Geriatrics Final Review

Define Chronic Illness

Illnesses that last longer than 12 months

Persistent regardless of treatment

Insidious & identified only during treatment

 

Identify Most Common Chronic Diseases in the United States (9)

• Heart Disease 

• Stroke 

• Cancer 

• Diabetes 

• Obesity 

• Chronic lung disease 

• Chronic kidney disease 

• Alzheimer’s Disease

• Osteoarthritis 

Chronic Illnesses that are the Leading Causes of Death/Disability (3)

Heart Disease

Cancer

Diabetes

Major Lifestyle Risk Factors for Heart Disease (4)

Tobacco Use

Unhealthy Diet

Physical Inactivity

Alcohol Abuse

Strategies to Prevent Chronic Illnesses (4)

Physical Activity

Reducing Obesity

Stopping Smoking

Taking Prescribed Medications

Define the Chronic Disease Trajectory Model (3)

A conceptual model that aids HCP in understanding chronic illness & it’s effect on individuals

Views chronic illness from life-course perspective along a trajectory

Aids in designing interventions to promote healthy aging

Phases of Chronic Disease Trajectory Model (9)

• Pretrajectory

• Trajectory onset

• Stable

• Unstable

• Acute

• Crisis

• Comeback

• Downward

• Dying

Define Pre-Trajectory Phase (3)

Before illness course occurs

Preventative phase

No S/S

Pre-Trajectory Phase Components (2)

Preventative practices used to prevent chronic disease

Nurse - advocates for health promoting activities

Define Trajectory Onset

S/S present, diagnostic period

Define Stable Phase

Controlled illness course/symptoms

Define Unstable Phase (2)

Illness course/symptoms not controlled by regimen

Not requiring hospitalization

Define Acute Phase (2)

Active illness/complication

Requires hospitalization for management

Define Crisis Phase (2)

Life-threatening

Acute threat to self-identity

Define Comeback Phase (2)

Period of temporary remission from crisis

Less likely to occur in frail individuals

Define Downward Phase (2)

Progressive decline in physical/mental status

Increasing disability/symptoms

Define Dying Phase

Immediate weeks, days, hours preceding death

Define Frailty

Multidimensional syndrome characterized by decreased reserves & diminished resistance to stressors

Define Primary Frailty

Frailty with no medical or social diagnosis

Define Secondary Frailty

Frailty related to downward progression of specific chronic disease

Does Chronic Disease Cause Frailty? (4)

Unclear

The more frail one is the faster they move across trajectory

The less likely they move backwards to stability

The more likely they are at increased risk of death when unstable

Frailty Criteria

3 of the following:

Unintentional weight loss

Self-reported exhaustation

Muscle weakness

Slow walking speed

Low activity

Nurse’s Role in Caring for Person’s with Chronic Disease (7) “Perceptions”

• Assess person’s strengths & challenges

• Teach healthy lifestyle modification, energy perservation, & self care strategies

• Encourage reduction of modifiable risk factors

• Counsel individual to develop reasonable expectations

• Provide access to resources

• Collaboration

• Advance care planning & palliative care when appropriate

Goals of Promoting Healthy Aging (4)

Minimize risk for disease & fraility

Alleviate symptoms

Avoid/delay development of complications (end-organ damage)

Maximize function & quality of life

Define Pain

Unpleasant sensory & emotional experience

Includes 37 different types

Multidimensional with sensory, psychosocial, emotional, personal, & spiritual components

Define Acute pain (4)

Result of an acute event (fracture, infection)

Temporary & controllable w analgesics based on intensity

Resolves when underlying cause is removed

Autonomic overactivity

Define Chronic Pain

Pain lasting 3-6 months associated w progressive disease

Periods of excerbations & remission

Define Persistent Pain

Unremitting, requires constant treatment

Health Care Professional Barriers to Pain (6)

Lack of education regarding pain assessment & management

Concern regarding regulatory scrutiny

Fears of opioid related effects/addictions

Beliefs that pain is a normal part of aging or that cognitively impaired elders have less pain

Personal beliefs & experiences & pain

Inability to accept self-report w/o objective signs

Patient & Family Barriers to Pain (4)

Lack of ability to assess pain in cognitively impaired

Fear of medication side effects or addiction

Beliefs that pain is a normal part of aging & nothing can be done

Fear of being a bad patient & fear of what pain may signal

Health Care System Barriers

Cost

Time

Cultural & Political Bias Concerning Opioids

Factors Altering Pain Perceptions

Prior experiences

Expression of pain in regards to cultural, cognitive, functional, & psychological status (depression/anxiety)

Goals of Pain Management

How does Pain in Older Adults Differ from Pain in Younger Patients

Factors Affecting Perception of Pain

Data to Include in a Pain Assessment

Assessing Pain in Cognitively Impaired Older Adults

Pharmacological Pain Management Therapies

Define Nonpharmacological Pain Therapy

Nonpharmacological measures alone, or combined with pharmacological approaches, are the most effective & appropriate way to control pain,

Types of Nonpharmacological Therapies (10)

Heat & Cold

Exercise

Transcutaneous Electrical Nerve Stimulation (TENS)

Acupuncture & Acupressure

Assistive Devices 

Energy/Touch Therapies

Relaxation, Meditation & Guided Imagery

Music

Activity

Cognitive Behavioral Therapy & Education

Heat & Cold (3)

Cold - Acute muscle pain; reduces muscle & nerve irritation; Do not use on areas where PVD is present

Heat - Arthritis; heat moves into tissue

Do not allow direct skin exposure (burns)

Exercise (Nonpharm therapy) (4)

Passive, active range of motion, & stretching

Tightened muscles pain (fall) - warm, stretch, cool

Can be guided by a nurse

Complex movement & stretching is led by PT

TENS

Limited conclusive evidence of its efficacy

Acupuncture & Acupressure (3)

Acupunture - tiny needles inserted in specific pathways of body (chinese medicine)

Acupressure - Pressure applied with fingers at same locations as acupunture

Low back pain, neck pain, knee pain/arthritis, headaches

Asisitive devices

Offload/reduce stress & weight on painful joints

Energy/Touch therapy (7)

Massage

Healing teach (noncontact)

Therapeutic touch

Yoga, tai chi, meditation, reiki

Varies by culture

Unacceptable - cross gender touch in muslim or jewish

Always request permission prior to touch

Activity (3)

Inactive people are more uncomfortable

Use analgesics prior to activities (20-30 mins prior)

Nurse - learn patient’s body tolerance for activity & work within those parameters

Cognitive Behavioral Therapy & Education (Pain) (4)

Learning self efficacy & self care to mediate pain

Coping with circumstance

Identifying goals & treatment contracts

Replacing helplessness, hopelessness & anxiety with determination

Life Stressors Encountered with Older Adults

Interventions for Stress in Older Adults