Geriatric Care and Theories of Aging Flashcards
The Four M's Framework for Age-Friendly Care
The Four M's framework is a guide for age-friendly care that should be incorporated into the care planning process for older adults.
What Matters: This component focuses on the older adult's specific goals, values, preferences, and desired health outcomes.
Healthcare providers should ask: "What is most important?" and "What are the health care goals?"
The resulting care plan must align with these patient priorities.
Medication: Focuses on using age-friendly medications and avoiding those that may cause harm.
Nurses and providers should monitor for side effects, drug interactions, and polypharmacy (the use of multiple medications).
Mentation: Focuses on preventing, identifying, and managing cognitive and mental health issues.
Key areas of concern include dementia, depression, and delirium.
Mobility: Promotes safe movement on a daily basis.
Goal is to prevent falls, functional decline, and muscle loss.
Mentation Assessment Tools
Mini Mental State Exam (MMSE): A tool used to assess various cognitive domains.
Assessment Areas: Orientation, memory, attention, language, and visuospatial skills.
Scoring: Total of points. Lower scores on the scale indicate potential cognitive impairment.
Montreal Cognitive Assessment (MOCA): This tool is noted for being more sensitive for detecting cognitive impairment than the MMSE.
Assessment Areas: Executive function, attention, memory, language, and abstraction.
Scoring: Total of points. A score of > 26 is considered normal.
Mini-Cog: A quick screening tool for cognitive impairment.
Components:
Three-word recall.
Clock drawing test.
Advantages: It is fast, exhibits little education bias, and is particularly useful in primary care settings.
Geriatric Depression Scale (GDS): A tool specifically designed to screen for depression in older adults.
Features: Consists of yes/no questions.
Focus: Emphasizes mood rather than physical symptoms.
Purpose: To detect depression early in the geriatric population.
Medication Management in Older Adults
Polypharmacy:
Definition: Defined as taking or more medications.
Risks: Increased risk of falls, confusion, hospitalization, drug interactions, and noncompliance.
Nursing Actions for Medication Safety:
Review medications regularly.
Assess for duplicate therapies.
Monitor closely for adverse effects.
Adverse Drug Events (ADEs):
Definition: Harm caused by the use of medication.
Examples and Clinical Indicators (i.C.):
Bleeding resulting from anticoagulants.
Hypoglycemia resulting from insulin.
Sedation resulting from benzodiazepines.
Risk Factors for ADEs in Older Adults:
Reduced kidney function.
Reduced liver metabolism.
Use of multiple medications (polypharmacy).
BEERS Criteria:
A tool used to identify medications that may be inappropriate for older adults.
Use: Evaluating medication safety, reducing Adverse Drug Events (ADEs), and improving prescribing practices.
Commonly Flagged Medications: Diphenhydramine (Benadryl), benzodiazepines, and certain sleep medications.
Mobility and Functional Status
Systemic Effects of Immobility:
Musculoskeletal: Leads to muscle wasting, weakness, contractures, and bone loss.
Cardiovascular: Orthostatic hypotension, venous stasis, and increased DVT (Deep Vein Thrombosis) risk.
Respiratory: Atelectasis (collapsed lung) and pneumonia.
Gastrointestinal: Constipation.
Urinary: Potential for urinary issues.
Skin: Pressure injuries (skin breakdown).
Effects of Bed Rest: Even a few days of bed rest can cause significant loss of muscle strength, increased fall risks, and functional decline.
Fall Risk Factors:
Intrinsic Factors: Weakness, poor balance, vision impairment, cognitive impairment, and medications.
Extrinsic Factors: Clutter, poor lighting, loose rugs, and improper footwear.
Importance of Early Mobility:
Promotes: Strength, independence, circulation, pulmonary function, and overall quality of life.
Reduces: Falls, pressure injuries, and the length of hospital stays.
Functional Assessment Metrics
Activities of Daily Living (ADLs): Basic self-care tasks required for daily living.
Categories: Bathing, dressing, toileting, transferring, continence, and feeding.
Katz Index: A system that measures independence in ADLs. A higher function score corresponds to greater independence.
Instrumental Activities of Daily Living (IADLs): More complex tasks required for living independently in the community.
Categories: Managing medications, shopping, cooking, transportation, housekeeping, managing finances, and telephone use.
Lawton's IADL Score: Measures an individual's ability to perform IADLs.
Utility: Helps determine independence levels, need for assistance, safety concerns, placement needs, and quality of life.
Communication and Health History
Communication Barriers: Hearing impairment, vision impairment, and cognitive impairment.
Best Practices for Assessing Older Adults:
Establish rapport before beginning the assessment.
Avoid making assumptions about the patient.
Use open-ended questions to gather more detailed information.
Include caregivers in the process when appropriate.
Important Health History Components:
Functional Status: Can the patient perform ADLs and IADLs?
Social Support: Determining who helps the patient at home.
Medications: Comprehensive list including prescriptions, Over-The-Counter (OTC) drugs, and supplements.
Cognitive Ability: Screening for any memory or decision-making concerns.
Comprehensive Assessment Frameworks
FANCAPES: A holistic assessment framework consisting of:
F: Fluids (hydration status).
A: Aeration (respiratory function).
N: Nutrition (nutritional intake and status).
C: Communication (ability to communicate needs).
A: Activity (mobility and exercise).
P: Pain (pain assessment).
E: Elimination (bowel and bladder function).
S: Socialization (social support and interaction).
SPICES: A rapid screening tool for identifying common geriatric syndromes:
S: Sleep disorders (sleep disturbances).
P: Problems with eating (nutritional concerns).
I: Incontinence (bladder/bowel issues).
C: Confusion (cognitive changes).
E: Evidence of falls (fall history and risk).
S: Skin breakdown (pressure injuries and skin problems).
Biological Theories of Aging
Free Radical Theory: Cells are damaged by unstable molecules called free radicals; this damage accumulates over time.
Key Concept: Oxidative stress leads to aging.
Telomere Theory: Telomeres shorten with each cell division; eventually, telomeres become so short that cells stop dividing.
Key Concept: Shorter telomeres = cellular aging.
Mitochondrial Dysfunction Theory: Mitochondria become less efficient over time, leading to less energy production and more cellular damage.
Key Concept: The cell's "powerhouses" wear out.
Chronic Inflammation (Inflammaging): A state of low-level inflammation that is persistent throughout life.
Key Concept: Persistent inflammation accelerates the aging process and contributes to chronic disease.
Psychosocial Theories of Aging
Activity Theory: Suggests that people age successfully when they remain active and socially engaged.
Example: Participating in clubs and volunteer work.
Continuity Theory: Suggests that older adults maintain their previous habits, roles, and responsibilities as they age.
Example: A retired teacher who continues to tutor children.
Disengagement Theory: Proposes that aging involves a gradual and inevitable social withdrawal.
Example: Decreased participation in community activities.
Gerotranscendence: Suggests that older adults shift their focus from material concerns toward meaning, reflection, and wisdom.
Example: Increased spirituality and life reflection.
Role Theory: The loss or gain of roles affects how an individual adjusts to aging.
Example: Retirement, becoming a grandparent, or the loss of a spouse.
Cognitive - Functional Domains
Memory: The ability to store and retrieve information.
Example: Remembering appointments.
Executive Function: The ability to plan, organize, make decisions, and problem-solve.
Example: Managing finances.
Attention: The ability to focus and concentrate.
Example: Following multi-step instructions.
Orientation: Awareness of person, place, time, and situation.
Example: Knowing today's date or current location.