Rehabilitation and Maintenance in Older Adults

Question 1

What are the 4 main health strategies?

Answer 1

1) Preventive
2) Curative
3) Rehabilitative
4) Supportive
- not mutually exclusive

Question 2

What is the (i) goals (ii) methods of preventive health strategies?

Answer 2

i) Prevent health conditions/reduce incidence

ii) Health promoting, public health policies

Question 3

What is the (i) goals (ii) methods of curative health strategies?

Answer 3

i) Cure health conditions/control disease and consequences

ii) Medical and surgical specialties

Question 4

What is the (i) goals (ii) methods of rehabilitative health strategies?

Answer 4

i) Restore full function/optimise function

ii) rehabilitation/geriatric medicine

Question 5

What is the (i) goals (ii) methods of supportive health strategies?

Answer 5

i) Preserve independence and autonomy/optimise QOL

ii) Geriatric and palliative medicine

Question 6

What is the ICF?

Answer 6

International classification of functioning, disability and health

Question 7

What are the ICF components and their respective negatives?

Answer 7

1) Body function and structures → Impairment

2) Activities → Limitation

3) Participation → Restriction

Question 8

What are 2 things that can be done for an older person’s cognition and emotional health?

Answer 8

1) Daily reorientation
2) PT/OT, activity engagement
3) Reduce use of psychoactive substances

Question 9

What are 3 things that can be done for an older person’s mobility, vigour and self-care?

Answer 9

1) Early mobilisation
2) PT
3) Avoid restraints
3) Ready access to walking aids
4) Suitable bed height

Question 10

What are 3 things that can be done for an older person’s continence?

Answer 10

1) Assisted toileting
2) Call bell within reach
3) Orientate where toilet is
4) Medication review (eg. opioids)
5) Facility mobility
6) Avoid prolonged in-dwelling catheter/diapers/bedpans

Question 11

What are 3 things that can be done for an older person’s nutrition?

Answer 11

1) Review dietary restrictions
2) Make dentures available
3) Review medications
4) Dietician review
5) Scheduled fluids
6) Assess swallowing and modify diet

Question 12

What are 3 things that can be done for an older person’s skin integrity?

Answer 12

1) Turning in bed
2) Protective equipment (eg. heel protectors, padded dressing, air mattress)
3) Scheduled diaper changing
4) Protective clothing
5) Maintain good nutrition and hydration

Question 13

How should a patient with a bad leg go up and down stairs?

Answer 13

Hold handrail on good side

Going up → good leg first
Going down → bad leg first

Question 14

How do you support a patient with difficulty walking?

Answer 14

you become the walking aid → offer palm facing up, hand at their hip level, other hand support side

Question 15

When should a walking stick/straight cane be prescribed?

Answer 15

In a patient with mild stability issues eg. sensory ataxia

Question 16

When should crutches be prescribed?

Answer 16

Healthy with need for weight bearing (ok UL)

Question 17

When should a walking stick with an offset handle be prescribed?

Answer 17

Instability with need for unilateral weight-bearing eg. hip fracture

Question 18

When should a 2 wheel walking be prescribed?

Answer 18

mainly for parkinsons to overcome initiation failure + cerebellar ataxia (trunk swaying)

Question 19

When should a 4 wheel walker be prescribed?

Answer 19

mainly for limited exertional capacity eg. severe COPD, CHF

Question 20

When should a standard walker/pickup frame be prescribed?

Answer 20

bilateral weight bearing with ok UL

Question 21

What are 2 local programmes supporting older adults?

Answer 21

1) Council for Third Age (C3A)
- promoting ground up initiatives that encourage older adults to be active and socially engaged

2) National Silver Academy (NSA)
- learning opportunities from Unis and ITE

Question 22

What are 4 home-based community services for older people?

Answer 22

1) Home-medical
2) Home nursing
3) Home therapy
4) Home personal care
5) Meals on wheels
6) Medical escort and transport
7) Befriending service
8) Home hospice
9) Integrated home and day care (IHDC)

Question 23

What are 4 centre-based community services for older people?

