Unit 4 Flashcards

Question

Part D of Medicare

Answer 1

Prescription-drug benefit plan that provides coverage for a portion of the enrollee’s costs

Answer 2

Legislation passed in 2003 that created the prescription drug benefit in Medicare. Has four phases of coverage over the course of the calendar year -Beginning of year, enrollee pays a deductible of up to $415. Pay a reduced amount for their prescriptions of 25%. -Part D will count the total value of the drugs (not what plan members pay) until a limit is reached of $3,820 for the actual drug costs -pay more for generic drugs (37% instead of 25%) -Once their drug costs total $5,100, out-of-pocket payments for enrollees become reduced to 5% of the drug’s costs

Answer 3

Coverage gap in Medicare Part D within each calendar year when patients pay a higher percentage of certain drugs until they reach a certain threshold

Answer 4

-Medicare is a pay-as-you-go system. Tax revenue must be able to fund benefits paid out to Medicare recipients. -Hospital Insurance Trust Fund (HI), which covers Part A -Supplemental Medical Insurance Trust Fund (SMI), which funds Parts B and D. -Part C of Medicare is paid for via premiums by the insured through their individual Medicare Advantage plans. -By 2026 the Medicare Trust Fund will be brought to, or close to, zero.

Answer 5

Legislation by President Barack Obama in 2010 intended to expand health care insurance to all Americans. -Fails, fines you if you don't have insurance

Answer 6

Federal and state matching entitlement program that provides medical assistance for certain individuals and families with low incomes and resources. -services for older adults cover inpatient and community health care costs not included in Medicare, such as skilled nursing facility care beyond the 100-day limit covered by Medicare, prescription drugs (without a premium), eyeglasses, and hearing aids.

Answer 7

Federal law mandating that facilities meet physical standards, provide adequate professional staffing and services, and maintain policies governing their administrative and medical procedures. -nursing homes must be licensed in accordance with state and local laws, following all regulations -Physical services & providers always available -Qualified administrator to regulate legal policies & proceedures -Patients must be admitted regardless of race, ect.

Answer 8

Developed by President Clinton intended to improve enforcement of nursing home quality standards -More frequent inspections, background checks, ect -Monetary penalties on homes that violate the resident's rights

Answer 9

Federal program combined info on individual nursing homes with resources available to improve the quality of care in their facilities. -Quality improvement organizations (QIOs) contracted to assist skilled nursing facilities and improve their services. -ombudspersons help families and residents on a daily basis find nursing homes that provide the highest possible quality of care needed

Answer 10

GAO issued a major report analyzing the effectiveness of the online reporting system based on data from 63 nursing homes in California, Michigan, Pennsylvania, and Texas institutions that had a history of serious compliance problems. -Efforts to fix the problem didn't go well

Answer 11

Where information about nursing homes and nursing home residents comes from -collects info on certified NHs from state surveys -Assess the status/process of NHs -Gives fines/deficiencies to failing NHs

Answer 12

An optimal level of adjustment institutionalized persons experience when their levels of competence match the demands, or “press,” of the institutional environment. -An environment low in press will be relatively low in stimulation.

Answer 13

NH offers O-As individual homes within a small community of 6 to 10 residents and skilled nursing staff. -open-plan layout of shared spaces, medical equipment stored away, rooms are sunny and bright, and outdoor environment accessible

Answer 14

Irreversible end of circulatory and respiratory functions, or when all brain structures have irreversibly ceased to function.

Answer 15

When the organism loses its vitality

Answer 16

-Being asleep most of the time, disorientation, irregular breathing, visual and auditory hallucinations, being less able to see, slow urine production, and mottled skin, cool hands and feet, overly warm trunk, and excessive secretions of bodily fluids -unable to walk or eat, recognize family members, suffer constant pain, and feel that breathing is difficult (BIG)

Answer 17

The temporal pattern of the disease process leading to a patient’s death -Sudden death- people in good health whose death was accidental -Terminal Illness- people who have advance warning terminal illness such as cancer -Organ Failure- death due to organ failure as in COPD and chronic heart failure -Frailality- Declines in functioning among frail individuals & those w limited physical reserves.

