Gerontology Final Exam PDF

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Gerontology Final Exam Formal Caregiving What is formal caregiving (know some examples)? 

A variety of care services done by professionals o Home Health o Assisted Living o Nursing Homes

Be familiar with ADL's and IADL's. 

ADL: Activities of Daily Living o Ambulation o Transfer o Toileting o Bathing o Grooming/Dressing o Eating

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IADL: Instrumental Activities of Daily Living o Communication of some form o Shopping o Cooking o Cleaning o Taking care of money o Paying bills o Managing medication o Being able to enjoy leisure

What percentage of older adults lives in nursing homes? 

4% of population over 65 lives in nursing homes

What are the characteristics of typical nursing home resident? 

Female

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Widow or never married

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White

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Over 80

What is the best predictor of nursing home placement? 

Absence of convoy or support system

What is the difference between Medicare and Medicaid? How do they fund care? 

Medicare: pays up to 100 days if admitted to a nursing home for an acute illness or injury

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Medicaid: health insurance for the poor, including people made poor by nursing home bills

Describe the differences between assisted living, nursing homes, Continuous Care Retirement Communities (CCRCs), etc.  What is culture change? 

The movement from a “traditional” model of care, characterized as “hospital-like” in nature, to a new model that emphasizes personcentered care. This type of care has many forms and many names.

What % of care is formal? What % is informal?  Informal Caregiving What is informal caregiving (know some examples)? 

Comes from naturally existing relationships such as family, friends, church or non-professional services groups

What is the continuum of care for older adults? Be familiar with several services in the continuum. 

Entire spectrum of specialized health, rehab, residential services available to frail/chronically ill

What is the sandwich generation?

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Middle-aged women who care for their children and their parents

What is respite care? Know the benefits of respite care. 

Respite care: time off for the caregiver o Improved functioning o Reduced use of hospital days o Improvements in patient mortality

Be familiar with caregiver support services. 

Who provides the care for older people in their homes?  Know the 10 symptoms of caregiver stress. 

Denial

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Health problems

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Lack of concentration

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Irritability

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Sleeplessness

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Exhaustion

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Depression

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Anxiety

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Social withdrawal

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Anger

Know different types of informal care. 

Spousal caregiving

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Adult children caregiving

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Extended kin

Know the difference between formal care and informal care.

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Formal care is PAID

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Informal care is not

Elder Mistreatment Know what the different type(s) of elder mistreatment are. 

Physical

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Psychological/Emotional

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Financial/Material

Know what type(s) of elder mistreatment are the most commonly reported. 

Abuse

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Self-Neglect

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Exploitation

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Fiduciary Abuse

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Caretaker Abuse

Know the risk factors/reasons for elder mistreatment. 

Understand the process for and barriers to reporting elder mistreatment.  End of Life Be familiar with Hospice and the different roles within the organization. 

Started in the mid-70s

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1982 Medicare payments were authorized

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Hospice refers to any organization

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Provides support services to dying patients and their loved ones

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Stresses care for the person, not the disease

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Interdisciplinary team

Know the difference and similarities between Palliative Care and Hospice.

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Palliative Care: pain control, not hastening or prolonging life

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Hospice:

Be familiar with Kubler-Ross's stages of grief and with the Clusters of Grief. 

Kubler-Ross o Denial o Anger o Bargaining o Depression o Acceptance

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Clusters of Grief o Avoidance o Confrontation o Accommodation

What is grief? 

Deep sorrow, especially caused by someone’s death

How does widowhood affect men and women (are there differences)?  Understand active and passive euthanasia. 

Passive: results from a medical practitioner not doing something. Using no “extraordinary means” to prolong a person’s life

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Active: deliberate intervention to end a patient’s life

Be familiar with the different types of Advanced Directives. 

Durable Power of Attorney for Healthcare (DPOA) o Designates a substitute decision maker o Person named must be 18 or older o Cannot be a healthcare provider o Document must be signed by the person initiating the directive and either witnessed by two people or notarized

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Lying Will

o Gives instructions about not prolonging death artificially o In effect if:

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person is diagnosed with a terminal illness by 2 doctors

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person is in permanent vegetative state

Do Not Resuscitate (DNR) o Gives instructions not to attempt cardiopulmonary resuscitation 

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Success rate of CPR is thought to be much higher than it is 

15% of hospitalized patients survive and return to previous function

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Less than 5% effective in long-term care residents

Guardianship o Court appointed o Person must lack decision-making capacity o Some restrictions on decision-making 

Limitations on withholding or withdrawing life sustaining treatment

What are older adults' views on death? 

Less fearful than younger people about dying o Have completed most important life tasks o Are more likely to be in pain and may view death as an escape o Have lost many friends and family members o Role of life review – Integrity vs. Despair

Know where people want to die and where they actually die. 

90% want to die at home

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60% die in hospitals

Be familiar with Assisted Dying, understand concerns people have with the process and ways to relieve concerns.

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Resident must be 18 or older

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Must be diagnosed with a terminal disease that will lead to death within 6 months; diagnosed by 2 physicians

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Must request lethal drugs 3 times, including in writing, request must be signed by at least 2 witnesses

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Must wait 15 days before getting the prescription

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Must be competent

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Patient must administer the medication themselves o Vulnerable individuals coerced to ease burden of caring for them o Ease pressure to provide better quality palliative care o Less push to find new cures and treatments o God not humans should decide time of death o Some doctors say it’s never morally permissible to kill a patient

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