Gero Study Guide

• What are the risks for elder mistreatment?


  Elder

  Immobile, fragile, can’t care for self

  Illness/disease

  Need help

  Lack of support/resources
• What is elder mistreatment?


  Any knowing, intentional, or negligent act by a caregiver or any other person that causes harm or a serious risk of harm to a vulnerable adult.”
• Elder mistreatment is any Harm that is caused by someone in a caring or trusting relationship
• Elder mistreatment is found in all socioeconomic, racial, and ethnic groups in the U.S. and across the globe
• Elder mistreatment is One of our most unrecognized and underreported social problems
• Elder mistreatment May be intentional, accidental, episodic, or recurrent
• Elder mistreatment always warrants further assessment
• The incidence of elder mistreatment is impossible to quantify, but is increasing
• Most elder abuse occurs in the home setting where most of the caregiving occurs
• Most abusers are spouses or adult children
• Majority of documented elder abuse cases are among Caucasian elders
• Elder mistreatment falls into 2 categories: Abuse and neglect
• What are the types of elder mistreatment?


  Physical abuse, sexual abuse, emotional abuse, medical abuse/neglect, financial abuse/material exploitation, discrimination, abandonment, neglect
• Part A of medicare?

  When 65 years old, automatically eligible for this benefit. Covers medical costs of acute care, short-term rehab in a skilled facility, and home health and hospice services
• Part B of medicare?

  Elective however necessary. Covers outpatient services, lab, diagnostics, OT, PT, Speech, durable medical equipment, and diabetic supplies other than Rx. Participants pay a monthly premium based on income level.
• Part C of medicare?


  Medical advantage plans, are elective, offered by many insurance carriers, and uses a prospective payment system. These plans are required to include both traditional Medicare Part A and Part B, and there may be additional benefits based on the contract. Some of these Plans include coverage for medications.
• Part D of medicare?


  It is an elective drug program with premiums and co-payments. All Medicare participants can sign up for this except if someone already has a Medicare Advantage Plan that also includes a drug benefit. Individuals on Medicare and Medicaid (because of low income) are automatically enrolled in Part D.
• Who makes decisions in care planning?


  The guardian, the POA, 18 years of age, family CAN NOT, whoever is sound mind, and surrogates
• Whoever is sound of mind includes?


  Joint tenancy of property including bank accounts

  Powers of Attorney for Finances and Health Care

  Power of Attorney bank accounts

  Trusts
• Who are surrogates?

  Guardians of the Person or Estate

  Court orders pursuant to Chapters 51 (mental health) and 55 (protective placement/services) of Wisconsin Statutes

  Representative Payees for Social Security Administration benefits

  Implied consent in medical emergencies
• Who activates a POA?

  need 2 physicians or 1 physician and 1 licensed psychologist to determine whether someone lacks the capacity to make decisions.  POA is then activated (Registered and signed by you and an attorney)
• Who appoints a guardian to make decisions if no POA was designated before the patient became incapacitated? If a POA is not executed, a Guardian of the Person must be appointed if the principal loses the mental ability to make health care decisions. Lawyer, psychologist, doctor, family
• What is the most common chronic condition in older adults?

  High blood pressure
• What are other common chronic conditions in older adults?

  High Cholesterol

  Ischemic Heart Disease

  Arthritis

  Diabetes

  Heart Failure

  Chronic Kidney Disease

  Depression

  COPD

  Alzheimer’s Disease

  Atrial Fibrillation

  Cancer

  Osteoporosis

  Asthma

  Stoke
• What constitutes a diagnosis of fragility?


  at least 3 conditions for a formal diagnosis to be made:

  Unexplained weight loss

  Self reported exhaustion

  Weak grip strength

  Slow walking speed

  Low activity
• Signs and symptoms of disease are subtle in the very old.
• Illness in the older adult complicated by physical changes of aging and multiple medical problems.
• Most common atypical signs of illness in the old?

  Decline in functional or mental status

  Anorexia or reduced oral intake

  Incontinence

  Falls
• Some common altered presentation of illness in elderly?

  Infection

  Myocardial Infarction

  Depression

  Acute abdomen
• Infection – Absence of Fever
• Myocardial Infarction – Shortness of breath more common than chest pain
• Depression – Lack of sadness, may be hyperactive or vague somatic complaints
• Acute abdomen – May present with tachypnea and vague respiratory symptoms
• VERY IMPORTANT to know the person’s baseline functional and mental status, behavior, appetite, and any chronic conditions. Especially in someone with cognitive impairment.
• Listen to family caregiver to obtain baseline information
• HTN is due to a normal change in the aging vascular system and life long habits (smoking). Inadequate control of BP is common if over 80
• Teaching for HTN?

  Ensure patient is taking prescribed blood pressure medications correctly.

  Make sure patient is taking BP at home

  Explain best assessment to determine accuracy of home blood pressure monitoring devices
• Non-pharmacologic interventions for HTN?


  Diet, exercise, avoid stress, limit alcohol/smoking
• Coronary artery disease increases significantly with age. Atypical manifestations include SOB, unexplained fatigue, unexplained falls, and change in mental status
• What is more common presentation with CAD? Shortness of breath