OA1!

Healthy people 2020

health equity, eliminated sesparties, improves health of all groups

Sentence

progressive body system deterioration (with age), can increase risk of mortality (normal to aging)

Programed theories

body knows what it is supposed to do, biological timeline, genetic codes have instructions for production and death

Error theory

programed from birth, when cellular functions impaired, environmental assaults and bodys constant need to make energy and fuel metabolic activities cause toxic byproducts

Psychological aging theory

coping strategies

Jung's theory of individualism

as person ages extroversion shifts to introversion

Erikson's stage older adult

integrity vs despair (have I lived a good life)

Disengagement theory

no longer want to be in big crowd

Activity theory

stay active as they age to enjoy it

Continuity theory

maintain previous habits and values

Medicare

federal, people over 65, limited prescription drug benefit

Medicaid

state, based on income, for low income, children, pregnant women, elderly adults, people with disability (long term care expenses are big)

Medicare C

medicare advantage (covers A B and D), can chose to receive through private insurance

Skilled nursing facility

short term stay in a medical setting, high level of care, around the clock care

Assisted living facilities

level of care can vary, help with daily living, need some assistance but do not require nursing home care

Nursing home

maximum amount of care needed, also memory floors for memory impairment, higher level of medical care than can be provided at assisted living

Retirement communities

do not provide medical care, housing complex for older adults who can mostly care for themselves, live as independently as they can for as long as they can

Congregate housing

includes at least one shared meal per day with other residents

Rehabilitation hospitals

return to previous level of functioning or optimal level of functioning after hospitalization or injury

Residential care facilities

“dorm”, 24 hour supervision and health monitoring, no kitchen, eat in groups

Transitional care unit

shift from hospital to home, less therapy programs

Rehabilitation facilities

provide services for specific groups (head injury)

Community nursing care

skilled care in home

Geriatric evaluation schedules

hospitalization for acute illness, change in living status, abrupt change in physical or socal function, annual exam

Advanced directive

set of instructions prepared in advance of ill health that determines wishes

Frailty Is

instability, immobility, intellectual impairment, incontinence

Frailty

3+ unexplained weight loss, weakness and exhaustion, poor endurance, decline in gait speed, slowness, low activity

Normal brain changes

decrease in brain size and weight, decrease in short term memory

Changes in CNS

memory, movement, seizure disorder, stroke

Changes in PNS

motor, sensory, autonomic disorders (movement and receiving messages)

dementia loss of

memory, orientation, attention, language, judgment, reasoning

Neurodegenerative dementia

insidious and gradual onset

Vascular dementia

more abrupt caused by stroke, hemorrhagic event, or hypoxia to the brain

Diagnose dementia tool

mental status exam (SLUMS)

Dementia characterized

loss of cognition + aphasia, agnosia, apraxia, amnesia, anomia, executive function loss

Aphasia

inability to speak coherently / understand language

Agnosia

inability to recognize or identify objects

Apraxia

inability to execute motor activities

Amnesia

memory loss

Anomia

misuse of objects or failure to identify them

Executive function loss

inability to think abstractly, make sound judgements, and plan/carry out complex tasks

Domains to evaluate stage of dementia

memory, orientation, judgment and problem solving, community affairs, home and hobbies, personal care (6)

Lew body dementia

small deposits in brain seen on CT scan, more psychiatric symptoms like hallucinations *personality changes

Frontotemporal lobe group dementia

rare, more progressive, nerve cell loss in frontal lobe (not visible on CT), often misdiagnosed as psychiatric disorder, usually occurs at younger age, more personality changes

Alzhimers

chronic progressive degenerative disease of brain, fatal within 4 to 6 years

Alzhimers CM

memory failure, personality changes, increasing inability to manage ADL

CT scan shows for alzheimer's

brian atrophy

Hippocampus

memory stored in brain

Mild Alzhimers

memory, personability, spacial, disorientation

Moderate Alzhimers

aphasia, apraxia, confusion, agitation, insomnia

Late Alzheimer's

resistiveness, incontinence, eating difficulties, motor impairment

Cholinesterase inhibitors

slow down progression of alzhimers

Cholinesterase drugs

donepezil, rivastigmine, galantamine

Glutamine regulators

work by protecting nerve cells from excess buildup

Glutamine drug

memantine

Glutamine + cholinesterase together

better slows progression when together (donepezil and memantine) (namzaric)

