Aging and Health: Understanding the Challenges of Older Adults, Exams of Nursing

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Health Care of the Older Adult Final Exam with

Correct Solutions

1. What does life expectancy depend on (2)? who lives longer? what is the average age of living back then and now? - Correct Answer o The proportion of Americans 65 years of age and older has tripled in the past 100 years  Life expectancy varies by gender and race - typically women live longer than men (especially white women)  Life expectancy has risen dramatically in the past 100 years --> 1900— years of age, 2009—78.8 years of age
2. What is gerontologic/geriatric nursing? What is gerontology? What is geriatrics? and what is the goal of geriatrics? - Correct Answer o Gerontologic/geriatric nursing: nursing process applied to older adults in all environments, including acute, intermediate, skilled care, and in the community  Gerontology: combined biologic, psychological, sociologic study of older adults within their environment  Geriatrics: the practice that focuses on the physiology, pathology, diagnosis and management of the disorders and diseases of older adults  Goal of care: promoting and maintaining functional status & helping older adults identify and use their strengths to achieve optimal independence
3. What is the main cause of pain and disability in older adults? What are the leading causes of death, mention 5? - Correct Answer o Chronic conditions (which some are preventable/treatable) - are the major cause of disability/pain in older adults  Leading causes of death:  Heart diseases & Cancer (malignant neoplasms) - two leading causes of death in older population, but the numbers have been decreasing  Chronic obstructive pulmonary diseases, Stroke & Alzheimer disease
4. What two services influence the patient to maintain good health and functional independence? What does nurses promote in older adults, and what happens if they don't? - Correct Answer o Older people are more likely to maintain good health and functional independence if --> Encouragement and Community-based support services are present  Nurses promote lifelong health behaviors for their pts - bc the impact of unhealthy behaviors can result in chronic disease
5. Cardiovascular changes, explain the general changes in the heart of an older adult (2)? explain the more specific changes (6)? what are the recommendations for the patient in regards to orthostatic hypotension (4)? - Correct Answer o

Age-related changes reduce the efficiency of the heart & contribute to decreased compliance of the heart muscle  Changes include:  Myocardial hypertrophy (left ventricle): resulting in decreased cardiac output  Increased fibrosis & calcified tissues: resulting in reduced stroke volume due to the heart valves becoming thicker and stiffer & the heart muscle and arteries losing their elasticity  Calcium and fat deposits accumulate in the arterial walls & veins become stiff/tortuous (increasing arterial resistance) --> resulting in hypertension and increased workload  Slower heart recovery rate to stress (such as during exercise)  Orthostatic hypotension - due to decreased baroreflex sensitivity (especially w/ alpha blockers)

• Pt is advised to rise slowly from positions, avoid straining, consume 5/6 small meals, avoid extremes in temperature  Age-related changes in the hematopoietic system - lead to increased rates of anemia

6. Do younger adults and older adults share the same demonstration of symptoms? what is the S/S an older adult can present thats not typical for a MI? When a patient complains of indigestion or upper extremity pain, what needs to be considered? - Correct Answer · Older adults often present w/ different symptoms than younger adults  These Pts w/ heart disease - may present w/ dyspnea or neurologic symptoms rather than substernal chest pain that's typically associated w/ myocardial ischemia

• When pt complains of symptoms related to digestion (burning or sharp pain/discomfort in upper body), breathing, and upper extremity pain - cardiac disease must be considered

7. How quickly does respiratory changes occur in the older adult and how does the patient react? what are the changes in the respiratory system in an older adult (3)? what is the most important risk factor of respiratory illness? what do you want to educate your patient on in regards to that? what are the typical S/S an older patient exhibits when having a respiratory disease (5)? what are some activities that may help maintain respiratory function (4)? - Correct Answer o Age-related changes may be subtle and gradual - healthy older adults are able to compensate for these changes

• changes:  Diminished respiratory efficiency & Reduced maximal inspiratory and expiratory force: occur as a result of calcification and weakening of the muscles of the chest wall  Lung mass decreases and residual volume increases  Smoking most significant risk factor - advised to educate pt on smoking cessation

 Older adults typically exhibit fatigue, lethargy, anorexia, dehydration & mental status changes - when respiratory diseases manifest  Activities to help maintain adequate respiratory function: exercise, increased fluid intake, pneumococcal & flu vaccine, and avoidance of people who are ill

