drug reactions
22
Q
What percentage of change in weight means malnutrition in the elderly?
A
Loss of 5% body weight in 1 month
or
Loss of 10% Body weight in 6 months
23
Q
Everything ___ ___ with age!
A
slows down
24
Q
Do older adults present in a similar way like an adult patient?
A
No
Typically an adult may present more s/s with an adult making things less obvious –> gotta be very observent
25
What are some important presentations that may appear in a geriatric patient?
GERD
Hiatal Hernia
Esophageal Cancer
Peptic Ulcer
Cancer of the Stomach
Diverticular Disease
Bowel Obstruction
Gastric Volvulus
Ulcerative Colitis
Chron's Disease
Constipation - Excessive straining/laxative use
Diarrhea
Fecal impaction
26
What are some social and economic changes in the elderly that leads to malnutrition?
Social Isolation
Loneliness
Depression
Sedentary Lifestyle
"Food Insecurity" r/t insufficient funds
27
Why is social isolation and loneliness so prevalent in the elderly, and why does it contribute to malnutrition?
1. Living location - 25% live in a rural area in the middle of nowhere and therefore it may be easier to go to a nearby gas station rather than a grocery store farther out
2. Deaths of spouses and children moving out
3. Caregiver may be just as old as them and not even be able to effectively care for themselves
28
How does depression contribute to malnutrition?
Depression and Loneliness --> Less desire to eat --> Older people are lonelier and their appetite leaves
29
How can a sedentary lifestyle for the elderly contribute to malnutrition?
Sitting all day or inability to ambulate may make it so people only live off candy, soda, cookies, coffee, etc
30
What is Food Insecurity ?
Insufficient funds makes it so a person has to choose between things (ex: rent, food, medications, etc) and may not be able to afford good nutrition
They end up making prioritization choices since they are living off of social security - which is not enough
31
How does Vitamin D dosage needs change with age?
Dosage needs increase
32
Who is at risk for Vitamin D deficiency?
People in cold climates (like BU)
Decreased Sun exposure (like BU)
Decrease in milk intake
Use of anticonvulsants and corticosteroids
33
What can occur with Vitamin D deficiency?
Rickets
Osteomalcia
Obesity
34
Benefits of Vitamin E?
Skin Health
Eye Health
35
Who is at risk for Vitamin E deficiency?
Users of Anticoagulants
36
Why is Vitamin B12 particularly important for the energy?
It is given to the elderly a lot/ added to a lot of medication regimen since it aids with memory
37
Who is at risk for Vitamin B12 deficiency?
Malabsorptive Disease (Crohn's Disease)
Vegan Diet --> low protein in diet with vitamin B12
Medications that alter pH
38
What do Vitamin B12 deficiencies cause?
Macrocytic Anemia
Neurological Problems
Poor Memory
Depression/Irritability
39
Who is at risk for Calcium deficiency?
Poor dairy intake / fortified calcium foods
Excessive Caffeine and Protein
Inadequate Vitamin D
Medications like Corticosteroids, Colchine, Phenobarbital, Methotrexate, Cholestyramine
40
What do Calcium deficiencies cause?
Osteoporosis
Peridontal Disease
41
Who is at risk for Vitamin B6 deficiency?
Alcoholics
Autoimmune Disorders
42
What does Vitamin B6 deficiency cause?
Glossitis
Cheilosis
Depression
Confusion
43
Glossitis
Tongue Inflammation
44
Cheilosis
Inflammation of the Corner/Edges of the mouth
45
What are some things we can do to improve nutrition in the elderly?
be proactive
give the rights foods and amounts
encourage them
provide education
involve and speak to family members
46
How much fluid should a man have per day? A woman per day?
Men - 13 Cups
Women - 9 Cups
47
Who is at risk for dehydration?
Age
Incontinence
Polyuria
Cognitive Impairment
48
Signs and Symptoms of Dehydration
Tenting of the skin (stays in the same position)
Urine color is darker
Dry mucus membranes
Sunken eyes
Postural changes - orthostatic hypertension - in BP and Pulse
Confusion
49
Is tenting enough on its own to diagnose dehydration?
