Week 10 Flashcards
1
Q
T/F: When defining elder abuse, we are most concerned with physical abuse
A
False! Not always physical abuse. Can be financial, abandonment, isolation, mental suffering, etc.
2
Q
What has caused OA abuse to become more prominent recently?
A
Elder abuse has become more of an issue since OA started living longer
3
Q
What was elder abuse called before Adult Protective Services Developed
A
Before 1960’s and 1970’s, “elder abuse” was called “Granny Bagging”
4
Q
Why might reporting elder abuse or mistreatment be problematic
A
- Losing trust of family member
- Elder may be taken away if reported abuse–don’t know where they’ll be going
- May not be able to prove abuse, especially of OA can’t verbalize that abuse is occuring
- May lose trust of pt –they may fear loss of daughter/caregiver
5
Q
Where are OTs most likely to encounter elder abuse? A. Adult day care center B. Nursing home C. Home setting D. Hospital
A
C. Home setting
- Only 5% occurs in nursing homes–services and regulations in place to prevent abuse
- At home, no one is watching to witness if abuse is occuring
6
Q
What is meant by an example of elder abuse?
A
Examples of elder abuse are the highest level of abuse–actually see abuse occuring
7
Q
What is meant by a sign of elder abuse?
A
Signs of elder abuse: consequences of abuse
-both physical and psychosocial
8
Q
What are the most obvious signs of elder abuse?
A
Physical e.g., bruises, cuts, scrapes, dirty clothes, hygiene , not appropriately dressed for weather
9
Q
What are some signs of elder abuse?
A
- Anxiety, Depression: Careful though, may be due to something else!
- Malnutrition
- Physical: cuts, scrapes, dirty, same clothes, not appropriately dressed for weather hygiene, bruises (careful though–OA bruise easily, even meds can cause bruising)
10
Q
Why is it important not to make assumptions about elder abuse?
A
- Signs may be due to other factors other than elder abuse
- OA bruise easily–even meds can cause
- Anxiety and Depression may be due to something else
11
Q
What is meant by risk factors for elder abuse?
A
Risk factors: indicators of possible abuse occurring
-May be scenario that can lead to abuse e.g., shift in family dynamic, new family member coming in
12
Q
Possible risk factors for elder abuse:
A
- Shift in family dynamic, roles e.g., new family member coming in
- Increase in health conditions–getting sicker
- Cognitive decline
- Caregiver burnout
- Caregiver alcoholism
13
Q
Is caregiver burnout a sign or risk factor of elder abuse?
A
Caregiver burnout is a risk factor of elder abuse! Signs are consequences of elder abuse, whereas risk factors are indicators of possible abuse occurring
14
Q
T/F: There is a universally accepted tool to screen for elder abuse, making it generally easy to recognize
A
False! There is no universally accepted screening tool. Measuring elder abuse is very difficult.
- There are checklists/tools, but these can be controversial (no universally accepted way to have caregiver fill out)
- Tools generally used more to collect info–can write down on perspectives to organize thoughts
- Not as reliable as would hope
15
Q
The following are all what kind of signs of abuse?
- Pressure sores
- Bruising
- Low weight
- Burns/restraint marks
- Broken bones
- Hygiene
- Poor nail care
- Dehydration
- Over/under medicated
- Decreased functional capacity (risk)
A
Physical signs.
16
Q
How could poor nail care be a sign of elder abuse?
A
Can be indication of poor hygiene, neglect
Self neglect: individual chooses not to care for self. May be due to mental condition. We can help figure out why this is happening
17
Q
The following are all what kind of signs/risks of abuse?
- Confusion
- Anxious
- Fearful/suspicious
- Depressed
- Sudden behavior changes
- Bills are confusing (risk)
A
Mental Status Signs and Risks
18
Q
What are some environmental signs/risk factors of elder abuse?
A
- Filth
- Lives alone
- Clutter
- Close quarters
19
Q
What are some relationship signs and risks for elder abuse?
A
- Inconsistent stories
- Caregiver speaks for pt
- Delay in seeking care
- Problem behaviors: being aggressive, demanding, complaining
- Caregiver status untreated mental health issues, abuse of alcohol, frustration, resentment, expressing burden/burnout (risk)
- Won’t let OT talk to pt alone
- Previous reports of abuse (risk)
- Pt body language (e.g., no eye contact)
20
Q
What are some signs and risks in caregiver for elder abuse?