8. Integumentary system, what can aging affect? what are the changes of the skin in an older adults (5)? What are the recommendations for the patient (6)? - Correct Answer o Aging can interrupt all functions of the skin and affect appearance  Epidural proliferation decreases à resulting in dermis becomes thinner  Elastic fibers are reduced, and collagen becomes stiffer  Subcutaneous fat diminishes & less vasodilation à results in the body being less able to conserve body heat (seen in the face the lack of fullness) - Those changes lead to lack of fever and reduced tolerance to temperature extremes/sun exposure  Loss of resiliency with wrinkling and sagging of the skin - skin is drier and more susceptible to injury/infections/burns  Hair pigmentation may change, and balding may occur (genetic factors strongly influence this) · Advise patient - not smoke, avoid exposure to sun, use sunscreen 15 SPF or higher, protective clothing, using emollient skin cream containing petrolatum/mineral oil, avoid hot baths, & maintain optimal nutrition/hydration
9. Reproductive system, what are some influences in men and women that can reduce sexual activity (5)? what are the changes in females (6)? what are the changes in males (5)? - Correct Answer o Sexual activity declines with the loss of a partner, primarily for women as a result of widowhood and for men as a result of poor health, erectile dysfunction, medications, and emotional factors  Female: ovarian production of estrogen and progesterone decline w/ menopause - Changes: vaginal narrowing, decreased elasticity, decreased vaginal secretions, atrophy of the uterus and ovaries, and decreased muscle tone resulting in relaxed vagina and perineum  Male: less firm testes but may continue to produce viable sperm up to 90 years of age, diminished production of testosterone (at about age 50) - Decreased libido and erectile dysfunction may develop due to health or medications
10. What are the significant changes at occur in the genitourinary system at age 90? what can renal function changes be due to (2)? what are the general changes (3)? what is a GU issue an MALE older adult may have (1) and the consequences (2)? what is a GU issue for females (3)? what type of women are at risk for urge/stress incontinence? what exercise is recommended? - Correct

Answer o Loss of nephrons/kidney mass is not significant until 90 years of age & changes in renal function may be due to a combination of age and pathological conditions (Ex. HTN)  Changes include:  Decreased filtration rate  Diminished tubular function with less efficiency in reabsorbing and concentrating the urine  Slower restoration of acid-base balance in response to stress  Male: benign prostatic hyperplasia - causing a gradual increase in urine retention and overflow incontinence  Female: relaxed perineal muscles, detrusor instability (urge incontinence), urethral dysfunction (stress urinary incontinence) - women who have had difficult vaginal births are at risk for urge/stress incontinence (do Kegels)

11. Gastrointestinal system, what are the changes the older adult experiences (7)? - Correct Answer o Decreased sense of thirst, smell, taste - altering satisfaction with food  Decreased salivation - older adults report dry mouth as a result of medications and disease  Difficulty chewing and swallowing food - associated with lack of teeth or disease  Delayed esophageal, gastric emptying - resulting in delated emptying of stomach contents & early satiety  Diminished secretion of gastric acid and pepsin - reduces absorption of iron, calcium & vitamin B  Reduced gastrointestinal motility (ex. DM) - resulting in constipation (advise to eat high fiber/low fat diet/fluids)  Difficulty swallowing (dysphagia) - risk for aspiration pneumonia (can occur in the absence of coughing)
12. What is the recommended nutritional health for an older adult (3)? why? what are some issues that older adults run into when it comes to nutrition? what supplements are recommended for the patient? what type of diseased older adults are risk for malnutrition (2)? - Correct Answer o Older adults require fewer calories & require more nutrient-rich, healthy diet in response to alterations in body mass and a more sedentary lifestyle  Recommendations include reducing fat intake while consuming sufficient protein, vitamins, minerals, and dietary fiber for health and prevention of disease  Budgetary constraints and physical limitations may interfere with food shopping and meal preparation  Recommendation: intake daily calcium supplements (1200mg) to maintain bone health  Hospitalized older adults at risk for malnutrition - especially those w/ cognitive impairment or dementia