No sometimes that occurs in the elderly
50
What are some good nutritional assessment tools to use?
Anthropometrics
Laboratory Values
Nutritional History
Physical Exam
Screening Tools
51
What is the gold standard for nutritional assessment?
there is NO gold standard nor a consensus on one nutritional assessment tool, but the MNA has been validated in over 400 studies..
The lab values is what is very important
52
Anthropometrics
Measurement of the individual
You take Height, weight, weight history, muscle mass, and fat mass and see how it fluxuates
53
Important Lab Values for Elder Nutrition?
BUN
Creatinine
Serum Folate and B12
CBC - Anemia (find out why, and can tell us if they have it), MCV (elevation should be looked at), Hgb, Hct
Prealbumin - shorter half life than albumin; gives more current information on protein status
Transferrin < 180
Cholesterol <160
Albumin < 3.4 g/dL
54
What are some normal changes of aging regarding blood/cells?
Stem cell amount in marrow decreases
Eryropoietin administration is less effective
Lymphocyte regarding immunity is less effective
Plt Adhesiveness increases with age
Average H/H values decrease but should remain in the normal range
55
What does increased Plt adhesiveness increase the risk for?
Stroke Risk
56
When gathering a nutritional history it is important to do what?
1. Diet Recall - ask open ended questions, include fluid/alcohol/food preparation, and cultural influences
2. Gather food frequency (ex: how often do you snack or have meals?)
3. Get food records for no more than the last 2 days
57
Things to Look for in a Physical Exam of Elder Nutritional Status
Lips, oral Mucosa, gums, tongue, teeth
angular lesions (like cheilosis)
Abdomen distention/changes
Neurological deficits
GI/GU issues like incontinence, weight fluctuation, etc
I&O
!!Difficulties Swallowing, Acid Reflux, Sensory Changes (vision, hearing, taste, smell), Appetite changes/present?, Depression influencing nutritional status
58
How can a nurse promote nutrition overall?
Nutritional care plan based on findings
respect food habits and preferences
Be aware of physiological factors that alter nutrition
give them some choices / substitutes
offer encouragement at meals
complaints and rejections may be evidence of an underlying problem - note these
give adequate time for eating - DO NOT RUSH THEM
encourage independence in feeding themselves instead of having us do it all
59
What are some things Nurses can do to promote proper nutrition during mealtimes?
Be present - use therapeutic communication (ex: eye level)
provide adaptive equipment (ex: sippy cup)
provide proper food and drink consistency based on the person (dietician assesses this)
pleasant environment (nice lighting, etc)
adequate time - no rushing
encourage socialization
give smaller more frequent meals
avoid interruptions in eating - try not to administer meds during meals
use appealing tableware and bright colors
serve food promptly and at proper temperatures
Provide for them the way you would like things!
60
How can family support be used to manage elder nutrition?
Request family bring in favorite meals or seasonings
Visit at meal times
Help feed them
Discuss QOL issues (palliative care, hospice, discuss end of life, etc)
61
If someone is going into palliative/end of life care what can occur with their nutrition/diet?
what is now important is their comfort rather than restricting something like salt
62
Ways to minimize risk for aspiration?
Minimize distractions
follow proper thickened liquids
sit at the same level
NEVER engage in forceful feeding
consistent feeding techniques
proper positioning (90 degrees)
do NOT try to rush. One bite at a time
watch for aspiration (make sure they can swallow)
provide oral care prior to meals
make sure individual is alert
63
Weight loss may have ___ etiology
unknown
64
What may be needed if a person is unable to feed themselves/swallow?
Have alternative feeding methods available like Tubes
65
There may be what kind of dilemmas regarding malnutrition for which you should have plans in place?
ethical dilemmas
66
Important things to keep in mind when someone is tube feeding?