A
- Caregiver speaks for pt
- Problem behaviors: being aggressive, demanding, complaining
- Caregiver status: untreated mental health issues, abuse of alcohol, frustration, resentment, expressing burde/burnout (risk)
- Won’t let OT talk to pt alone
- Previous reports of abuse (risk)
21
Q
What are some signs/risks of elder abuse regarding social support?
A
- Screened telephone calls
- Isolation
- Reported money disappearing
- Changing MDs frequently
- Previous person handling finances left (risk)
- Isn’t allowed to attend religious services
- Intercepted mail
- Pt told he/she is sick and must stay in bed
22
Q
The goal of this program is to investigate and attempt to resolve complaints made by or on behalf of individual residents in long-term care facilities
A
The goal of the Long-Term Care Ombudsman Program is to investigate and attempt to resolve complaints made by or on behalf of individual residents in long-term care facilities. These facilities include nursing homes; residential care facilities for the elderly (also known as assisted living or board and care facilities). Can help to identify elder abuse occurring, but overall problems with services remain
23
Q
What are the four goals to address elder abuse in older adults?
A
- Address Medical Problems (communicate with professional team)
- Secure safety
- Restore sense of control; victim empowerment
- Identify and eliminate the cause
24
Q
How can we restore a sense of control and empower victims of elder abuse?
A
- Provide resources
- Ask caregiver to leave room so give control back to older adult, then ask direct questions e.g., is abuse going on
- Let them know this is common and they are not alone
25
How can we address elder abuse concerns with caregivers ?
Ask caregivers questions without putting them on the spot and blaming them e.g., some people find it hard to care for adults with dementia. Is it hard for you?
26
Who do most elder abuse programs target?
Most elder abuse programs target the victim, but not the abuser
27
How can we help abusers of elder abuse?
- Provide an area where they can open up
| - Offer resources
28
T/F: While it is encouraged, you are not required to report elder abuse
False! We are responsible for reporting and turning in the report. We can talk with the supervisor for help, but we are responsible for filling out a form and submitting
29
How can we support support caregivers of OA?
- Attend to shifting roles and family dynamics e.g., daughter changing catheter
- Educate about effects of disease/disorders (interdependence vs independence--some reluctance to get help)
- Provide resources e.g., are they capable of getting respite services?
30
What is interdependence vs. independence regarding caregiving?
- Interdependence: relying on each other for needs
- Independence: Able to meet needs on own
- Some may be reluctant to get support
31
How can an OT use time strategically when working with OA at the end of their life?
Take one meaningful task and draw it out to help them fill their day
32
T/F: When working with OA who are nearing the end of their life, you should most of all focus on balance and strength
False! When working with OAs who are nearing the end of their lives, you should focus on occupation! Use adaptations to make the task easier
33
Management strategies for OAs nearing the end of their life include which of the following:
A. Focus on occupation
B. Define a "new normal"
C. Find "just right" challenge
D. Safety
E. Engage in productive activity
F. Distract away from difficult topics or situations
G. "Error-Prof" the environment
H. Use time strategically
I. Maintain relationships with family/friends
All of these!
34
What does Error-proofing mean? How does it work for OAs?
Any method that makes it difficult/impossible for an error to occur. It changing a person's expectations of what is correct. Example=automatic breaking in car
35
When discussing compensatory strategies for OA nearing the end of their life with pts and families, how should we approach them?
- Use respect, care, and non-controlling conversational strategies
- Respect the loved ones and patient as the expert!
- They know what works best and what doesn't work well
- Ask the caregiver, family, and pt if possible--each has a different perspective on what works and what doesn't
36
Adapting the task, physical environment, or social environment are...
Compensatory activities! Can help OA who are nearing the end of their lives
37
T/F: "Problem behaviors" in OA are maladaptive behaviors and should be corrected
False! "problem behaviors" are just a cue for us to intervene
38
How can we help family/caregivers find the right compensatory strategies for the OA?
- Try different strategies until something works!
| - work something into the family's routine that they already do
39
What can help us as OTs to accept death when working with OA who are at the end of their lives?
- Exposure to losses across life contributes to awareness that it is a natural part of long life
- Recognize that end of life is natural part of life that everyone goes through
40
What are some common behaviors of nearing death?
- Renewed Interest in spirituality/religion
- Searching for meaning of life
- Start reevaluating relationships with loved ones, family
41
Generally, fear of death increases as one gets closer to the end of his/her life
False. Generally, fear of death decreases with age. BUT, fear of the dying process remains consistent--fear of losing control. May have greater fear of death if terminally ill, institutionalized, weak religious beliefs, psychological illness
42
If an OA is institutionalized, he/she may have a greater fear of...
