WGU study guide for care of the older adult OA (Answered Correctly), Updated 2022

WGU study guide for care of the older adult OA (Answered Correctly), Updated 2022 Baby Boomers large group of people born between . Considered more affluent, better educated and healthier. Baby boomers have entered the older age group as of 2011 Baby Boomers unique characteristics that make them a challenge for healthcare professionals They expect and demand excellence in geriatric care. Health disparities exist among minority elder group. Other vulnerable older adults are veterans, those with disabilities, and prisoners. Top five racial groups in United States European Americans, African Americans, Hispanic Americans, Asian Americans, and Native Americans European Americans individualistic, stoic (don't want to be a burden to others), elder Europeans lose their sense of self worth. Trust authority (will tend to follow health care advice) European Americans - top five health disparities smoking by pregnant women, drug induced deaths, deaths from poisoning, deaths from melanoma, and deaths from COPD before age 45. African Americans second larges minority populations. Role of religion and spirituality plays important role in health and wellness. Equate good luck, good fortune, and good health with being right with God. Disease and illness can be thought of as being in disfavor with God. Believe they have less control over their health and well being than God. Illness/disease is part of God's plan. Closer ties with extended families and rely on their close family ties for support. Distrustful of health care personnel because of discrimination in medical care and because most authority figures in health care are not African Americans. African Americans - top five health disparities new cases of gonorrhea, congenital syphilis, new cases of AIDS, and deaths due to HIV infection. The impact of racism has long been considered one of the factors that contribute to decreased longevity and increases of chronic illnesses Hispanic Americans high values on family, religion, and community. Emphasize family interdependence over independence. They turn to family first before seeking outside health care. Seek the use of homeopathic remedies in conjunction with religious artifacts before engaging the health care professional. They disagree with is silence and noncompliance. May not seek health care because they feel that their illness/disease is a punishment of sins. Many do not seek health care because they do not have access to it (lack of insurance, communication difficulties, or fear of ramifications due to being in country illegally. Religion varies. Strive to achieve balance between "hot" or "cold" within the body. Illnesses are categorized as either hot or cold, and treated with reciprocal type of substance, found in either food or medicine. Diabetes and heart disease are two health problems that have increased within this cultural group Hispanic Americans - top 5 health disparities congenital syphilis, new case of TB, new cases of AIDS, exposure to particulate matter, and cirrhosis deaths Asian Americans most still practice holistic (naturalistic) medicine and may incorporate this as an adjunct to Western medicine. Use herbal supplements Majority of influence comes from Confucianism (stresses accommodation and avoids confrontation). Follows a naturalistic perspective, defining health and illness as a balance between the individual and the world around the individual. (Strives to be in harmony with the universe in which he or she lives) Basic concept of Chinese medicine is that all things, including the body, are composed of opposing forces called yin and yang. (Health is said to depend on balance of these forces). Chinese medicine focuses on maintaining the yin-yang balance to maintain health and prevent illness. If the balance of yin and yang is broken, it is essential to restore the balance. To regain balance, the belief is that the balance between the internal body organs and the external elements of earth, fire, water, wood, and metal must be adjusted. Treatments may involve - acupuncture, moxibustion (burning of herbal leaves on or near the body), cupping (the use of warmed glass jars to create suction on certain parts of the body), massage, herbal remedies, movement and concentration exercises (tai chi) Some elders may forgo life sustaining treatment because of the principles of ren. Ren is the golden rule of Chines decision making "Do not do to others what you do not want done to yourself". Asian Americans - top 5 disparities new cases of TB, congenital syphilis, no pap test among females 18, exposure to particulate matter, and carbon monoxide exposure Native Americans Insulated from the rest of the country, either literally (by way of land reservation) or in other ways such as linguistically. Follow