Keep HOB elevated 30-90 degrees
Watch for aspiration, constipation, and dehydration
Flush the tube before eating
Help prevent diarrhea and dehydration
67
Nursing Process of Nutrition
Assessment (of nutrition status) --> Diagnosis (of needs) --> Set nutritional goals and focus on expected outcomes --> Planning and Implementation --> Evaluation
68
What are some physiological factors that contribute to poor nutrition?
Dysphagia
Inability to feed self - dependency
Xerostomia
Poor dentition
Altered sensory perception
Constipation
Depression
Pain
Social Isolation
69
Nursing Interventions to increase Nutrition
Enhance eating environment
Improve taste perception (ex: seasoning)
Encourage nutrient dense foods
Saliva stimulation
Offer Frequent fluids (avoid dehydration)
Food/Liquid Consistency (dysphagia diet and texture modifications)
Offer feeding assistance
70
Mini Nutritional Assessment (MNA)
the most commonly used SCREENING tool for nutrition/malnutrition in the elderly
71
What things does MNA screen for
appetite (# of meals per day, check fluid intake)
weight loss
mobility (do they need help eating)
psychological stress
neuropsychological problems
BMI
Self view of their nutrition
72
Things to Assess for screening during the MNA?
Living arrangement
medications
pressure ulcers
number of meals they have
protein intake
fruits and vegetables
fluid intake
mode of feeding
self view of their nutrition
mid arm circumference
calf circumference
73
What is the role of the geriatric nurse in elder nutrition?
role is extremely important regarding the identification of factors that impact dietary intake , understanding the special considerations in the older adult, and implementing interventions that will help improve their overall nutrition and hydration
74
____ and ___ Elders will have better outcomes
Nourished and Hydrated elders will have better outcomes
75
What is cognitive function?
complicated process by which an individual perceives, registers, stores, retrieves, and uses information
76
Body and ___ are inseparable
mind
77
Most elders will not suffer significant ___ ___
memory impairment
78
What are some physical illnesses that lead to cognitive impairment?
stroke
heart disease
Parkinson's disease
endocrine disorders
cancers
epilepsy
B12 Deficiencies
chronic pain
viral illnesses
alzheimer's
length hospitalizations
79
Cognitive impairment may be associated with ___ factors
psychosocial
80
What are some psychosocial factors that influence cognitive impairment
serious losses (like jobs or people)
difficult relationships
change in social roles
loneliness
poverty
unplanned moves / forced relocation
medication side effects (A BIG ONE)
depression
81
Dementia
chronic, progressive, insidious and PERMANENT states of cognitive impairment
82
Delirium
an acute and sudden impairment of cognition that MAY be considered temporary
83
Depression
most often found
characterized by low mood
difficulty thinking and somatic changes
can also be pre-cursor to dementia
84
Dementia is both a ___ and ___ illness
chronic and terminal illness
*it isnt terminal itself, the deterioration is what brings on the terminal
85
Dementia has no ___ course and no ____
no uniform course and no predictability
86
Alzheimer's Disease is the ___ leading cause of death in the United States? It kills more than ___ and ___ cancer combined?
6th leading
breast and prostate
87
The biggest risk factor of Alzheimer's Disease is ..
Age!!!
88
How many people in the US have Alz D?
5 million Americans
that is 13% of seniors
89
Every __ seconds someone in the US develops the disease?