Anti Amyloid antibody

IV infusion, new drug, reduce cognitive and functional decline

Vascular dementia

unchanged personality, abrupt onset, usually result from TIA or stroke, death of brain tissue due to lack of blood supply

Safety for dementia

leave clues for patients, get rid of doormats, decrease temperature in water heater to avoid burns, handrails in shower, well lit areas

Parkinsons

chronic progressive neurological disorder, loss of nerve cells in substantia nigra area of brain, (*decreased dopamine)

Parkinson's diagnosis

exclusion

Early parkinsons

one sided symptoms, change in posture and walking and facial expressions

Middle parkinson's

difficulty rising from sitting piston, maintained flexed posture

Late parkinson's

inability to stand or walk

Parkinson's triad

tremor, rigidity, bradykinesia (slow movement), pill rolling

Motor parkinson's symptoms

TRAP tremor, rigidity, akinesia (loss of voluntary muscle movement), postural instability

Extrapyramidal parkinson's

tremor, tardive dyskinesia (involuntary twitch), dystonia (involuntary muscle contraction), rigidity, akathisia (motor restlessness)

Amantadine parkinsons

release dopamine, decrease symptoms, decrease twitch

carbidopa/levodopa

has parkinsons (take before meals or after, may become dizzy)

Anticholinergics parkinsons

relieve tremors

Delirium assessment tool

CAM

CAM

acute onset and fluctuations & inattention + disorganized thinking OR altered level of consciousness

Hallmark delirium ss

sudden onset, inattention, fluctuates at different times of day

Delirium cause

infection or retention

DELIRIUMS

drugs, emotions, low O2, infections, retention, ictal (post seizure), undernutrition, metabolic electrolyte changes, subdural hematoma

Early delirium

inability to concentrate, irritability insomnia, loss of appetite, restlessness, confusion

Late delirium

agitation, misperception, misinterpretation, hallucinations

SSRI

depression (PRAM, TINE, LINE)

SSRI ADR

dry mouth, nausea, diarrhea, HA, insomnia

GI normal changes

start at 50, decreased absorption

Drugs that impact GI tract

antidepressants, neuro epileptics, HTN, diuretics, iron and ca supplements, antiemetics, antacids containing aluminum, opioids, laxatives, KCL, some antibiotics

Gastric volvulus

emergency, requires immediate surgery, twisting in stomach

Diverticulitis

small bulging pouches in digestive tract than can cause bleeding, LOWER GI

Hiatal hernia

lower esophageal sphincter becomes less competent and moves through diaphragm

First indication of hiatal hernia

espo phergal bleeding or respiratory complications

Hiatal hernia causes

obesity, pregnancy, increased age, ascites (with liver failure), medications

Hiatal hernia CM

similar to GERD, heartburn and dysphagia

Hiatal hernia dx

barium swallow, endoscopy (camera visualize lower esophagus and stomach)

Hiatal hernia diet changes

eliminate caffeine and chocolate

Meds that can lower LES pressure

nitrates, calcium channel blockers, antidepressants, NSAIDS, potassium

Acidophilus capsules (probiotics)

help decrease regurgitation and heartburn with hiatal hernias

GERD cause

reflux of gastric contents into lower esophagus (not 1 single cause) incompetent LES

GERD

incompetent lower esophageal sphincter lets gastric content move from stomach into esophagus when supine or increased abd pressure

Main predisposing factor to GERD

hiatal hernias

Most common CM of GERD

heartburn intermittently (also dyspepsia (upper abd pain) and regurgitation)

GERD dx

symptoms more than twice a week and difficulty swallowing

GERD dx studies

radionuclide test, capsule endoscopy, monitoring pH; barium swallow, upper GI endoscopy, biopsy, esophageal manometric study

GERD resp

wheezing, cough, dyspnea, sore throat, regurgitation

GERD chest pain

mimic heart attack, relieved with antacids

GERD complication

esophagitis (esophagus inflammation) lead to impaired swallowing