naturalistic approach, believing that health is a balance of the mind, body, and spirit, and illness occurs when there is an imbalance or disharmony with nature. Health beliefs are blended with religion, carrying a magic facet as well as holistic and naturalistic approaches Native Americans - top 5 health disparities fetal alcohol syndrome, smoking by pregnant women, alcohol related motor vehicle deaths, cirrhosis deaths, and new cases of gonorrhea Age related changes which may affect therapeutic communication Visual acuity Hearing loss Speech and language difficulties ways to communicate or assist patient with disabilities such as hearing deficits, vision impairments, or aphasia and dysarthria. Hearing deficits - Do not shout. Project voice from diaphragm (deepens voice). Make use of other unimpaired senses. (examples - 1)use touch or by using a visual cue and wait for patient to visually orient to you before speaking, 2)stand in front of person in a well lit room (helps the patient lip read), 3) speak to side that has better hearing, 4) make sure hearing aid is in and turned on, 5) use gestures or objects for communication. Limit background noise. Allow adequate time for response. Use short sentences and speak clearly May need to write or use a pictogram grid Vision impairments - Position yourself within their vision field. Give verbal indication of the actions you are about to do (avoid startling or scaring them). Label objects or simplify what is in their visual field. Aphasia/Dysarthria (speech impairments) - May be more anxious or self aware. Limit distractions Face patient and maintain eye contact May need to use multiple forms of communication (body language, written or pictorial information) Use short uncomplicated sentences with simple choices. Summarize message for accuracy. Take time and do not correct every error and respect the elder's limitations. Be patient!! Communication with a delirious elder Keep discussions simple and questions concise. Use large print calendars and clocks to assist with orientation. Pictures of family may assist in reorienting. Well lit room. Offer frequent reassurance. Avoid physical restraints Use distraction and soothing conversation. Communication with dementia Make sure the person is attending to you prior to beginning the conversation. Face the person Speak slowly and clearly. Eye level Reduce or limit background noise. Break tasks into small manageable steps and provide simple and clear directions ( one step at a time may be needed ) Praise efforts. Use concrete terms and familiar words. Offer simple choices. Allow adequate time to respond. Do not argue or attempt to reason with someone regarding delusions or hallucinations. Encourage discussion of life events, traditions, memories. Use large print calendards Label items Establish a familiar environment Hearing aids are one of the most common and economical devices used by a person with hearing deficits. Consider the types that would best suit the older adult BTE (Behind the ear) - worn behind the outer ear. Has an adjustable volume and is battery powered. IT IS THE MOST COMMON. Suitable for the entire range of hearing loss. OTE (over the ear) - very small and sits on top of the outer ear. ITE (in the ear) - custom fitted, adjustable volume and battery powered. Much smaller and some may have difficulty using. Used for mild to moderate hearing loss. ITC (in the canal) - tiny that fit in the ear canal and barely visible. Customized fit. May be too small for some to use. CIC (completely in canal) - smallest type. Difficulty handling and positioning the device. Most expensive. Some patients have several deficits that affect communication abilities. Consider patients who are post CVA, TBI, or paralysis and what technology could be utilized to assist them with effective communication Broca's aphasia is a nonfluent, agrammatic expressive aphasia. They have good auditory comprehension and are able to understand but have difficulty producing intelligible speech. Communication - patience!!! Wernicke's aphasia is a fluent aphasia. They are able to speak, although the speech may contain odd words/sounds. They have impaired auditory comprehension and has great difficulty understanding what is said. Rely on nonverbal gestures. NEED SPEECH THERAPY Dysarthria - may be difficult to understand when they are speaking. Patience !!! May use assistive technology to augment or replace vocal communication. Encourage to speak slowly and use simple sentences or single words. Allow time for patient to respond. If there is no speech - assess the patient's yes/no reliability; use a picture board or eye blink. May use writing, typing or communication board. Deaf - use qualified sign language interpreters Paralysis - depending on the type, but communication is difficult. ALS(as it progresses) or a pontine stroke - they can