65 seconds
90
How many seniors die from Alzheimer's or another Dementia
1 in 3
91
Alzheimer's treatment is very ___
expensive
costs 214 billion in the US in 2014
by 2050 it could rise as high as 1.2 trillion
92
Namenda
An Alzheimer disease medication
it is crazy expensive - 30 tablets are 451 $
93
What are the stages of Alzheimer's Disease
Stage 1 - Normal Adult
Stage 2 - Normal Older Adult
Stage 3 - Start of Early AD
Stage 4 - Mild AD
Stage 5 - Moderate AD
Stage 6 - Moderately Severe AD
Stage 7 - Severe AD
94
Stage 1 AD
No impairment - the normal adult
95
Stage 2 AD
self report of memory impairment, no objective cognitive impairments are noted -- normal older adult
may be aware they forget (keys lights etc)
96
Stage 3 AD
cognitive impairments recognized by others
anxiety
impaired performance in demanding work and social settings
Compatible with Early AD
they know they are failing, other people noticed, and anxiety starts with inability to keep up with things
97
Stage 4 AD
withdrawal
denial of having AD
depression from reality
inability to perform ADLs and complex tasks
flattening of affect
cognitive impairment evident on exam
Mild AD
98
Stage 5 AD
disoriented to time and place
needs assistance in clothing selection
Moderate AD
in a nursing home at this point
99
Stage 6 AD
forgets name of spouse and other family members
personality and emotional changes
inability to perform many ADLs
agitation
Moderately Severe AD
sad and painful -calm and relaxed personality may change
100
Stage 7 AD
loss of verbal and psychomotor skills
incontinence
needs total assistance
Severe AD
eventual failure of systems and death
101
Other Types of Dementia
Vascular Dementia
Lewy Body Dementia
Frontotemporal Lobe Dementia
AIDS related Dementia
Trauma related Dementia
102
Vascular Dementia
thought to be caused by cardiovascular factors
something like a stroke could cause this
103
Lewy Body Dementia
similar to Parkinson's disease
protein particles called Lewy bodies accumulate in the brain
104
Frontotemporal Lobe Dementia
issues in this part of the brain leads to personality changes and atrophy of the frontal lobe
you have to rule out delirium first
105
What must be ruled out to diagnose dementia?
Delirium must first be ruled out
it cannot be sudden severe and acute state of confusion, rather insidious and appear permanent
106
Trauma Related Dementia
brain trauma like with athletes and foot ball players can lead to dementia later on
107
Main symptoms of Dementia
short term memory impairment
108
What is needed for a clinical diagnosis of Dementia?
loss of intellectual ability with impairment severe enough to interfere with social or occupational functioning
delirium must be ruled out
109
Tests that should be done for checking for Dementia
CBC - complete blood count
TSH
Basic Metabolic Panel and LFTS
Vitamin B12
MRI or CT - checks for structural brain damage
110
How should care be planned for Dementia Patients? What is the primary intervention?
there is no medications or technology preventing or curing dementia (but new advances are coming)
Symptomatic Nursing care is the primary intervention for dementia treatment
find ways to deal with those developing challenging behavioral and psychiatric symptoms
111
Teach patients and caregivers about the effects of Dementia --> _____
teaching about Dementia --> promote comfort + reduce feelings of distress
112
In order to give symptomatic nursing care as a primary intervention for dementia, what is required to be done?
Understand dementia is life limiting and a chronic illness
Caregivers need expertise (LTC and End of Life Care)
Family caregivers will need supportive care too
alleviate symptoms and teach patients and caregivers about the effects of dementia
113
Persons with Dementia and their families need nursing for what reasons?
Promote independence and autonomy
Prevent avoidable complications
Provide comfort
Promote Quality of Life
Safety
114
Do not assume what about the families of dementia patients?
Do not assume they understand basic care techniques
assistance and support to the families of a person with dementia are an integral part of nursing
115
What things should nurses do to prepare for dementia patient care?
Review basic specific care like lifting, bathing, and managing inappropriate behaviors
Prepare family for the guilt, frustration, anger, depression, and other feelings that accompany the responsibility of a caregiver
assist the family with obtaining respite care (and getting them support groups)
encourage the family to network with support groups and obtain counseling as needed
116
Respite Care
A place where a dementia patient can go for some limited time to give the family caregivers respite and rest
117
How can a safe environment be promoted for Dementia Patients in the home?
Modify strategies used to prevent injury to toddlers to provide a safer physical environment
Tour home with caregiver to identify safety issues and develop a plan to rectify them
118
As nurses we can help elderly with dementia to live ...
full, dignified lives by showing patience, compassion, and understanding
119
What really sets Delirium apart from Dementia?
