[11.07] Dealing with the Elderly V2.pdf

109.35 million

What was the Philippine population based on the 2020 census?

100.98 million

What was the Philippine population based on the 2015 census?

92.34 million

What was the Philippine population based on the 2010 census?

114 million

What is the projected Philippine population by 2025?

138.67 million

What is the projected Philippine midyear population by the year 2055?

8.5 percent

What percentage of the Philippine population in 2020 were senior citizens?

7.5 percent

What percentage of the Philippine population in 2015 were senior citizens?

60 years and over

How does the Philippine Statistics Authority define the senior citizen population age range?

79.71 years

According to the United Nations, what is the current projected life expectancy in the Philippines?

71.41 years

What was the Philippine life expectancy in 2021?

healthier lifestyles and medical science advances

What are the two main reasons why projected life expectancy is increasing?

children younger than 5 years old

In 2020, the number of people aged 60 and older globally outnumbered which group?

double

Between 2015 and 2050, what is the proportion of the world population over 60 expected to do?

12 percent to 22 percent

What are the specific percentage shifts for the global elderly population between 2015 and 2050?

80 percent

In 2050, what percentage of older people will be living in low and middle income countries?

multispecialty and coordinated care

A growing elderly population requires what specific type of care?

degenerative osteoarthritis

What is an example of a musculoskeletal condition that nearly everyone will experience with age?

degenerative and communicable

Elderly populations suffer from which two types of diseases due to declining physiologic function?

ramps, toilet grab bars, and priority lines

What are three examples of physical structure or process changes communities must implement for the elderly?

decreased physiologic reserve

Which guiding principle notes that elderly organ systems are at higher risk for rapid decline when sick?

muscle mass and strength

Name a physiologic factor expected to decrease in the elderly.

bone density

Name a physiologic factor expected to decrease in the elderly.

exercise capacity

Name a physiologic factor expected to decrease in the elderly.

respiratory function

Name a physiologic factor expected to decrease in the elderly.

thirst and nutrition

Name two physiologic factors related to intake expected to decrease in the elderly?

ability to mount an immune response

What immune system factor decreases in the elderly?

functional and cognitive status

What two statuses are more accurate predictors of health, morbidity, and mortality than just medical diagnosis?

memory, mental status, and decision making

Assessment of cognitive status in the elderly includes which three areas?

independence in activities of daily living

Assessment of functional status focuses on what?

needs and goals of the patient and caregivers

Diagnostic and therapeutic plans should be based on whose stated needs?

surrogate decision makers and advanced directives

What two planning steps are important for critically ill elderly patients?

family, friends, and community

The social context of care requires the physician to consider which three groups?

polypharmacy and drug interactions

What medication-related issue must be noted due to multiple maintenance medications?

falls and injuries

Limitations of mobility make the elderly specifically prone to what?

Comprehensive Geriatric Assessment

What is the multidimensional, interdisciplinary assessment used to evaluate an elderly patient?

medical, psychological, physical function, and socioeconomic context

What four dimensions does the CGA evaluate?

unidentified and potentially reversible problems

What does the CGA help physicians detect?

coordinated and integrated management plan

The CGA helps develop what type of plan for long term care?

history and physical examination

What is the first part of a medical assessment in a CGA?

detailed review of medications

What essential medication step is part of the medical assessment?

neurological assessment

Which specific system assessment is listed under the medical portion of the CGA?

nutritional evaluation

What evaluation is necessary during the medical assessment of an elderly patient?

Katz Index of Independence

What is the proper name for the Katz ADL Index?

eating, dressing, bathing, transferring, toileting, and continence

What six activities are assessed by the Katz ADL index?

Lawton Instrumental Activities of Daily Living

What is the full name for the IADL Scale?

telephone, shopping, food preparation, housekeeping, laundry, transportation, medications, and finances

What eight tasks are assessed by the Lawton IADL scale?

independently, with assistance, or dependent

What are the three ratings used for patients in ADL and IADL tasks?

Tinetti Balance and Gait Assessment

What tool is used to assess strength, gait, and balance?

