GERIA FINALS

manifesting makapasa

Medical screening

rules out treatable causes but is insufficient alone for intellectual decline evaluation.

brain tissue biopsy or autopsy

Definitive dementia diagnosis often requires a ? or ?, reflecting diagnostic challenges.

Computed Tomography (CT) Scans

detect intracranial tumors, hematomas, hydrocephalus, and structural brain changes relevant to dementia diagnosis.

Magnetic Resonance Imaging (MRI)

provides high-resolution images to identify subcortical attacks and white matter disease, aiding vascular dementia diagnosis.

Electroencephalography (EEG)

measures brain electrical activity, correlating background frequencies with cognitive function and dementia progression.

Positron Emission Tomography (PET)

? scans assess glucose metabolism and cerebral blood flow, supporting differential diagnosis of Alzheimer's and frontotemporal dementia.

Nonpharmacological Interventions

First-line treatments focus on unmet needs rather than suppressing symptoms in dementia care.

Need-driven Behavior Model

This model views disruptive behaviors as communication of unmet needs needing empathetic response.

Cholinesterase Inhibitors

These drugs slow Alzheimer’s progression and reduce symptoms in dementia patients.

Antipsychotics

• drugs used only if the resident behaviors result in "significant distress for the patient or poses a safety risk for the persons with dementia or those around them"

• is associated with "increased risks of mortality, stroke, and more common side effects such as falls, sedation, and cognitive decline"

Geriatric Depression Scale

• tool that effectively assesses depression in older

  adults by minimizing somatic symptom influence.

Glasgow Coma Scale

• assessment scale that measures eye opening, verbal response, and motor response to assess consciousness level.

• vital in critical care for detecting neurologic

  status changes and guiding interventions.

Sundown syndrome

SYMPTOMS:

• involves confusion, agitation, altered sleep

  cycles, and psychomotor disturbances in dementia patients.

POSSIBLE CAUSES:

• neurologic damage, REM sleep disruption,

  sleep apnea, and suprachiasmatic nucleus deterioration.

neuroleptics

Medications like low-dose ? are reserved for severe cases of sundown syndrome posing danger to self or others.

Wandering Behavior

TRIGGERS:

• often caused by sleep issues, previous active lifestyle, or psychotropic medication use.

COMMON REASONS:

• due to boredom or basic needs like using the

  bathroom.

Paranoia and Suspiciousness

CAUSES:

• arises from memory loss and sensory impairments in dementia, leading to insecurity and mistrust.

NONPHARMACOLOGIC STRATS:

• Securing valuables, labeling items, and avoiding confrontation help reduce anxiety and suspicion.

CAREGIVER RESPONSE:

• respond with empathy and reassurance to build

  trust and reduce triggers.

Hallucinations and Delusions

NATURE:

• ? are usually visual, while ? involve false beliefs affecting perception.

CAUSES

• overmedication, toxicity, fever, or infection requiring careful medical evaluation.

CAREGIVER APPROACH:

• calm the individual, validate feelings without reinforcing delusions, and adapt interventions as disease progresses.

Catastrophic Reactions

TRIGGERS:

• Sensory overload, fatigue, and misinterpreted actions often trigger exaggerated emotional responses

S/SX:

• Restlessness and refusal to perform tasks

MANAGEMENT STRATS:

• Removing triggers, creating calming environments, using soothing tones, and providing reassurance help de-escalate reactions.

T

T or F: Medications are used only if nonpharmacologic methods fail or safety risks arise, focusing on quality of life.

10% - 20%

Anxiety remains common in older adults, with ? to ? experiencing Generalized Anxiety Disorder.

Generalized Anxiety Disorder

PSYCHOLOGICAL SYMPTOMS:

• chronic worry, restlessness, fatigue, irritability, muscle tension, and disturbed sleep.

PHYSICAL SYMPTOMS:

• rapid heartbeat, sweating, and muscle tension, reflecting anxiety in older adults.

TRIGGERS:

• Life changes such as health decline, financial strain, and loss of independence

• breathing exercises, music therapy, physical activity

Nonpharmacologic Interventions for Anxiety:

• Relaxation techniques like, and ?, ?, and ? reduce acute anxiety in older adults.

Schizophrenia

• involves altered perceptions and disrupted thought processes affecting reality understanding.

• ELDERLY SYMPTOMS:

  • Older adults show more delusions and hallucinations, with fewer disorganized

    and negative symptoms.

late teens, mid-30s, 45

Typical onset of Schizophrenia occurs in ? to ?, with rare cases starting after age ?