Acute
Sudden
MAY be temporary
120
Etiologies for Delirium
disturbances in neurotransmission in the brain which control cognition, behavior and mood
cholinergic failure
poor cerebral blood flow
complication of illness
drug or substances effect on the brain
general anesthesia
121
What is the biggest concern with detection for Delirium?
it is often just seen as CONFUSION (which is sometimes seen as normal in the elderly BUT it IS NOT)
delirium over dementia is difficult to determine
it IS an medical emergency
causes acute, distress, sometimes fearful
122
Potential (Specific) things/ Diagnoses that cause Delirium
CNS infections
Hypothyroidism
B12 Deficiency
CNS masses (neoplasms and subdermal hematomas)
medication side effects
123
The Yale Delirium Prevention trial demonstrated the effectiveness of what?`
Orientation and therapeutic activities alleviate cog impairment
early mobilization prevents later immobilization
non pharm approaches minimize psychoactive drug use and effects
you can intervene to prevent sleep deprivation
communication methods and adaptive equipment helps with vision and hearing issues
EARLY INTERVENTION FOR VOLUME DEPLETION
124
Volume depletion causes ...
confusion/delirium so make sure to offer enough fluids so it doesn't get worse
125
What are the consequences of delirium?
significant distress
associated with high morbidity during hospitalization
functional decline
post op complications
increased length of stay
low rate of recovery to prior level of functioning
potential institutionalization
126
Types of Delirium
Hypoactive
Hyperactive
127
Hypoactive Delirium
Quiet
"Pleasantly confused"
lethargic
inactive
withdrawn
limited, slow and wavering vocalizations
128
Hyperactive Delirium
heightened alertness
easily distracted
hallucinations
delusions
agitated
aggressive
fast and / or loud speech
wandering
repetitive movements
removing tubes
attempting to get out of bed
129
What is the scarier type of Delirium
hyperactive
130
What is the main symptom of both hypo and hyperactive delirium?
Patient is NOT acting like themselves
131
Nursing Interventions for Delirium
Reassess cognition using established tools
make sure basic needs are met (NUMBER 1 PRIORITY)
review medications
understand behavior, determine root cause
maintain safety with MINIMAL restraints!!
lessen invasive procedures
modify the environment
family involvement
132
___ can be a precursor to dementia
Depression
133
What are some common vents that require psychological adjustments and could lead to depression
widowhood
confronting negative attitudes of aging
retirement
chronic illness
functional impairments
decisions about driving a car
death of friends and family
relocation from home to assisted living
134
More events needing coping and adaptation occur when ...
a person lives longer
135
What subgroups of risk factors for depression exist?
High levels of stress and poor coping
Impaired mental health - previous depression
(and substance abuse)
136
What are some risk factors for high levels of stress and poor coping?
diminished economic resources
immature developmental level
unanticipated events, such as the death of a spouse
many daily hassles at the same time in one day
many major life events occurring in a short period of time
unrealistic appraisals of situations
137
Depression may be associated with ...
stroke
heart disease
Parkinson's disease
endocrine disorders (diabetes)
cancers
epilepsy
B12 deficiency
chronic pain
viral illness
serious losses
138
What things/changes relate back to depression in the elderly?
difficult relationships
changes in social roles
retirement
widowhood
loneliness
poverty
unplanned moves
medication side effects
age related changes!
139
Depression risk can be decreased through ...