13. Sleep, what are some factors that affect sleep quality (5)? what are some consequences of poor sleep (4)? what are the recommendations for sleep (7)? - Correct Answer Factors that affect sleep quality:  Respiratory problems during sleep (ex. HF/COPD)  Restless leg syndrome  Nocturia or incontinence, prostate hypertrophy  Pain (Ex. osteoarthritis)  Dementia or social isolation (loneliness)
14. Sleep - Consequences of Poor Sleep  Cognitive decline  Increase risk for falls  Daytime fatigue  Reduced physical and mental health --> resulting in reduced quality of life · Recommendations: use bed only for sleep/sex, maintain consistent bedtime routine, avoid napping, limit alcohol intake, avoid stimulants (Ex. coffee/nicotine), reduce liquid intake to avoid nocturia, engage in physical activity
15. Musculoskeletal system, what are the changes that occur in the older adult (2)? what are the recommendations for the patient (4)? - Correct Answer o Changes:  Alterations in bone remodeling leading to --> Loss of bone density, muscle strength, size & Deterioration of muscle fibers and cell membranes  Degenerated joint cartilage · Recommendation: encourage older adults to exercise ("use it or lose it") such as aerobic exercises (ex. walking), resistance and strength training and flexibility, encourage calcium and vitamin D intake
16. Neurological system, what are the changes that occur in an older adult (4)? what is the recommendation (2)? and what is NOT a normal process of aging? - Correct Answer o Homeostasis is difficult to maintain but older adults adapt and function adequately  Changes:  Decreased nerve cells— decreases contribute to small loss of brain mass  Decrease in the synthesis and metabolism of major neurotransmitters - Reduced speed in nerve conduction à resulting in older people taking longer to respond and react  Increased confusion with physical illness, loss of environmental cues  Reduced cerebral circulation (becomes faint, loses balance)  Recommendation: advise adequate nutrition and absorption of Vitamin B12 for neurologic health  Memory loss (cognitive decline) is NOT normal with aging
17. What is sensory loss? what is sensory deprivation? - Correct Answer o Sensory loss - inability to see or read, hear, or discriminate taste (Pt more likely to be far sighted, difficulty w/ close sight ex. reading a book)

 Sensory deprivation - is the absence of stimuli in the environment or inability to interpret existing stimuli (perhaps as a result of sensory loss)

18. Sensory system, what are the changes that occur in the older adult (4)? what are the increased risk of having macular degeneration? is cataracts treatable? what is changes in smell related? - Correct Answer o Changes:  Vision - diminished ability to focus on close objects; inability to tolerate glare, difficulty adjusting to changes of light intensity (due to slow pupil dilation), decreased ability to distinguish colors (especially blue from green) - Cataracts is highly treatable with surgery of insertion of new lens  Macular degeneration (primary cause of loss of vision) - affects central vision, color perception and fine detail affecting reading, driving, and seeing faces - RISK increased in patients with family history or smoking  Hearing: decreased ability to hear high-frequency sounds to a generalized loss of hearing (known as presbycusis) - Older adults have difficulty hearing high frequency sounds and sounds that sound alike  Taste and smell: decreased ability to taste, smell - Sweet tastes are dull in older adults which results them in adding more sugar - Changes in smell are related to loss of cells in nasal passages & in the olfactory bulb
19. What is ageism? what are older adults afraid of? do older adults have positive or negative images in society? - Correct Answer o Ageism - prejudice or discrimination against older adults, predominates in society (based on stereotypes)  Fear of aging and inability of many to confront their own aging process may trigger ageist beliefs  Negative images in society - older adult should understand the aging process and respect it
20. What are common stressors among older adults (5)? what is coping? what are the coping strategies older adults may have? do older adults have ALOT or less amount of resources to deal with stress? - Correct Answer o Common stressors:  Normal aging changes that impair physical function, activities, and appearance  Disabilities from injury or chronic illness (ex. arthritis)  Social and environmental losses related to loss of income  Decreased ability to perform previous roles and activities  Deaths of significant others  Coping

 Abilities to adapt to change, make decisions, and respond predictably are also determined by past experiences  Often has fewer choices and diminished resources to deal with stressful events  Many rely strongly on their families and spiritual beliefs for comfort during stressful times

21. Living arrangements for older adults (read over, kinda) what is a ALF? and what is a long-term care facility? - Correct Answer o 90% live in the community  3.4% reside in nursing homes  81% Live at home or with family  Continuing care retirement communities  Assisted living facilities - provides a degree of independence for the patient with minimal nursing assistance  Long-term care facilities - offer continuous nursing care
22. Nursing management for older adults (Read over) - Correct Answer o Supporting cognitive function  Good sleep and hygiene can improve cognition, as can treatment of depression and anxiety  Promoting physical safety - in order to prevent falls and impaired skin integrity  Promoting independence in self-care activities  Reducing anxiety, agitation  Improving communication  Providing for socialization, intimacy needs  Promoting adequate nutrition  Promoting balanced activity, rest  Supporting home- and community-based care
23. What is polypharamacy? what should you advise the patient when they visit their doctors? what are the changes of drug absorption, metabolism, distribution, and excretion in the older adult may be due to? - Correct Answer o Polypharmacy: administration of multiple medications at the same time; common in older persons with several chronic illnesses (advise pt on medical visits, to bring all the medications that they are taking)  Aging changes alter drug:  Absorption - may be affects by changes in gastric pH & decrease in GI motility  Metabolism - due to decreased size of the liver or diminished intestinal and portal vein blood flow - decreased metabolism/delay breakdown of meds can result in prolong action of the med  Distribution - may be altered as a result of decrease in body water and increase in body fat