Answer 18

End of life when individual loses appetite (anorexia) and muscle mass (cachexia). -Common in those w AIDS and/or neurocognitive disorder

Answer 19

Physical: -Nausea, difficulty swallowing, bowel problems, dry mouth, and edema, or the accumulation of liquid in the abdomen and extremities that leads to bloating Psych: -Anxiety, depression, confusion, and memory loss

Answer 20

of deaths / by population alive during a certain time period

Answer 21

crude death rate for a specific age group -# of deaths within a particular age group / by # of people in that age group in the population

Answer 22

Mortality rate statistically modified to eliminate the effect of different age distributions in the different populations

Answer 23

longer life expectancy of people of Hispanic (or Latino) ethnicity despite living in harsher conditions within the United States -less likely to smoke and may have more robust social support networks

Answer 24

-education, marital status, SES, and geography -Political, economic, and social climates -exposure to air pollution -sex, age, race/ethnicity, social class, and region, the presence of fine particulate matter in the local area -Exercise, injuries (hip fracture), better health habits (good diet, no smoking, morning chronotype, ect)

Answer 25

The prevailing philosophy of death of a culture

Answer 26

prevailing view until the Middle Ages in which death was viewed as familiar and simple, a transition to eternal life

Answer 27

death and dying became glorified, and it was considered noble to die for a cause

Answer 28

Western attitude of a desire for death to retreat from the family and to be confined to hospitals

Answer 29

Dying become treated as nonpersons by family/health care workers as they spend their final months or years in a hospital or NH

Answer 30

Universally among terminally ill patients including denial, anger, bargaining, depression, and acceptance -ignores other emotions such as curiosity, hope, relief, and apathy. -the dying person must be allowed to talk openly with family members and health care workers

Answer 31

Death should not involve extreme physical dependency or the loss of control of bodily functions.

Answer 32

Patients have autonomy in making decisions about the type, site, and duration of the care that they receive at the end of life

Answer 33

steps to leave a legacy that will continue to define oneself after one is gone

Answer 34

Thoughts about mortality when individuals pass the age when other people close to them had themselves died

Answer 35

when thoughts of death are activated, either consciously or unconsciously, we get wide range of beneficial effects -adopt better health habits, more focus on intrinsic rather than extrinsic goals, more compassionate, and more motivated to have close interpersonal relationships. -more creative, less likely to hold stereotypes, and feel greater attachment to their community -can come at a price

Answer 36

1990, guarantees the right of all competent adults to have an active role in decisions about their care

Answer 37

legally binding document in which patients express their wishes for end-of-life care -Living will -Durable power of attorney for health care (DPAHC) -ensuring patients play an active role in deciding on their treatment but they also facilitate communication among patients, health care staff and families, protect an individual’s resources, alleviate anxiety, and reduce the chances of the patient’s being maltreated

Answer 38

an advance directive that stipulates the conditions under which a patient will accept or refuse treatment -Document directing wishes when life-threatening situation & unable to make decision -NO flexibility -Access is hard to get

Answer 39

AKA health care proxy, is appointed to make decisions to act on a person’s behalf should that person become incapacitated -33% disagreement

Answer 40

directs health care workers not to use resuscitation if the patient experiences cardiac or pulmonary arrest

Answer 41

When patients do not have their DNRs respected but instead receive active life support that includes resuscitation

Answer 42

Advance directive that contains orders for a physician’s assistant or nurse practitioner

Answer 43

An advance directive that contains orders for the physician

Answer 44

Terminally ill individuals decides, while they are still able to, they want their lives to end before dying becomes a protracted process -physicians can prescribe medications to hasten death without being subject to prosecution. The individuals must have a terminal illness and a prognosis of 6 months or less to live

Answer 45

Medical and supportive services for dying patients -needs for physical comfort and psychological and social support and given the opportunity to express and have their spiritual needs met -controlling pain and other symptoms

