Lifespan- Caregiving, Frailty, and Aging

oldest old

those over 85

robust aging

aging successfully, with good mental and physical health

high levels of social contact, good health and vision, fewer stressful life events in the previous 3 years than their less robust peers

what are characteristics of robust aging

more than 50%

what percent of the oldest old live in their old homes

75%

what percent of the oldest old are widowed

35%

what percent of the oldest old live alone

25%

what percent of the oldest old live with an adult child

21%

what percent of the oldest old reside in nursing homes

programs and policies that decrease dependence and increase self determination

what is the most critical need for the oldest old

stay in their own home

medicare does not cover most programs which help elders...

married

a majority of men in the oldest old are

widowed

predominate lifestyle for women over 75 is

formal caregivers

health professionals, hospitals, nursing homes, day care centers

informal caregivers

family, friends, neighbors, church

very high

what is the level of stress of care giving for frail, disabled persons for family members

old

between 80 and 90, they begin to describe onself as

self-efficacy

life satisfaction in later life is dependent on a sense of

self-efficacy

feeling in control of one's life and master one's environment effectively

individual differences

studies of centurions found full and meaningful lives with diversity the norm

46 year old working daughter

who is the typical caregiver

yes

are multiple generations involved in caregiving

care provided in older adults home

how is independence encouraged in informal caregiving

sandwich generation

41% of caregivers also have children under the age of 18

daughters

who has greater stress reactions and distress when caring for elder relatives? daughter or spouse

strong moral obligation to provide emotional, financial, and physical (instrumental) support

why do daughters have greater stress reactions and distress when caring for elder relatives

demography, increased longevity, women changing roles, changing intergenerational relationships

what are factors of a weakened caregiver system

fewer children to provide care, greater strain on middle age caregiver without siblings

how has the demography weakened caregiver systems

adult children in young old generation caring for oldest old

how has increased longevity weakened caregiver systems

women

traditional sexual division of labor puts most of the burden of caregiving on

passing on family business, economic interdependence, sense of obligation

how has changing intergenerational relationships weakened caregiver systems

40%

what percent of caregiving is provided by spouses

wives

when caregiving is performed by spouse who is often the caregiver? wives or husbands

stress, economic strain, interpersonal conflict, limited mobility, health declines

when caring for a chronically ill spouse it often involves what on the caregiver

worker, labor of love, sense of duty, at crossroads

what are the 4 types of husband caregivers

worker

schedules everyday, reads all about disease, desk for insurance paperwork

labor of love

provides care out of devotion, not duty

sense of duty

feels responsibility, duty to spouse

at crossroads

new to the role, hasn't found coping strategies yet, floundering in crisis

history of relationship, caregivers social support, coping skills, self image

stress as a caregiver is manifested by

unmarried children who live with parent

who provides the most care

caregiver and care recipient

when providing care for older parent there is overwhelming stress for both

provider, manager

what are the two kinds of caregivers

provider

more stressed out, less likely to provide stimulating activities

caregiver stress

confilcting emotions including devotion, love, anxiety, sadness, frustration, guilt

role strain and role overload

what are problematic in caregiving

burnout and depression

what are common among caregivers, but coping abilities may vary

respite care

programs that provide substitutes to allow time off for caregivers

support groups

provide a network of counseling, information, problem solving, emotional support

frailty

chronic inflammatory state with increased serum interleukin-6, decreas hemoglobin and hematocrit; hormonal deficits linked to immune dysregulation, change in gene expression with shortened telomeres; reduced ability to autocorrect due to loss of efficacy on human systems

weight loss 4.5 kg/yr, fatigue at least 3 days per week, reduced muscular strength with hand grip, reduced physical activity, reduced walking speed (>7 sec)

what is the frailty cycle

short physical performance battery

what is an outcome measure to test frailty

balance assessment, walking assessment, 5 x sit to stand

what are the components of the short physical performance battery

standing feet together, semitandem, tandem

what are the 3 positions for balance assessment of short physical performance battery

4 m

how far do you walk for the short physical performance battery

functional status (ADLs), clinical status, cognitive function and psychological and affective status, pharmacological treatments, social, economic, and environmental conditions, individual preference, needs, values

older adults in whom frailty status has been identified should be assessed for

muscular strength and body weight

frailty is caused by concominant factors whose main aspect is the progressive reduction of

promoting physical activity and monitoring diet and bodyweight

the main strategies to stabilize the system and control frailty are

very fit, well, managing well, vulnerable, mild frail, moderately frail, severely frail, very severely frail, terminally ill

what are the different classifications of frailty

very fit

people who are robust, active, energetic, and motivated. These people commonly exercise regularly. They are among the fittest for their age

well

people who have no active disease symptoms but are less fit than people in category 1. Often they exercise or are very active occasionally

managing well

people whose medical problems are well controlled, but are nor regularly active beyond routine walking

vulnerable

while not dependent on others for daily help, often symptoms limit activities. A common complaint is being "slowed up" and/or being tired during the day

mildly frail

these people often have more evident slowing, and need help in high order IADLs (finances, transportation, heavy housework, medications), typically progressively impairments shopping and walking outside alone, meal preparation, and housework

moderately frail

people need help with all outside activities and with keeping house. Inside they often have problems with stairs and need help with bathing and might need minimal assistance (cuing, standby) with dressing

severely frail

completely dependent for personal care, from whatever caise (physical or cognitive) even so, they seem stable and not at high risk of dying (within 6 months)

very severely frail

completely dependent, approaching the end of life. typically, they could not recover even from a minor illness

terminally ill

approaching the end of life. Thus category applies to people with a life expectancy of <6 months, who are not otherwise evidently frail

weight loss, physical activity, muscle strength, energy level, walking speed

what are components that may affect frailty

disability, cumulative medical conditions, functional and cognitive decline, poor nutrition

what are cumulative deficits of frailty

maintaining life purpose, positive attitude toward aging and participation in life, regular engagement in moderate physical activity throughout life, avoid sedentary behavior, increased activity even in the presence of poor health, healthy died such as Mediterranean diet, cessation of smoking, socially engagement, sleep, proper body weight

what are prevention of frailty

drug treatment for chronic disease, fall prevention, exercise, nutritional support, psychological support

what are multimodal interventions for preventing frailty

8 hours of sitting time per day

frailty=

decreased mobility

frailty is linked to

multisystem dysregulation

the state of frailty is associated with

sarcopenia

what is the prime component of frailty

multicomponent

assessment of frailty needs to be

physical activity of all types

what interventions are effective to prevent frailty

physical activity, vitamin D, protein intake, education

what are frontline management of frailty

supervised, tailored, contains self-efficacy training, if practitioner encourages

older adults will maintain a physical activity program if..