 Excretion - due to decreased renal blood flow or loss of functioning nephrons (may stay in body longer)

24. assessment of knowledge of medication use, and compliance (read over, kinda) What is the dosage in which older adults should start taking medications? what should you encourage the medication regimen to be? - Correct Answer o Need adjustment of dosage due to age; "start low, go slow" - especially with antihypertensives  Assess knowledge of medications and use  Any medication is capable of altering nutritional status and appetite, as they can cause N/V, irritate the stomach, cause constipation or diarrhea, and decrease absorption of nutrients  Review need for medication, coordination of prescriber  Factors that affect compliance - The number of medications prescribed, the complexity of the regimen, difficulty opening containers, inadequate patient education, financial cost, and disease or medication interfering with the patient's life  Keep medication regimen as simple as possible  Assess patients understanding of when and how to take each medication, as well as the purpose of the medication - in order to promote medication compliance
25. Are older adults likely to seek help for mental heath symptoms? - Correct Answer o Older adults are less likely to acknowledge or seek treatment for mental health symptoms
26. What is Depression? when can it occur (3)? what are the S/S an OLDER adult may display (8)? risk for suicide is increased in what population? when depression and medical illness coexist, what occurs? What is the treatment for mild depression (5) and major depression (2)? - Correct Answer o Older adults are less likely to acknowledge or seek treatment for mental health symptoms  Depression: most common affective or mood disorder of old age  Can occur after a major precipitating event or loss and is often related to chronic illness or pain  Older person may exhibit more subtle signs of depression such as fatigue, diminished memory and concentration, feelings of worthlessness, sleep disturbances, appetite disturbances with excessive weight loss or gain, restlessness, impaired attention span and suicidal ideation  Risk for suicide is increased - especially in white older adult men  When depression and medical illness coexist - neglect of the depression can impede physical recovery  Treatments for Depression: - Mild depression: nonpharmacologic measures such as exercise, bright lighting, increasing interpersonal interactions, cognitive therapy, and reminiscence therapy

• Major depression: antidepressants and short-term psychotherapy, combined use is effective in older adults

27. Why can substance abuse occur? and how do you assess the older adult patient for this? - Correct Answer o Substance abuse caused by misuse of alcohol and drugs may be related to depression  Assessing for drug and alcohol use with direct questions in a non- accusatory manner should be part of the routine physical assessment
28. What is delirium? what can occur if this is not treated (3)? what are the S/S the patient may present (8)? What are the causes of delirium (10)? nursing considerations (what is the patient at risk for? what do you need to monitor in the patient? what is a very common cause of this in older adults? what is the recommended environment for the pt? what else would you recommend? can delirium be mistaken for dementia? what is the differentiation? - Correct Answer o acute, confused state that begins with disorientation (is a medical emergency)  If not immediately evaluated and treated, can progress to changes in level of consciousness, irreversible brain damage, and sometimes death  Patients may experience altered level of consciousness, ranging from stupor (hypo alert-hypoactive) to excessive activity (hyperalert- hyperactive); alternatively, they may have a combination of these two types

• Thinking is disorganized, short attention span, hallucinations, delusions, fear, anxiety, and paranoia may also be evident  Delirium causes: physical illness, surgery, medication or alcohol toxicity, dehydration, fecal impaction, malnutrition, infection, head trauma, lack of environmental cues, and sensory deprivation or overload  Nursing Considerations
• Delirium increases the risk for falls, nutritional and fluid intake should be supervised and monitored.
• MANY TIMES, the acute confusion is caused by an UTI in the older adult
• Quiet and calm environment, encourage familiar environmental cues and communication with family and friends
• Sometimes delirium may be mistaken for dementia · Changes noted that are long term is more so dementia, whereas changes that are abrupt is more so delirium