Answer 46

the best end-of-life care is adapted to the nature of the patient’s needs, rhythms, and situations as these vary over the dying trajectory -Discussion w patient, provide comfort and respect the patient’s end-of-life wishes, assurance of dignity, and attention to the individual’s goals. -Minimizing burden to family and assisting bereaved through stages of mourning and adjustment. -Addresses organ procurement and transplantation, which are intended to protect the interests of living and deceased donor

Answer 47

people cope with the death of another person -anger, depression, anxiety, feelings of emptiness, and preoccupation with thoughts of the deceased -impaired attention and memory, a desire to withdraw from social activities, and increased risk of accidents

Answer 48

Bereaved can continue to benefit from maintaining emotional bonds to the deceased. the deceased person becomes a part of the survivor’s identity

Answer 49

Practical adaptations to loss are as important to the bereaved person’s adjustment as the emotional -Taking on new tasks or functions, called the “restoration-oriented”. The “loss-oriented” involves -coping with the direct emotional consequences of the death. -may allow individuals to remain optimistic and feel a greater sense of personal control.

Answer 50

Survey of a large sample of British adults focusing on the relationships among health, social class, and occupation -to investigate specifically social and occupational influences on health and illness including psychological work load, control over work pacing and content, opportunity for using one’s skills, and social support at work

Answer 51

controlling pain and other symptoms, and it is likely to take place within the home, beginning when the patient no longer wishes to receive active disease treatment. -As illness worsens, more palliative care -Hospice

Answer 52

the absence of disease, high cognitive and physical function, and engagement with life -Is incomplete/flawed, excludes the many variations that exist among successful agers who do not meet every single criterion -Those from disadvantaged backgrounds may not be able to achieve all three conditions due to stressful early lives or lack of access to health care and other resources in later life -Doesn't account that individuals think they have aged successfully

Answer 53

According to the WHO, maximizing opportunities related to health, participation, and safety in order to improve quality of life. -Economics -Health & social services -Behavior -Personal -Physical environment -Social role of autonomy and independence, placing greater emphasis on the individual’s ability to get around in the environment, rather than on whether the individual needs physical accommodations due to disability

Answer 54

Cognitive performance that is above the average for an individual’s age group as objectively measured -High cortical thickness -Great brain plasticity -High white matter density -Faster encoding -“Super-aging” phenotype -Improved network connectivity engage individuals, families, and policy makers in discussions of the factors that promote health, rather than those that focus solely on diagnosis and treatment of neurocognitive disorders

Answer 55

Those 80 years and older with episodic memory that is comparable to, or superior than, that of middle-aged adults -cortical thickness, greater brain plasticity, an activated inflammatory response that protects the brain’s white matter, improved connectivity in the default mode and information filtering networks in the brain, faster electrophysiological encoding, and a “super-aging” phenotype

Answer 56

View intended to provide a greater understanding of the strengths and virtues that enable individuals and communities to thrive.

Answer 57

Overall assessment of an individual’s feelings and attitudes about one’s life at a particular point in time

Answer 58

An individual’s overall sense of happiness

Answer 59

O-As maintain high subjective well-being despite facing challenges from their objective circumstances. -Subjective well-being (happiness) ↔ Life-satisfaction -Contradicts the belief that well-being is determined by social indicators, or objective measures of social and economic welfare.

Answer 60

Demographic and social structural variables account for individual differences in levels of well-being

Answer 61

People’s personalities influence their level of well-being throughout life

Answer 62

People of all ages participate in their communities, treat everyone with respect, regardless of age, makes it easy for older people to maintain their social connections, and helps people maintain their health and activity even at the oldest ages.

Answer 63

How O-As communicate about aging influences their feelings about aging and their ability to age successfully.