18 points or less

On the Tinetti assessment, what score indicates a high risk of falls?

19 to 23 points

On the Tinetti assessment, what score indicates a moderate risk of falls?

24 or more points

On the Tinetti assessment, what score indicates a low risk of falls?

16

What is the maximum potential balance score on the Tinetti assessment?

12

What is the maximum potential gait score on the Tinetti assessment?

28

What is the maximum combined score for the Tinetti assessment?

Mini Mental State Examination

What does MMSE stand for?

orientation, registration, attention/calculation, recall, and language

What are the five main categories of the MMSE?

24 to 30

What MMSE score range indicates no cognitive impairment?

18 to 23

What MMSE score range indicates mild cognitive impairment?

0 to 17

What MMSE score range indicates severe cognitive impairment?

Geriatric Depression Scale

What tool uses a series of yes or no questions to screen for depression?

greater than 5

What score on the 15 item Geriatric Depression Scale suggests depression?

cognitive impairment/dementia and depression

What are the two most common psychiatric conditions elderly need screening for?

financial stressors, caregiver concerns, and threats/abuse

A social assessment for the elderly includes checking for what three things?

empty nest syndrome

What is the term for children getting married and moving out of the family house?

multigenerational household

What is the term for grandparents living with children and grandchildren?

custodial or surrogate parenting

What is it called when children live with grandparents while parents work abroad, common among OFWs?

index patient

What term describes the primary patient being evaluated in a family genogram?

unilaterally extended family

In Case 2, what was the family structure of the Santos family?

family in later years

In Case 2, what was the stage of the family life cycle for the Santos family?

Sandwich Generation

What term describes middle age adults caring for both elderly parents and their children?

Club Sandwich Generation

What term describes young old adults taking care of old old parents, children, and grandchildren?

mental health, independence, and access to healthcare

What are three major issues in the later years stage of the family cycle?

unresolved conflicts

What often resurfaces during stressful situations in dysfunctional families?

pace the interview more slowly

When interviewing the elderly, how should the physician adjust the speed?

address the patient first

Who should the physician always address first before the companion or caregiver?

early in the patient care

When should caregivers and family members be involved in the process?

emotional concerns

What should a physician recognize as underlying explicit requests or concerns?

direct evaluation of the elderly patient

Do not make significant treatment changes based on family reports without what?

home visit

What can a physician do to verify the family's report if needed?

Modified Caregiver Strain Index

What tool can be used to screen for caregiver burden?

Filipino

In what language is there a validated local version of the MCSI?

nature of illness, trust, and resources

What are three factors to note in the evaluation of caregiver burden?

silent patients

What term is used to describe primary caregivers of chronically ill elderly patients?

demented or disruptive

What two patient conditions increase the likelihood of caregiver burden?

guilt about anger or resentment

What specific feeling in a caregiver toward the patient increases burden?

conflictual relationship

A history of what kind of relationship between patient and caregiver increases burden?

isolated or lonely

A caregiver is more likely to experience burden if they are depressed and what?

denies the patient diagnosis

Caregiver burden increases when the family does what regarding the diagnosis?

leaves caregiving to one person

What family distribution of work increases caregiver burden?

adult day care and respite care

The lack of which two community programs increases caregiver burden?

not a popular decision

How is nursing home placement generally viewed in Filipino households?

balance between patient and family needs

The decision for nursing home placement should consider what balance?

private assisted living facilities

Home Health Care, Big Hearts, and Happy Nest Care are examples of what in the NCR?

non-profit assisted living facilities

Anawim Home and Kanlungan ni Maria are examples of what?

abandoned by families

Most residents of non-profit homes for the elderly have been what?

24 hour nursing care

Assisted living facilities provide what level of nursing care?

RA 344

Which republic act is the Accessibility Law of 1982?

ramps and steel bars

RA 344 provides the minimum standards for the installation of what in public buildings?

RA 7432

Which 1992 act maximized the contribution of seniors and established the OSCA?

Office of Senior Citizens Affairs

What does OSCA stand for?