Intellectual disability

• involves below-average intellectual functioning and affects independent living skills.

PALLIATIVE CARE

• Improving the quality of life of patients and their families a life threatening

• Goal: Prevention and Relief of Suffering

Prevention and Relief of Suffering

Goal of Palliative Care

WHO, 2016

• Provide relief from pain and other distressing symptoms.

• Affirms life and regards dying as a normal process.

• Intends to neither hasten nor postpone death.

• Integrates the psychological and spiritual aspects of patient care.

• To help patients live as actively as possible until death.

• To help the family cope during the patient’s illness and in their own bereavement.

• Uses a team approach

• Enhances quality of life, may also positively influence the course of illness

• Applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life

Hospice

• A program of care designed for the last 6 months of life

• Supports patients and families throughout the dying process, including bereavement services

• Prognostication vs Criteria Setting

• option

  • 6 months

  • bereavement

  • Prognostication, Criteria Setting

• Hospice care becomes an ?

  • Hospice is a program of care designed for the last ? of life

  • Supports patients and families throughout the dying process, including ? services

  • ? vs ?

F

T or F: Hospice is the same as palliative care

normal grief

• type of grief that consists of normal behaviors, reactions to loss, and symptoms

anticipatory grief

• type of grief that includes the process of “letting go” before an actual death has occurred

complicated grief

• type of grief wherein an individual has trouble progressing through the normal (generally accepted) phases or stages of grieving

disenfranchised grief

• type of grief that people experience when a loss is experienced and cannot always be openly acknowledged, socially sanctioned, or publicly shared.

Denial

• Stage of dying process wherein nurses should be sensitive to the person’s need for defenses.

• Accept the dying individual’s reactions and to provide an open door for honest dialogue.

Anger

• Stage of dying process wherein nurses should help the family gain insight into individual’s behavior

• Accept this as implying to the dying person that is fine to vent these feelings

Bargaining

• Stage of dying process wherein nurses should be aware that dying persons may feel disappointed at not having their ? honored or guilty over the fact that, having gained time, they want an additional extension of life even though they agreed that the request would be their last.

Depression

• Stage of dying process wherein nurses should understand that cheerful words may be far less meaningful to dying individuals than holding their hand or silently sitting with them

• Be particularly sensitive to the dying person’s religious needs and facilitate the clergy-patient relationship in every way possible

Acceptance

• Stage of dying process wherein nurses should use touching, comforting, and being near the person.

All stages

• Stage of dying process wherein nurses should permeate hope, as it can be used as a temporary but necessary form of denial, as a rationalization for enduring unpleasant therapies, and as a source of motivation.

No advanced directives yet

Review with patients as they are admitted to a hospital or nursing home setting and discuss the importance of the patient expressing his or her desires in a legally sound manner

With advanced directives

Review it with the patient to assure it continues to reflect the patient’s preference and place a copy in the medical record to inform all members of the interdisciplinary team

PAIN

• Complaints of discomfort, nausea, irritability, restlessness, and anxiety are indicators

• Nurses must regularly assess this because patients may not express this all the time

• GOAL

  • Prevent than respond after it occurs

• ALTERNATIVES

  • Guided imagery, hypnosis, relaxation exercises, massage, acupressure, acupuncture, therapeutic touch, diversion, and the application of heat or cold.

• Prevent pain

THE GOAL OF PAIN MANAGEMENT

• ? from occurring rather than to respond to it after it occurs.

RESPIRATORY DISTRESS

• Common problem in dying patients.

• Can result to psychological distress associated with the fear, anxiety, and helplessness

• INTERVENTIONS

  • Elevating the head of the bed, pacing activities, teaching the patient relaxation exercises, and administering oxygen can prove beneficial

DELIRIUM

• Inattention, altered level of consciousness, and disorganized thinking

• CAUSES

  • hypoglycemia, infection, hematological disorders

  • infection, nutritional deficiencies, dehydration

  • hypoxia, uncontrolled pain, sensory deprivation, sleep disturbance, alcohol or drug withdrawal

  • diarrhea, constipation, and urinary retention

  • Medication: Benzodiazepine, Anticholinergic, Meperidine

Benzodiazepine, Anticholinergic, Meperidine

Meds for delirium

T

T or F: Delirium is common at end of life

RELIGION

• Nursing staff must respect these practices to promote the fulfillment of patients’ spiritual needs

• NURSES CAN ASK

  • What gives you the strength to face life’s challenges?

