Care of the older adult notes
Many older patients are prescribed multiple drugs, take over-the-counter medications, and are often prescribed additional drugs to treat the side effects of the medications that they are already taking. The increase in the number of medications often leads to polypharmacy, which is defined as the prescription, administration, or use of more medications than are clinically indicated in a given patient. One widely used ADL tool is the Barthel Index : measure functional levels of self-care and mobility, and it rates the ability to feed and groom oneself, bathe, go to the toilet, walk (or propel a wheelchair), climb stairs, and control bowel and bladder. The original ADL tool was developed by Katz
Several interventions that may help the prescriber to prevent polypharmacy include knowing all medications, by both brand and generic name, being used by the patient; identifying indications for each medication; knowing the side effect profiles of the medications; eliminating drugs with no benefit or indication; and avoiding the urge to treat a drug reaction with another drug. Patient education on the risks of polypharmacy may help the patient as well. The Mini-Cog: The screening consists of a three-item recall and a clock-drawing test. This reliable tool can assist nurses with early detection of cognitive problems. Mini Mental State Examination (MMSE): measure change in cognitive impairment. It measures orientation, registration, attention and calculation, short-term recall, language, and visuospatial function. *Dementia is a permanent progressive decline in cognitive function Of the five senses—hearing, vision, smell, taste, and touch—it is the occurrence of diminished vision and hearing that seems to have the greatest impact on older adults. Problems with vision or hearing can have negative effects on social interaction and hence on social and psychological health. Presbyopia refers to an age-related change in vision.
Presbycusis refers to age-related progressive hearing loss. Age-related macular degeneration, the deterioration of central vision, Assessing Older Adults cognitive-testing tools such as the Mini–Mental State Exam or the Orientation–Memory–Concentration Test (OMCT).3 Both tools assess orientation to time and place, short-term memory, and concentration. The CAM is a standardized instrument developed for clinicians to identifydelirium, an acute change in mental status from baseline, quickly and accurately. Montreal Cognitive Assessment (MoCA© Version 7.1) was developed as a quick screening tool for MCI and early Alzheimer’s dementia. It assesses the domains of attention and concentration, executive functions, memory, language, visuoconstructional skills, conceptual thinking, calculations, and orientation
The interdisciplinary group or team (IDG/IDT):
Registered nurse—coordinates the plan of care for each patient Health Promotion
Healthy people 2010- preventative measures for ages 50-64
Healthcare Policy and Reform
Medicare is Title XVIII of the Social Security Act; it was passed in 1965, after years of trying to provide some kind of universal health insurance. It is an insurance program for those 65 or over who have paid into the Social Security system, the railroad fund, or are diagnosed with end stage renal disease. Activity: Healthcare Policy and Reform
In general, you should apply for Medicaid if your income is low and you match one of the descriptions below. Medicare is a Federal health insurance program for people 65 years or older, certain people with disabilities, and people with end-stage renal disease (ESRD). Medicare
Medicare is an insurance program. Medical bills are paid from trust funds which those covered have paid into. It serves people over 65 primarily, whatever their income; and serves younger disabled people and dialysis patients. Patients pay part of costs through deductibles for hospital and other costs. Small monthly premiums are required for non-hospital coverage. Medicare is a federal program. It is basically the same everywhere in the United States and is run by the Centers for Medicare & Medicaid Services, an agency of the federal government. Medicaid
Medicaid is an assistance program. Medical bills are paid from federal, state and local tax funds. It serves low-income people of every age. Patients usually pay no part of costs for covered medical expenses. A small co-payment is sometimes required. Medicaid is a federal-state program. It varies from state to state. It is run by state and local governments within federal guidelines. To qualify for Medicaid, an individual must fit into a category of eligibility and meet certain financial and resource standards. Medicaid provides three types of health protection: 1) health insurance for low-income families and people with disabilities, 2) long-term care (LTC) for older Americans and persons with disabilities, and 3) supplemental coverage for low-income Medicare beneficiaries for services not covered by Medicare Living Environment
Annual vaccination against influenza is recommended for all adults 65 years of age or older because more than 90% of the deaths from influenza occur in this population. Periodic boosters of tetanus vaccine, traditionally given every 10 years in the United States, are recommended for older adults by the USPSTF. The Beers List of medications to be avoided in the elderly has become a national guideline for prescribers and pharmacists in the United States (Fick etal., 2003). These medications include long-acting benzodiazepines, sedative or hypnotic agents, longacting oral hypoglycemics, analgesics, antiemetics, and gastrointestinal antispasmodics. Maintaining Functional Independence
“Elderly patients with unintentional weight loss are at higher risk for infection, depression and death” U.S. Public Health Service published the report Promoting Health/Preventing Disease: Objectives for the Nation. This 1980 report outlined 226 objectives for the nation to achieve over the following 10 years. Healthy People 2000, was initiated by the U.S. Public Health Service in another effort to reduce preventable death and disability for Americans. Healthy People 2010 initiative; however, the number of objectives has increased to 467, and these are distributed over 28 priority areas. Frailty is perceived as a general decline in the physical function of older adults that can increase vulnerability to illness and decline. Defining characteristics include unintentional weight loss of more than 10% in the prior year, feelings of exhaustion, grip strength in the weakest 20% for age, walking speed in the lowest 20% for age, and low caloric expenditure.