Nonpharmacological interventions and pharmacological interventions
140
Nonpharmacological Interventions for Depression
Light therapy for seasonal affective disorder (SAD)
electroconvulsive therapy (ECT) (Not used too much anymore)
alcoholics anonymous / support groups
141
Pharmacological Interventions
antidepressants
mood stabilizers
antianxiety drugs
142
Nursing Interventions for Depression
ID stressors and rate elder stress levels
Education of elder and family about stress theory and stress cycle
ID successful coping mechanisms used in the past
assist in examining current coping mechanisms and behaviors
alter or eliminate negative or maladaptive mechanisms
reinforce and strengthen positive coping mechanisms
investigate community resources, support groups, stress reduction clinics, and other stress relievers
initiate suicide self restraint contracts
encourage appropriate self care behaviors
ID and encourage effective coping strategies
encouraging hopeful attitudes
143
How can health aging, social interaction, education, and problem solving be fostered?
travel with senior citizens groups
outsides activities
taking classes
elder hostels
volunteer work
regular exercise
hobbies and crafts
increased family involvement
144
What things must be maintained and promoted as a client regresses?
Individuality
Independence
Freedom
Dignity
Connection
145
How to maintain and promote Individuality
learn the personal history and uniqueness of the patient and incorporate it into nursing care
146
How to maintain and promote Independence
even if it takes 3x longer to guide patients through dressing than it would to dress them, they should be afforded every opportunity for self care!
147
How to maintain and promote Freedom
major freedoms become limited so minor choices made by the client become especially important
148
How to maintain and promote Dignity
clients should be afforded the respect given to any adult including attractive clothing, good grooming, adult hairstyles, use of their names, privacy, and individuality
149
How to maintain and promote Connection
value the client as someone who is a member of a family, community, and universe.
Interaction and connection with other people and nature recognition and respect for the spiritual beings that live within the altered body and mind
150
How to help older patients with cognitive decline deal with anxiety?
plan specific interventions to minimize stress level
enhance feelings of trust and safety
promote self control by providing a daily routine with few variations to provide stability
diversional activities like music therapies, reminiscence, structure sensory stimulation, snoelezen room
151
What are some risk factors for Elopement of older patients?
severe cog impairment
exhibit more than one challenging behavior (ex: combative with care, not eating or drinking, abnormal behavior)
spend long periods alone (isolation)
in a darkened or unfamiliar environment
boredom (keep preoccupied)
stress and tension ( and stress increases with cog decline)
lack of control
lack of exercise
nocturnal delirium
don't leave cues like keys around for them to use
152
Nocturnal Delirium
at night a cognitively declining patient cannot sleep and become confused and try to get away/ elope from where they are
153
What is common to middle and late stages of dementia?
Resistance to Care
154
The major reason for institutionalization and use of psychotropic drugs is ...
resistance to care
155
Alternative strategies to drugs when a patient is resistant to care?
responding with a relaxed and smiling manner
"time out" with a pleasant distraction (disengage let them listen to music or ATV then re-approach once settled)
156
Why is insomnia very prevalent in cognitive decline?
death of suprachiasmatic nucleus --> death and loss of regulation of circadian rhythms
157
What is evident several months before AD diagnosis?
insomnia
158
Strategies to deal with the Difficulty of insomnia for caregivers?
Establish sleep hygiene --> very cut and dry sleep schedule
eliminate stimulation prior to bedtime
159
Symptoms of Caregiver Stress
Denial
Anger
Social Withdrawal
Anxiety
Depression
Exhaustion
Sleeplessness
Irritability
Lack of Concentration
Health Problems
160
Tips for Caregivers to prevent burnout/stress
Knowing available resources (adult day programs, visiting nurses, meal deliveries, etc)
Get Help (social support of those going through something similar)
Use relaxation techniques (visualization, meditation, breathing exercises)
Get moving and Physical Activity (do what you enjoy)
Time for You
Become an educated caregiver
take care of yourself !!!!
161
When planning care for patients with dementia it is important to understand what regarding the disease?