Answer 64

The ability to generate products or ideas that are original, appropriate, and have an impact on other -the idea or products are novel rather than being copies, precise renderings from a set of instructions, or mass-produced

Answer 65

“Big C”- eminent, famous “Little C”- everyday “Mini-C”- Constructing personal, or self, understanding

Answer 66

the tendency of peak scientific productivity to occur in early adulthood

Answer 67

of works a person could hypothetically produce in a life span with no upper limits. -Someone w low creative potential may continue to bake the very same cake, year in and year out, without variation

Answer 68

The age when individual begins to embark on their career. -Those w high degrees of creative potential (or total number of ideas) who start out early in life will peak earlier than those who start out later. -Age at death not factored, the model still suffers from not counting the works of people who might have been productive into later adulthood

Answer 69

Creative individuals who produce more works are more likely to produce one or more of high quality than are those who produce fewer works. -people are most likely to produce their best work during their peak period of productivity on the basis of probability alone

Answer 70

True creativity requires producing a large number of ideas in trial-and-error fashion, the best (most creative) of which will remain in the wake of all the failed ones. -Contemporary older adults have an even better chance of remaining productive throughout their later years than those living in previous centuries

Answer 71

A special quality common to O-A artists and writers. -The themes that emerge in the works of late-life artists are more likely to express tragic rather than uplifting themes, and they may stem from feelings of social isolation and the need to deal with physical limitation

Answer 72

Last burst of creativity of an older musician

Answer 73

Quality of an older artist’s work that allows it to persist over time

Answer 74

Bio- Activation of relevant brain areas & physical changes and diseases Psycho- Personality flexibility & ability to work from past experiences Social- Educational background & Definitions of eminence that exclude minorities (women, not-white races, poor, ect)

Answer 75

a comprehensive public response is needed if older individuals around the globe are able to achieve active aging

Answer 76

Connections between the brain’s default brain network and the executive functions carried out in the prefrontal cortex -pathways involved in the default network may be involved in successful cognitive aging

Answer 77

Claude Monet, famous for his impressionistic paintings of water lilies, developed cataracts at a time when cataract surgery was far less common and more complicated than today. However, at the age of 85, he had successful cataract surgery and went on to complete an enormous water lilies project that was installed in a Paris museum after his death.

Answer 78

INC depression, demoralization, grief, despair, hopelessness, & physical illness. -Issues w family (time, $, resources)

Answer 79

Guilt & Overdependence

Answer 80

Denial, Irritability, Anger, Lack of Concentration, Social withdrawal, Health Problems, Anxiety, Depression Note similarity to stress model, Exhaustion, Sleeplessness

Answer 81

-Physical – using Conflict Tactics Scale – at least one act of violence since 65 -Psychological – repeated threats & insults (chronic verbal aggression) 10/yr -Neglect – deprivation of assistance needed for important activities of daily living (meals, housework, personal care, etc.)

Answer 82

Spouses: 3/5 Adult child: 2/5 When being cared for by a spouse or child, poor health is more likely to be abused. -Abuse is more likely to happen when staff is less educated, less well paid, less supervised

Answer 83

Equal #s of M & F report, M more at risk for abuse -Less likely to report, feels seen as weak -Even more unwilling if abuser is a F or police is F

Answer 84

-Abuser was or believes they were abused by patient -Personality disorder -Substance abuse -Stress response

Answer 85

*Intergenerational counseling * Caregiver support groups * Respite care * Caregiver networks * Available services (e.g., Meals on Wheels; home health care aide, etc)

Answer 86

Lack of respiration and cardiac functioning

Answer 87

-Lack of EEG in cerebral lobes and brainstem 10 min –Rule out conditions imitating death - hypothermia –Re-evaluate 24 hours later

Answer 88

(Karen Ann Quinlan) – Only evaluate cerebral lobe function - brainstem function irrelevant

Answer 89

-Lack of personhood (not functioning as integrated, “whole” person) -Usually occurs after physiological death, but can occur before as in Alzheimer’s and deep coma

Answer 90

-Relinquishing of relationship as in wake/funeral -Also may occur before death

Answer 91

"Mercy killing" You don't decide to be euthanized -Passive is more accepted -Y-A more accepting of active, O-A are more religious, less educated, & think it will hasten death

Answer 92

Active: -Deliberate life ending (injection, shooting, ect) Passive: -Treatment restraint (no life support, no life surgery, ect)

Answer 93

Passive: -Cognitive status -Burden -Age/survival potential -Treatment cost -Amount of pain Active: -Life quality -Likelihood of recovery -Public outcry -Possible legal action