DEATH
43
T/F: If an OA has strong religious beliefs, he/she may have a greater fear of death
FALSE. Weak religious beliefs are generally associated with greater fear of death
44
T/F: If an OA is terminally ill or psychologically ill, he/she may have a greater fear of death
True. Being terminally ill or psychologically ill is associated with greater fear of death
45
Def: Active total care for those with illnesses which can't be cured (life threatening illness)
Palliative care. Must be serious condition (COPD, dementia, chronic)
46
Def: care philosophy aims to minimize pain and control symptoms once cure is not an option or desired (terminal illness)
Hospice care
47
Setting for Palliative care
Typically in hospital, extended care facility, or nursing home
48
Setting for hospice care
Typically at home but special facilities and care at nursing home available
49
Timing restrictions for palliative care
No time restrictions--can be at any stage of the life threatening illness. Can still seek cure for disease or rehab.
50
Timing restrictions for hospice care
Considered to be terminal and within 6 months of death. Just about improving symptoms and QOL, maybe pain control
51
Payment for Palliative care
Typically covered by regular insurance
52
Payment for hospice
Funding is an issue. Varies; some covered by Medicare; some private insurances. Lots of out of pocket expenses
53
T/F: funding is generally an issue in palliative care.
False. Most regular insurance covers palliative care. Funding is generally an issue with hospice care.
54
Palliative care philosophy vs. Hospice care philosophy
Palliative: Life threatening disease, but can can do rehab and may still be seeking cure. Active total care for illnesses that can't be cured. At any stage of illness.
Hospice: Terminally ill--cure is not an option. Terminal with 6 months to live. Just about improving symptoms and QOL, maybe pain control
55
Care philosophy aims to minimize pain and control symptoms once cure is not an option or desired (terminal illness)
Hospice care
56
Why may an OA nearing the end of life feel devalued?
May not be able to participate in productive society (In US we value productivity)
57
Why is it important to consider Loss and grief when dealing with OA nearing the end of life?
They may be experiencing losses of loved ones--need chance to grieve
58
What is the "double stigma" when dealing with OA nearing the end of life?
- Not only dealing with the stigma of an older adult, but also of a terminal illness
- this stigma can lead to a limitation in resources--why put money into them if we know they're going to die?
59
T/F: OTs have a difficult time receiving funding when offering care for terminally ill OA?
False. For OT, even if person not gaining function, can still be reimbursed (unlike IRF or SNF)
60
What kind of deficiencies in care may terminally ill OA receive?
- Often not part of decision making process
| - May be insufficient pain management ("on death bed anyway")
61
OTs role in working with terminally ill?
- Social support
- Not usually rehab (in palliative can work towards, but not in hospice )
- Advocacy for pt
- Help prepare for death
- Loss of independence and role can result in social death prior to biological death. OT can help person to adopt now and approach fxns and roles and maintain self esteem
62
What should end of life assessments look like for OA?
- Assessments can't feel like tests!
- May be very informal
- May need to break up into small chunks--may have limited endurance e.g., part in morning, part in evening
63
What should end of life assessments assess?
- Patient's priorities!
| - Usually want to do normal basic things to maintain own dignity (bucket lists not common)
64
End of life assessments usually find that OA's often want to complete a bucket list
False! End of life assessments usually find that OAs want to do normal basic things to maintain their own dignity (bucket lists not common)
65
Who else besides the pt can we assess to find information about an OA's end of life priorities?
- We can assess the family to gain info
| - Interprofessional team
66
How can we assess the environment to help OAs at the end of their lives?
- Asses for safety!
- Access to bathroom?
- Can they do basic self care activities?
- Assess for comfort and dignity of pt
67
a written statement of a person's wishes regarding medical treatment, often including a living will, made to ensure those wishes are carried out should the person be unable to communicate them to a doctor.
Advanced Directive. Includes:
- Written will
- Durable power of attorney
- Do not resuscitate
- Organ donation card
68
A legal document that enables your elderly parent to appoint an "agent," such as a trusted relative or friend, to handle specific health, legal and financial responsibilities.
Durable power of attorney
69
medical order written by a doctor that instructs health care providers not to do cardiopulmonary resuscitation (CPR) if a patient's breathing stops or if the patient's heart stops beating
Do Not Resuscitate (DNR)
70
T/F: If an OA has a organ donation card, his body will automatically be donated to science
False. This is not part of donating to science. Must connect with universities and make call on day of death
71
How does one write an advance directive (AD) and what should you do once it's done?
- Can be brief sentences-statements to tell wishes
| - Make copies and distribute to family members
72
What interventions can we do as OTs when working with an OA planning for the end of life?