not produce speech or use their hands to express. They are aware of the environment but with no motor function below the level of the eyes, it is difficult to effectively communicate to others. Use of electronic form of communication, either by blink of eye or use of reflector dot (worn on forehead) and they can move the mouse around to type words. Tobacco use is a common habit among older adults. In addition, there is also a prevalence of alcohol use and abuse. Be aware of the recommended approaches for tobacco cessation and alcoholism identification and prevention Willing to quit smoking- use the "5 A's" ask if they are smoking, advise them to quit, assess their willingness, then assist in an attempt to quit (counseling and pharmacotherapy) and arrange for follow up contact to prevent relapse. Not willing to quit smoking - - brief intervention to promote the motivation to quit by use the "5 R's" - Relevance, risks, rewards, roadblocks, repetition. Relevance (why quitting would personally relevant to him/her); Risks (patient to identify them); Rewards (patient to set up reward system) Roadblocks (patient to identify them) Repetition (repeat with each clinic visit) SMOKING CESSATION MEDS - Chantix, Zyban, Nicotine patch, Nicotine gum, Nicotine lozenge, Nictorol Inhaler, Nicotrol NS Alcoholism treatment - Identify ones that require treatment, determine one's readiness to discuss treatment; assess one's need for detox; plan for post detox treatment in coordination with other professionals. Assessment of elderly for alcohol abuse - cognitive decline, nonadherence with appointments, psychiatric history, insomnia, poorly controlled HTN, frequent falls, GI problems, nutritional deficiencies, delirium in hospital. Head, neck, and esophagus cancers are associated with chronic alcohol abuse. Liver cancer with cirrhosis is side effect of chronic alcohol abuse. Treatment consists of benzodiazepines, as well as thiamine and other vitamin supplements. Preventive measures such as flu and pneumococcal vaccines Pneumococcal - dose if not previously received, followed with dose at least one year after the most recent dose. Influenza -yearly by October Zostavax 60 Tetanus -every 10 years Elder abuse is often referred to as a silent crime with many case going unreported. Because of this the student should be aware of the classic cues that abuse may have taken place with the elderly. There are many factors that place an older adult at risk for abuse or neglect. Students should be aware of their local protocols when abuse or neglect is suspected. May include physical, sexual, psychological, and financial exploitation, neglect, and violation of rights. Physical abuse - shaking, restraining, hitting, or threatening with objects. Psychological -threats, insults, or harassment, harsh commands. Financial - form of scams, family misuse of money or possessions. Neglect - intentional or unintentional of required food, medication, or personal care is not provided. Abandonment is a form of neglect. Reporting to adult protective services agency is MANDATORY . Compare Healthy people initiative 2000 and 2010 Healthy People Initiative 2000 - initiated by the U.S. Public Health Service to reduce preventable death and disability for Americans. Older Americans did not reach the target goals in areas of physical activity, being overweight, and eating fruits and vegetables. Failing grades also in reducing hip fractures in 65 years and fall related deaths in 85. Financial assistance was provided through Medicare for mammogram coverage, pneumococcal vaccination, and influenza vaccination. Healthy People Initiative 2010 - initiated of the U.S. Department of Health and Human Services that utilized the skills and knowledge of an alliance - to develop a set of health care objectives designed to increase the quality and quantity of years of healthy life of Americans and to eliminate health disparities. There are three types of assessments: Physical , Cognitive and Functional Physical - assess physical health. It includes VS, assess for pain, BP problems, irregular heartbeat, abnormal breath sounds, etc. Functional - assessing what the older adult can still do for him or herself. Bathing, eating, dressing, etc. Dr. Katz and Dr. Barthel developed ADL/IADL indexes to measure the functional abilities. Cognitive - addresses thought processing, thinking and reasoning skills. Normal cognitive changes - Decline in information processing speed, divided attention, sustained attention, ability to perform visuospatial tasks, and short-term memory. Difference between delirium and dementia delirium as: • 1. Disturbance of consciousness with reduced ability to focus, sustain, or shift attention • 2. A change in cognition (such as memory deficit, disorientation, language disturbance) or the development of a perceptual disturbance that is not better