Special populations- family and older adults

Question 1

3 parts of the family systems approach

Answer 1

disease, assessment, intervention

Question 2

disease

Answer 2

Disease:

viewed as an ongoing process requiring continuity of care between health care provider and the family

Question 3

assessment

Answer 3

Assessment:

the relational context in which disease management takes place becomes paramount

Question 4

intervention

Answer 4

Intervention:
shifted from the patient to the family
family environment and other family (members are potential targets for intervention)

Question 5

If the individual is to change, his or her ______ must change.

Answer 5

If the individual is to change, his or her social context must change.
An individual’s problems impact all family members and the family’s reaction affects the individual.

Question 6

5 protective factors for disease management

Answer 6

1. Family closeness and connectedness
2. Problem-focused family coping skills
3. Clear family organization and decision making
4. Supportive relationships with extended family
5. Direct communication among family members regarding the chronic disease

Question 7

8 risk factors for disease management

Answer 7

1. Intrafamilial hostility
2. Criticism
3. Blame
4. Psychological trauma related to the initial diagnosis and treatment of the disease
5. Extra-familial stress
6. Lack of extra-familial support system
7. Family perfectionism and rigidity
8. Presence of psychopathology

Question 8

4 characteristics of the family system

Answer 8

1. External and internal boundaries
2. Internal hierarchy
3. Self-regulation through feedback
   homeostasis
4. Changes with time, adapting to family lifecycle development

Question 9

the family lifecyle

Answer 9

The single adult
Forming a committed relationship
The family with young children
The family with adolescents
Launching children
The family in later life

Question 10

the family lifecycle: difficulties negotiating tasks associated with any of the stages results in ….

Answer 10

result in increased problems for the family in resolving later family lifecycle stages.

Question 11

family cohesion. when the system is out of balance, what are the 4 types of out-of-balance families we see?

Answer 11

Enmeshed family
Disengaged family
Closed system
Open system

Question 12

what things can make a dysfunctional family? when one family member…

Answer 12

One family member often exhibits overt pathology
Identified as patient and considered by family as cause of family difficulties
One family member may act as an enabler

Question 13

what things can make a dysfunctional family? cohesion problems…

Answer 13

Cohesion problems: Overly thick boundaries, unhealthy triangulation, enmeshment, disengagement

Question 14

what things can make a dysfunctional family? roles and communication problems…

Answer 14

Role diffusion and confusion

Communication patterns and defense mechanisms are rigid

Question 15

4 steps of family-focused intervention

Answer 15

1. assessing the family
2. reframe attention to underlying family problems
3. empathic witnessing
4. referral

Question 16

1. assessing the family

Answer 16

Get a relatively complete understanding of the major conflicts or issues in the family.
Understand how the sick role, if present, is functioning as a coping strategy for the patient and the family.
Conduct the interview so that patients can bring out the full intensity of their feelings about the family problems.

Question 17

assessing the family: 5 things to ask about (screening)

Answer 17

family problems, medical problems, family dysfunction, lifecycle, patient-provider

Question 18

assessing the family: screening question: family problems

Answer 18

“how are things going with your family?”

Question 19

assessing the family: screening question: medical problems

Answer 19

“How is your family dealing with your medical problems?”

Question 20

assessing the family: screening question: family dysfunction

Answer 20

“I know you have been depressed lately; how has your family reacted to that?”

Question 21

assessing the family: screening question: lifecycle

Answer 21

“How are you handling the fact that your children are in high school?

Question 22

step 1: assessing the family: screening question: patient-provider

Answer 22

What does your family think about the treatment we’ve agreed upon?”

Question 23

what does a genogram-based interview (pedigree) include information about?

Answer 23

Demographic data
Dates of significant life events such as births, death, marriages, divorces, diagnosis of illness
Psychiatric, substance abuse, and medical histories
Key personality characteristics
Description of relationships
Roles
Family functioning

Question 24

genogram symbol for male/female, patient of interest, conflict, enmeshed family, triangular relationship, committed relationship, separated, divorced, biological relationship

Answer 24

male- square, female- circle
patient- extra square/circle around 
conflict- wavy lines
enmeshed- 3 parallel lines
triangular - triangle 
committed- single horizontal line 
separated- horizontal line with slash
divorced- double horizontal line with slash 
bio relationship- single vertical line

Question 25

step 2: reframe attention to underlying family problems

Answer 25

Focus the patient’s and family’s attention on the underlying family problems and away from the physical symptoms and sick role. Encourage the family to adopt healthy strategies for coping.

Question 26

step 3: empathic witnessing

Answer 26

Provide emotional support and empowerment to the patient | Enhance the therapeutic alliance

Question 27

step 4: referral

Answer 27

Not always needed Provide access to psychoeducation, relationship- strengthening programs for patients and their family members Address any resistance to family-focused intervention or to psychotherapy.

Question 28

advantages of family-focused perspective: Expands _______ of more aspects of the management process Incorporates more of the important players who ______ Harnesses the ___ and _____ of the family to optimize care Brings in the family as an _____ Addresses a broad array of ____ and _____that can affect outcomes over time Acknowledges family as ______ and responds to their ______

Answer 28

Expands clinical flexibility of more aspects of the management process Incorporates more of the important players who participate in disease management Harnesses the power and resources of the family to optimize care Brings in the family as an active participant Addresses a broad array of protective and risk factors that can affect outcomes over time Acknowledges family as caregivers and responds to their needs, stresses

Question 29

By 2020, __% of Americans will be over 65

Answer 29

20%

Question 30

Adult children can be ____, ____ or _____

Answer 30

overprotective, overinvolved, or in denial

Question 31

4 signs of successful aging

Answer 31

Acceptance of change Good relationships with family and friends Positive view of one’s life story Ability to find new sources of self-esteem

Question 32

factors that promote successful aging

Answer 32

``` Luck (avoiding injury, good genes) Good health behaviors Proper Diet Adequate Sleep Physical Activity Stress Management Strong relationships (friends and family) Financial security Spirituality Feeling valued by society Role in family/society; opportunity to be productive ```

Question 33

2 types of risk factors for unsuccessful aging

Answer 33

social and physical conditions

Question 34

risk for unsuccessful aging: 4 social conditions

Answer 34

Highly mobile, rapidly changing communities Youth-oriented aesthetics Deaths of family members and friends Forced retirement

Question 35

risk for unsuccessful aging: 4 physical conditions

Answer 35

``` - all about limiting function- Urinary incontinence Chronic pain Gait/mobility problems Hearing and vision loss ```

Question 36

signs of problems with aging

Answer 36

``` Declining hygiene Social withdrawal Poor nutrition Falls Alcohol abuse Chaotic finances Denial of health problems ```

Question 37

considerations for communicating with elderly patients: Ask early in interview if you are _______ Speak _______ Active ______skills are important Shorter more _____visits Xtra pair of _______ ______! They are on a different time schedule than you!

Answer 37

Ask early in interview if you are being heard and understood Speak distinctly, more volume IF necessary Active listening skills are important Shorter more frequent visits Xtra pair of reading glasses Patience! They are on a different time schedule than you! Take your time.

Question 38

family and caregiver interview: Can help provide complete _______ Can give insight to .... May need to occur .....

Answer 38

Can help provide complete view of problem Can give insight to memory/intellectual decline, depressive symptoms, paranoid thinking, limited ADLs May need to occur outside the exam room (with permission from pt) in a separate interview