29. What is the onset of dementia? what accounts for 70% of dementia? what are other non-alzheimer's dementias? what is vascular dementia due to? - Correct Answer o Symptoms subtle in onset and often progress slowly until they are obvious and devastating  Alzheimer's most common: accounts for 70% of dementia  Other Non-Alzheimer's dementias include degenerative, vascular, neoplastic, demyelinating, infectious, inflammatory, toxic, metabolic, and psychiatric disorders (ex. Parkinson's)

• Vascular dementia - due to hypoxia and ischemia from HTN results in diminished blood flow to the brain and can lead to infarcts

30. What is Alzheimers disease? what can it be caused by (7)? what age group of older adults is affected by this? is this a normal aging process? what are the two types of Alzheimers? - Correct Answer o Complex brain disorder that begins insidiously and is characterized by gradual losses of cognitive function and disturbances in behavior and affect.  Caused by a combination of various factors that may include genetics, neurotransmitter changes, vascular abnormalities, stress hormones, circadian changes, head trauma, and the presence of seizure disorders.  Affects half of those 85 and older and is Not a normal aging process  Two types: Familial/early onset and Sporadic/late onset (this is the most common one)  Familial/early onset: frequently associated with genetic mutations (occurs in less than 1% of cases) and occurs in middle aged adults
31. What is the pathophysiology of Alzheimer's disease? what cells are mostly affected? - Correct Answer · Pathophysiology  Uncertain but the disease includes specific neuropathologic and biochemical changes that interfere with neurotransmission

• These changes consist of neurofibrillary tangles (tangled masses of nonfunctioning neurons) and senile or neuritic plaques (deposits of amyloid protein, part of a larger protein called amyloid precursor protein in the brain)
• Cells that use the neurotransmitter acetylcholine are primarily affected · At the biochemical level, the enzyme active in producing acetylcholine, which is specifically involved in memory processing, is decreased

32. What are the clinical manifestations of Alzheimers in the beginning (2)? further progression of the disease (10)? and then even more intensified symptoms as the disease progresses (3)? - Correct Answer o Clinical Manifestations  Early stages - forgetfulness and subtle memory loss can occur  Further progression - patients lose their ability to recognize familiar faces, places and objects; may become lost in familiar environments

• Repeat stories or questions, the ability to formulate concepts and think abstractly disappears, patient may be unable to recognize the consequences of their actions and exhibit impulsive behaviors
• Patient may become depressed, suspicious, paranoid, hostile and even combative
• Progression of the disease intensifies symptoms - speaking skills deteriorate to nonsense syllabus agitation and physical activity increase, and pt may wander at night

33. What is the assessment and diagnostic findings of Alzheimers disease (3)? what is the medical management of Alzheimers (3)? what is the primary goal? how often should patient be reevaluated? - Correct Answer o Assessment & Diagnostic Findings  Official diagnosis is at autopsy; AD is a diagnosis of exclusion; a diagnosis of probable AD is made when the medical history, physical examination, and laboratory tests have excluded all known causes of other dementias - Diagnostics used - CBC, chemistry profile, vitamin b12 and thyroid hormone levels, screening w/ electroencephalography, CT, MRI and examination of the cerebrospinal fluid  Medical Management  Primary goal: to manage the cognitive and behavioral symptoms - No cure, but there is several medications that can slow the progression of the disease (Ex. Hydrochloride (Aricept), Rivastigmine Tartrate (Exelon)) - Behavioral problems can be managed by behavioral and psychosocial therapies - Depression and behavioral problems can be treated pharmacologically  Patient should be reevaluated routinely, as the disease can progress and change S/S
34. What are some safety precautions used for Alzheimers patients? mention a few - Correct Answer · Safety is biggest concern with Alzheimer patient  Safety precautions: install lock in the doors, bed on the lowest position and side rails up, bed close to the nursing station, put label on patient saying where to return, put all knifes away, label room/drawers/or other items as needed, reorient client to person place and time as needed, ID bracelet, keep daily routine as consistent as possible, and provide realistic information about that increased anxiety - Put alarms on doors and windows as the patient may try to leave at night - Patients experience more confusion at night - due to sundowners' syndrome (therefore, lights are helpful)  Do not argue with patients who have AD - try to reason with them
35. Nursing management for Alzheimers, mention ways to Support cognitive function, promote physical safety, and promoting independence in self-care activities - Correct Answer o Supporting cognitive function  A quiet, pleasant manner of speaking, clear and simple explanations, and the use of memory aids and cues help minimize confusion and disorientation and give patients a sense of security  Ex. displayed clocks and calendars, color coding the doorway to help pt know which is their room  Promoting physical safety