- Discuss client's priorities
- Collaborate with team and client to set goals
- Deal with life and death at the same time
73
```
When collaborating with the team and client about end of life, you may set goals relating to all except the following:
A. Planning for death
B. Contacting family
C. Emotions of grief and loss
D. Maintaining autonomy
E. Engagement in meaningful activity, roles, and relationships
F. Functional independence as appropriate
G. Building strength, ROM, and endurance
H. Symptom control
I. QOL
J. Living life to its fullest
K.Communication
L. Collaboration
M. Spiritual support
N. Meaning making
```
All except G, usually: building strength, ROM and endurance. May help establish legacy and must be comfortable relating to religion and spirituality
74
T/F: When doing OT for end of life, the main goal is to maximize functional indepdence
False! You want to maximize functional independence as appropriate, BUT you are not "rehabilitating". Instead you are finding the appropriate level of maximizing functional independence.
75
Traditional OT vs. OT at the end of life:
Traditional OT:
-Little attn to progressive nature of disease, permanent loss of fxn and mobility, and preparing for death
-Maximizing fxnal independence
-Help clients return to activities, roles, relationships
OT end of life:
-Not "rehabilitating"
-Address dual states of living and dying
-Sense of being is reinforced through engagement in activities
-Engage clients in occupations that help affirm life and prepare for death
-Must be meaning in everything you do with pt
76
Occupations in traditional OT vs. OT at end of life
Traditional OT: help clients return to activities
OT end of life: sense of being reinforced through engagement of activity
-engage pt in occupations that help affirm life and prepare for death
-Find sense of closure through occupation
77
Outcomes for tx for OT end of life:
- Live normally
- Achieve sense of control
- Manage care through illness (caregivers included)
- Find sense of closure through occupation
78
When working with someone on end of life priorities, how often should you reassess goals?
Daily!
79
What questions can you ask to see if goal outcomes were met for OT nearing end of life?
- meaningful experience at end of life?
- help feel sense of control before died?
- able to help with priorities of life?
- set any goals related to priorities?
- did you reassess goals daily?
- was the process of goals successful?
80
Questionnaire's such as the end of life occupation questionnaire is an effective way to receive information regarding pt's level of content with their lives
False! Don't have a very good way to measure this--questionnaire's are awkward and uncomfortable. We can give them to family members at the end of life, but they may not want to do it. Up to us whether or not to use.
81
How can we combat compassion fatigue when working with OAs at end of lives?
- Utilize support groups
- Find an outlet
- Educate yourself
- Communicate with team
- Find closure
82
Why is self-reflection important when working with OAs at end of lives?
- Must recognize own limitations and find what you are and are not comfortable with
- What you need to do to protect yourself from compassion fatigue or caregiver burnout e.g., engage in own rituals to deal with grief, support group
- Learn from your experiences - have to draw line between work space and home life (may need to attend support group, attend pt's funeral etc to deal with separation)
83
Javier is a 54-year-old male who has been admitted to the VA due to a serious exacerbation of symptoms related to liver and kidney failure. He has been referred to OT. You review his chart and find that two months ago, the physician diagnosed Javier as having end-stage liver and kidney failure, and the prognosis states “poor.” Based on the latest physician assessment at this last admission, the physician updated the life expectancy to two weeks. Besides the liver and kidney failure, Javier has a history of hepatitis C and substance abuse. What assessments would you perform?
- Ask what's meaningful--priorities?
- Maybe wouldn't do formal assessments
- Assess safety
- Ask about self-care
- Ask about plans for end of life--2 weeks to live
OT DID:
- MoCa
- Found max assist for dressing and self-care
- Found Hx of falls and has fallen once
- Social work: reach out to daughter
84
Javier is a 54-year-old male who has been admitted to the VA due to a serious exacerbation of symptoms related to liver and kidney failure. He has been referred to OT. You review his chart and find that two months ago, the physician diagnosed Javier as having end-stage liver and kidney failure, and the prognosis states “poor.” Based on the latest physician assessment at this last admission, the physician updated the life expectancy to two weeks. Besides the liver and kidney failure, Javier has a history of hepatitis C and substance abuse. What interventions would you do?
-Help write advanced directive (usually social work does this)
-Plan for death
-Est. DNR (do not resuscitate)
OT collaborated with Javier to address:
-Engagement in meaningful self-care (e.g., shaving, washing face, brushing teeth)
-Writing farewell letter to loved ones
-Collab with daughter to include her in father's care: safety concerns, burden of care, games and activities with Javier