  • Do you feel a connection with a higher being or spirit?

  • What gives your life meaning?

• decline

• rapid, weak

• dyspnea, apnea

• pupil

• profuse

• cold

• incontinence

• pallor, mottling

• hearing, vision

SIGNS OF IMMINENT DEATH

• ? in BP

• ?, ? pulse

• ? and periods of ?

• slower or no ? response to light

• ? respiration

• ? extremities

• bladder and bowel ?

• ? or ? of skin

• loss of ? and ?

COMPREHENSIVE GERIATRIC ASSESSMENT

Multidimensional, interprofessional, diagnostic process to identify care needs, plan care, and improve outcomes for older people

COMPREHENSIVE GERIATRIC ASSESSMENT

An evaluation designed to optimize an older person’s ability to enjoy good health, improve their overall quality of life, reduce the need for hospitalization and/ or institutionalization and enable them to live independently for as long as possible

Physical health

These dimensions belong to what domain

• History taking

• Physical examination

• Diagnostics

• Nutritional assessment

• Medication review

Functional health

These dimensions belong to what domain

• Activities of daily living

• Instrumental ADLs

• Sensory assessment (hearing, vision)

• Gait and balance

Psychological health

These dimensions belong to what domain

• Cognitive disorders (delirium, dementia, mild cognitive impairment)

• Affective disorders (depression, anxiety)

• Spiritual well-being

Socioenvironmental supports

These dimensions belong to what domain

• Social network and support

• Living situation

• Environmental safety

• Economic resources

Quality of life measures

These dimensions belong to what domain

• Physical conditions

• Social conditions

• Environmental conditions

• Personal resources (mental health, life perspective)

• Preferences for care

• Memory loss

• Confusion

• dementia

A request for a geriatric assessment would be appropriate when there are persistent or intermittent symptoms such as:

• ?

• ?

• Or other signs of possible ?

diffuse

When doing geriatric assessment, you must use ? lighting with increased illumination, and avoid directional or localized light

glossy, polished

When doing geriatric assessment, you must avoid ? or highly ? surfaces, including floors, walls, ceilings, and furnishings.

mental status exam

If the patient's responses to initial questions are clearly inappropriate, turn to the ? immediately

Katz Index of Independence in Activities of Daily Living

• tool used to screen for basic functional activities of older patients if he/ she can still perform

ADLs

self-care activities that a person performs daily (eating, dressing, bathing, transferring between the bed and a chair, using the toilet, controlling bladder and bowel functions)

Lawton IADL Scale

• tool used to check if older patients can do the IADL that are needed to live independently (doing housework, preparing meals, taking medications properly, managing finances, using a telephone)

Nutritional health Checklist and Mini Nutritional Assessment

• assessment used to identify older adults who have or are at risk for malnutrition.

Tinetti’s Performance Oriented Mobility Assessment

• task-oriented test that measures gait and balance abilities; useful tool to assess a patient’s fall risk

Hearing Handicap Inventory for the Elderly

• tool that accurately identify persons with hearing impairment

Mini Mental Status Examination

• used to screen for cognitive dysfunction

Mini-Cog

• shorter than the MMSE and measures executive function 

• composed of a three-item recall and the Clock Drawing Test (CDT) and takes about 3 minutes to administer

Montreal Cognitive Assessment (MoCA), and Saint Louis University Mental Status Examination (SLUMS)

• tools that are better at identifying mild neurocognitive disorder and are available online; unlike the MMSE, which is copyrighted

Confusion Assessment Method (CAM)

• tool that takes 5 minutes to administer (Inouye et al., 1990)

• instruments designed to screen for delirium

POLYPHARMACY

• Numerical definition of 5 or more medications daily.

• Associated with:

  • Increasing age

  • Multiple Diseases

  • Disability

• Effects:

  • Nursing home placement

  • Admission to hospital

  • Mortality

• Negative Outcomes

  • Higher healthcare costs

  • ADEs, drug-interactions

  • Medication non-adherence

  • Decreased functional status

  • Geriatric syndrome

Appropriate Polypharmacy

• Type of polypharmacy:

  • prescribed for the purpose of achieving specific therapeutic objectives

  • reasonable chance they will be achieved in the future

  • minimize the risk of adverse drug reactions (ADRs)

  • patient is motivated and able to take all medicines as intended

Inappropriate polypharmacy

• Type of polypharmacy:

  • the indication has expired or the dose is unnecessarily high

  • one or more medicines fail to achieve the

  • therapeutic objectives

  • one, or the combination of several medicines

  • cause ADRs (or at risk)

  • patient is not willing or able to take one or more

  • medicines as intended

Multi-Morbidity

• 2 or more long term health conditions

  • Physical and mental health

  • Ongoing conditions

  • Symptom complexes

  • Sensory impairment

  • Alcohol and substance misuse

• Prevalence: Global Problem

DEPRESCRIBING

• Goal of managing polypharmacy and improving outcomes

  • Tapering

  • Stopping

  • Discontinuing

  • Withdrawing Drugs

POLICIES

• Polypharmacy key points of consideration:

  • for regular, holistic medication reviews 

  • for patients taking multiple medications

APPROPRIATE POLYPHARMACY

• Polypharmacy key points of consideration:

  • at the point of medicines initiation, during medication review and at care transitions

SAFETY CULTURE

• Polypharmacy key points of consideration:

  • enabling health care professionals and patients to discuss issues of polypharmacy and make patients to feel safe in asking questions

MULTIDISCIPLINARY

• Polypharmacy key points of consideration:

  • team work by removing barriers

MEDICATION REVIEWS

• Polypharmacy key points of consideration:

  • A structured evaluation of patient’s medicines

  • Identifies drug related problems

  • Recommending interventions

  • Sharing of information about the outcomes in polypharmacy with health care professionals

PEOPLE-CENTERED APPROACH

• Polypharmacy key points of consideration:

  • while reviewing medication with patients and their caregivers

LIFESTYLE ISSUES

• Polypharmacy key points of consideration:

  • during medication review process

TECHNOLOGIES

• Polypharmacy key points of consideration:

  • to reduce medication- related harm, improve patient experience and medication adherence

REPORTING

• Polypharmacy key points of consideration:

  • of medication incidents

Pressure Ulcers

Common Problem:

• Bedsores (decubitus ulcers)

• injuries to skin and underlying tissue resulting from prolonged pressure on the skin

Symptoms:

• Unusual changes in skin color or texture

• Pus-like draining

• Swelling

• Tender areas

• An area of skin that feels cooler or warmer to the touch than other areas

Common Sites:

• Tailbone or buttocks

• Backs of arms and legs

• Shoulder blades and spine

• Back or sides of the head

• Hip, lower back or tailbone

• Heels, ankles and skin behind knees

Risk Factors:

• Immobility

• Poor nutrition

• Dehydration

• Incontinence

• Nursing home neglect

• Lack of sensory perception

• Medical conditions affecting blood flow

stage I

• stage of pressure ulcer where the skin is intact with localized, non-blanchable erythema over a bony prominence

• area may be painful, firm or soft and warmer or cooler when compared to the surrounding tissue

• darkly pigmented skin may not show visible blanching, but the color will appear different than the color of the surrounding skin

• indicated the px is at risk for further tissue dmg if not relieved

stage II

• stage of pressure ulcer where there is a partial thickness wound presenting as a shallow, open ulcer with a red/pink wound bed

• may also present as intact or open/ruptured serum-filled or serosanguinous-filled blister

• slough may be present but does not obscure the depth of tissue loss

stage III

• stage of pressure ulcer where there is a full thickness wound

• subcutaneous tissue may be visible but bone, tendon and muscle are not exposed

• may include undermining or sinus tracks

• slough or eschar may be present but does not obscure the depth of tissue loss

stage IV

• stage of pressure ulcer where there is a full thickness wound with exposed bone, tendon or muscle

• often includes undermining and/or sinus tracks

• slough or eschar may be present on some parts of the wound bed but does not obscure the depth of tissue loss

suspected deep tissue injury

• pressure ulcer where a localized or maroon area of intact skin or a blood-filled blister occurs when underlying soft tissue is damaged from friction or shear

• may start as an area that is painful, firm, or mushy/boggy, and warmer or cooler than the surrounding tissue but can deteriorate into a thin blister over a dark wound bed or a wound covered in thin eschar

• deterioration may be rapid, exposing additional layers of tissue even with optimal treatment, and may be difficult to detect in individuals with dark skin tones

unstageable

• pressure ulcer where the wound in which the wound bed is covered by sufficient slough and/or eschar to preclude staging

braden

assessment scale for pressure sore risk

ERGONOMICS

• Designing equipment to adjust the work environment and work practices to prevent injuries before they occur.

• Note: Health care facilities especially nursing homes have been identified as an environment where ? stressors exist.