Answer 23

1) Active Aging Centre (AAC)/ Active Aging Care Hub (AACH)

2) Day care

3) Dementia Day Care

4) Day Rehab Centre

5) Centre-Cased Nursing

6) Day Hospice

7) Integrated Home and Day Care

Question 24

What are 2 residential community services for older people?

Answer 24

1) Nursing Home
2) Shelter and Senior Group Home
3) Community Hospital
4) Inpatient Hospice

Question 25

What are the 3 individual healthcare financing options in singapore?

Answer 25

1) Medisave 2) Medishield life (and other insurance) 3) Out-of-pocket (OOP)

Question 26

What are 2 community healthcare financing options in singapore?

Answer 26

1) Voluntary Welfare Organisations (VWOs) 2) Community Development Councils (CDCs)

Question 27

What are 3 governmental healthcare financing options in singapore?

Answer 27

1) Subsidies and Schemes 2) Medifund 3) Subventions for public sector health services

Question 28

What is the Chronic Disease Management Programme?

Answer 28

Covers 23 conditions for which a patient can receive subsidies (if CHAS, pioneer, Merdeka) + can claim medisave

Question 29

What is the pioneer generation package?

Answer 29

For SGeans born before 1950 and SG citizens before 1987 - MediSave top-ups - Outpatient care subsidies (additional 50% off the bill after deduction of CHAS benefits) - Additional participation incentive to join CareShield Life - MediShield Life premium subsidies - Pioneer Generation Disability Assistance Scheme (PG-DAS) – lifelong cash assistance $100/month for those who permanently need assistance in at least 3 out of 6 ADLs

Question 30

What is the Merdeka Generation Package?

Answer 30

For SGeans born 1950-1959 and SG citizen before 1997 OR before 1950 and citizen before 1997 but didnt not get Pioneer gen package - PAssion Card Silver Card Top-Up – one-off $100 for use on active ageing programmes, ActiveSG, public transport etc MediSave Top-Ups - Outpatient care subsidies (additional 25% off the bill) - Additional participation incentive to join CareShield Life - Additional MediShield Life premium subsidies

Question 31

What is the Community Health Assist Scheme (CHAS)?

Answer 31

Enables all SGeans to receives subsidies for medical/dental care at participating clinics, regardless of income - tiered by household monthly income and annual value of home (in subsidy: blue>orange>green)

Question 32

What is the National Medical Savings Scheme (Medisave)?

Answer 32

Helps individuals set aside part of their income to pay for personal and approved dependent's healthcare expenses (eg. outpatient care, vaccinations, scans, hospital stays, health screenings)

Question 33

What is Medishield Life?

Answer 33

Basic health insurance plan for all SGeans and PRs - life time overage and auto-inclusion

Question 34

What is Medifund?

Answer 34

Safety net for SGeans - endowment fund set up by the government - for those who face financial difficulties with their remaining bills after receiving government subsidies and other means of payment (eg. Medisave, Medishield life)

Question 35

What is IDAPE?

Answer 35

Interim Disability Assistance Programme for the Elderly - government assistance scheme (payout/month) - Unable to perform at least 3 out of 6 ADLs (washing, feeding, dressing, toileting, mobility, transfers) - Singapore Citizen born before 30 Sep 1932 OR born between 1 Oct 1932 and 30 Sep 1962 but with pre-existing disabilities as at 30 Sep 2002 - Per capita household monthly income ≤ $2,800 OR no household income and living in residence with annual value ≤ $13,000

Question 36

What is Eldershield?

Answer 36

Severe disability insurance scheme which provides basic financial protection to those who need long-term care (monthly cash payouts) - SGeans & PR auto covered at 40 unless opt out

Question 37

What is CareShield Life?

Answer 37

"ElderShield 2.0" - lifetime and worldwide coverage - premiums fully payable by MediSave