what 3 disorders commonly cause altered cognition in older adults?
dementia: confusion, not correctable; progressive and deteriorates over time
delirium: acute confusion; hallucinations; typically related to a specific cause; example
is an ICU patient who has been in a car accident: delirium due to meds and lack of
sleep-ie, beeping, lights in ICU
depression: very common in older adults, especially as they begin to lose their
independence and loved ones (children move and start their own families, spouse dies,
etc.)
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what is a caregiver?
any person who is providing care for a person who is unable to provide complete care
for themselves
how do we assess for a caregiver burden?
level of care older adult requires may exceed caregiver ability
,Caregiver burnout- signs of possible caregiver burnout include:
1. increased stress
2. anxiety
3. social isolation
4. depression
5. weight loss or gain
How do we perform environmental assessments?
Tripping hazards of any kind (cords, rugs, sock type narrow walkways, furniture, clutter
etc.)
-Check stove type to see if there is an open flame
-Make sure there are no fire hazards around the stove or oven
Wheel chair ramps should not be too steep and not of wood and must have a landing
How is an evaluation performed at the end of life?
Maximize or minimize interventions to make person comfortable, nursing judgment with
experience will tell you what's appropriate
Use information from caregivers and other existing sources
Be aware that caregiver stress may be heightened during this period of added strain
When do we stop assessing patients in end of life care?
-head-to-toe assessments do not get done, but you will be doing select things, such as
pain assessments to keep them comfortable
-just make the patient as comfortable as possible before passing
What is functional ability?
,-ones ability to carry out the activities needed to live in modern society
-includes driving, use of telephone and completing personal activities, such as bathing
and toileting
- "can I do this activity?"
- ex: I can brush my teeth
what is functional status?
describes what the person actually does in terms of activities and tasks
older adults may pass in and out continuously through several stages of independence
and disability
"did I do this activity?"
- ex: I can brush my teeth, but with my arm injured, can I?
what are the 2 approaches to a functional assessment?
- individual's self-report about his or her ability to perform tasks-not always super
accurate
- observe his or her ability to perform tasks-this is best (ex: have patient get out of chair
and walk across the room)
what is a functional assessment?
-assessing someone's ability to complete day-to-day tasks
base for care planing, goal setting, and discharge planning
, must be completed to determine eligibility for services to include but not limited to:
durable medical equipment walker, home modifications sending to a different/new
facility, and inpatient or outpatient rehab services
what are the 3 domains of a functional assessment?
activities of daily living ADLs
instrumental activities of daily living IADLs
mobility
what is activities of daily living ADLs?
measure tasks necessary for self care which are needed to survive
this is the most important part of the functional assessment
- ambulation: walking, including propelling a wheelchair, using stairs
- transferring, such as bed to chair
goal of measuring functional abilities necessary for independent community living. not
absolute survival needs, but ways to function in society. a patient can still survive, but
makes it more difficult to perform basic ADLs.
shopping
meal preparation
housekeeping
laundry
managing finances
taking medications
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