 All obvious hazards are removed, and handrails are installed, adequate lighting, prohibit driving  Promoting independence in self-care activities  Such as simplify daily activities by organizing them into short, achievable steps so that the patient experiences a sense of accomplishment

36. Nursing management for Alzheimers, mention ways to reduce anxiety and agitation, improve communication, providing for socialization and intimacy needs
    • Correct Answer o Reducing anxiety and agitation  Environment should be kept familiar and noise free  If patient experiences a catastrophic reaction (which is an overreaction to excessive stimulation), patient may be combative and agitated - Methods to calm patient: move pt to familiar environment, music, stroking, rocking, or distraction  Improving communication  Use clear, easy to understand sentences to convey messages; listens and simple written instructions serve as reminders that have been proven to be helpful, & nonverbal communication (in later stages of disease)  Providing for socialization and intimacy needs  Socialization w/ friends can be comforting, encourage pt to participate in simple activities and hobbies  Having a pet may provide stimulation, comfort and contentment
37. Nursing management for Alzheimers, mention ways to promote adequate nutrition, promote balance activity and rest, and supporting home, community and transitional care - Correct Answer o Promoting adequate nutrition  Food is cut into small pieces to prevent choking, and liquids should be easy to swallow if they are thickened  Promoting balanced activity and rest  Pt w/ dementia exhibit sleep disturbances, wandering and behaviors that may be inappropriate - These occur due to unmet underlying physical or psychological needs  Supporting home, community and transitional care  Respite care is a commonly provided service in which caregivers can get away from the home for short periods while someone else tends to the needs of the patient
38. What is the geriatric triad? - Correct Answer cognitive changes, falls, incontinence
39. Older adults may experience impaired mobility, how do you avoid this from happening? what 2 things can older adults experience due to impaired mobility? and what is the most common type of fracture in older adults? - Correct Answer o Impaired mobility

 To avoid immobility, older adult is encouraged to stay as active as possible  Even in hospitalization bed rest, patient should perform active ROM and strength exercises  Dizziness  Falls and falling - hip fractures are common among older patients

40. Why does urinary incontinence occur in older adults? older adults are susceptible to infection, what is recommended for them to have in order to reduce sickness? why do older adults have altered pain and febrile responses? what temperature is considered a system symptom signaling infection? - Correct Answer o Urinary incontinence  Detrusor hyperactivity w/ impaired contractility is common among older patients  Susceptibility to infection - flu and pneumococcal vaccine should be given to patient  Altered pain, febrile responses  The response to pain may be lessened bc of reduced acuity of touch, alterations in neural pathways, and diminished processing of sensory data; temperature of 100 F w/ systemic symptoms signal infection
41. Altered emotional impact in older adults and altered systemic response in older adults (read over) - Correct Answer o Altered emotional impact  Older adults believe "you are as old as you feel"  An illness that requires hospitalization or a change in lifestyle is an imminent threat to well being  Nurses must recognize the implications of fear, anxiety and dependence in older patients  Altered systemic response  Older adults may be unable to respond effectively to an acute illness or, if a chronic health condition is present, they may be unable to sustain appropriate responses over a long period
42. What is physical abuse associated with in older adults? what are the other forms of abuse? what do you need to do as a nurse? - Correct Answer o Physical abuse - associated with staff misconduct in long-term care facilities, or family members, paid caregivers  Other forms of abuse - Psychosocial, Emotional, Sexual, Abandonment, neglect, and Financial exploitation  During health history assessment, older adults should be asked about abuse in private  As a nurse, you have to report any forms of abuse detected
43. Potential economic effects (read over, kinda) what is hospice services? and what is their focus? - Correct Answer o Social services (ex. Medicare, Medicaid, supplemental security income, section 202 housing, senior centers)

 Health care costs of aging - two major programs that finance health care à Medicare and Medicaid  Home health care  Hospice services à program of supportive and palliative services for patients w/ advanced illness  Their focus is quality of life by focusing on symptom management, pain control & emotional support  Aging with a disability

44. Providing resources to family caregivers (Read over) - Correct Answer o Informal or unpaid family caregivers provide most of the long-term care to people in the community  REACH OUT  Evidence based intervention to promote health and well-being for people who care for others with Alzheimer's disease or dementia