Dementia is a family disease
Dementia is a public health problem (more are getting it and caregiving needs are required by informal family and friends or Medicare and Medicaid providers)
162
Adult Day Centers
almost like an adult day care that gives the clients opportunities to be social and participate in activities in a social environment
163
What things does adult day centers provide?
counseling
health services
nutrition - from dieticians
personal care
activities
behavioral management - with trained staff
164
In Home Health Care
Includes a wide range of services provided in the home rather than in a hospital
it allows a client to stay in familiar environment and is of great assistance to caregiver
165
Types of In Home Health Care Services
Companion services - let the families go out
Personal care services - helps with grooming
Homemakers - help with chores around the home and take a load off the caregiver
Skilled care - nursing care like med management and wound care
166
Residential Facilities (LTC)
Provide a communal living environment for those who need a higher level of care that can be provided at home
167
Types of Residential Facilities
Retirement housing
assisted living
nursing home / skilled nursing facility / LTC
Alzheimer's Special Care Units / Memory Care Units
Continuing care retirement communities
168
Retirement Housing
residential facility
appropriate for those with early stage AD who are still able to care for themselves independently
client may be able to live alone safe, but difficulty managing an entire house
limited supervision is provided and some offer opportunities for social activities, transportation, and other amenities
almost like living in a hotel (call bell available) - supervision but mostly on their own !!
169
Assisted Living
residential facility
bridges the gap between independent living and living in a nursing home
provides housing, meals, supportive services, and health care
Resident may choose which services they receive from facilities such as bathing, dressing, eating, or medication reminders
May or may not provide services specifically for dementia
all services are available - or they choose just services needed
Staff MAY OR MAY NOT be specifically trained for dementia
170
Nursing Home / LTC Unit
residential facility
provides around the clock care and long term medical treatment giving services addressing issues like nutrition, care planning, recreation, spirituality, and medical care
staff may OR may not have experience or training with caring for dementia clients
always a physician here and nurses and aides
24/7 care
everything is included in the care here
171
Alzheimer's Special Care Units / Memory Care Units
SCUs are residential facilities designed to meet the specific needs of individuals with AD and other dementias
Can take many forms and exist at various levels of residential care
a cluster setting in which clients with dementia are groups together on a floor or unit - DONT WANT TO PUT THEM WITH SOMETHING LIKE THE REHAB FLOOT SINCE THE REHAB COULD BE DISTRACTED AND ALZ ARE ANXIOUS
staff has extensive training in dementia care, specialized activities are provided and staff can care for behavioral needs of residents - VERY SPECIALIZED STAFF
172
Continuing Care Retirement Communities (CCRI)
Residential facility providing different levels of care (independent, assisted living, and nursing home) based on individual needs
Client is able to move throughout the different levels of care within community if their needs change (changes from rehab to Nursing home to LTC, etc ,etc)
payment includes and initial entry fee (ex: 250-500 thousand) w/ subsequent monthly fees or payment based solely on fees - very expensive out of pocket
commonly has a waiting list
guaranteed care until end of life
173
Respite Care
respite care provides caregivers a temporary rest from caregiving, while the person with AD continues to receive care in a safe environment
it gives caregivers the chance to spend time with friends/families or to just relax - important to prevent burn out, gives break, etc
Provided comfort and peace of mind knowing that the client is spending time with another caring individual
174
Forms of Respite Care
In Home Health Care Services
Adult Day Centers
Residential Facilities
(sometimes done out of homes)
175
Hospice Care
focuses on comfort and dignity at the end of life
primary purpose is to manage pain and other symptoms during the last six months of life
provided at home or in a nursing facility
gives counseling about the emotional and spiritual impact of the end of life and gives grief support to family
176
Medical Care in Hospice Care focuses on ...
Symptom Management
Less chemo, anitbiotics, and dialysis - more giving them comfort and what they want in diet
177
Hospice care is for the estimated last ___ months of live
6 months of life (may not be exact)
178
Hospice may require what to give caregivers relief?
some respite care too for the client
179
Hospice focuses on ___ and ___ of the client
comfort and dignity
180
What things should be asked when deciding where a loved one goes?
Patient choice on where to go
Family involvement as it is a team approach decision
Interdisciplinary Team - makes recommendations to help make choices
The important points to keep in mind are dignity, comfort, and safety
181
What are the 3 most important points of Geriatric Care?
Dignity (#1; Always at the forefront)
Safety
Comfort
