Geriatrics

Geriatrics Health and Diagnosis

Geriatric WalkThe syndromes of failure to thrive, pressure ulcers, and falls, common in the elderly, share features that make them particularly challenging. Their etiologies are multifactorial; they require an interdisciplinary approach to maximize care; and they often herald disability; institutionalization, and death. Maintaining open communication with patients and caregivers is vital. It not only empowers them to play a role in care; but also focuses their expectations realistically. Clinicians should continually reassess their objectives, remembering that in elders concern is as much for independence and quality of life as it is for cure. Chronic and degenerative diseases impact quality of life, yet many older adults are active, engaged, and pleasure seeking.

Types of diagnostic concerns: Urinary Incontinence; Depression; Elder Abuse; Movement Disorders; Types of Hearing & Vision; Oral health; Nutrition; Pressure Ulcers; Memory problems. (C. Williams, 2008, Current Diagnosis & Treatment in Family Medicine)

Elder Health Interventions

The focus of treatment planning with the frail elderly patient is always the provision of comfort and the maintenance of independent functioning. Independence is usually the shared goal of patient and clinician. To achieve this in the face of aging and progressive disease, treatment planning must include utilization of community care resources, skillful medical management, and rehabilitation therapies.

Elder Screening Tools:

Mini Mental Status Examination
Geriatric Depression Scale
Functional Assessment Screening In The Elderly
Fall Prevention Training

Multifactorial interventions:

Appropriate use of assistive devices; Exercise programs with balance and gait training; Safety modification of environment; Review of medications; Education on long-term planning; treatment of cardiovascular & postural hypotension. (Gonzales & Kutner, 2008, Current Practice Guidelines in Primary Care) Social Issues & Barriers To Care.

Social Issues & Barriers to Care

The growing number of older adults will present unique challenges to their health care providers and caregivers because of the vulnerabilities that often accompany aging in America . Factors that increase the vulnerability of the elderly may include: Medical chronic illness; economic insecurity; mental health issues including substance abuse; cultural and educational diversity; frailty and dependency including the risk of elder abuse. Despite the financial gains achieved by older Americans in the last century, many still face financial insecurity. It remains to be seen if Medicare reforms will substantially improve the economic well-being and health of elders. In order to meet the needs of the elderly population who live in poverty, health care providers will need to be aware of the multidisciplinary resources that exist in their communities.

Key Elder Care Concepts:

Use a patient-friendly approach; Focus on function and on goals; involve caregivers; Ask about geriatric syndromes (e.g., falls, memory problems, depression; Use assessment tools; Use life expectancy to guide; Prevention efforts; Get health care team help; Connect patients with community resources. (Talmadge & Wheeler, 2007, Medical Management of Vulnerable and Underserved Patients)

National & Local Resources

Sleep and Aging – A Senior Guide to Sleep

Dementia and Sleep Disorders

Diseases and Their Effects on Sleep

Senior Driver’s Safety

Senior Safety Resource

American Association of Retired Persons

The Association of Mature American Citizens, Inc.

NIH Senior health information

RxAssist Volunteers in Health Care

Alzheimer’s Association 800-660-1993

Family Caregiver Alliance 800-445-8106

Elder Abuse 800-962-2873

ElderCare of Alachua County 352-265-9040

Comfort Keepers352-331-7760

ATC (MV) Transport 352-375-2784

United Way Information & Referral- 352-332-4636 or 211

Social Security Administration 800-772-1213

ACCESS program 866-762-2237

Alachua County Social Services 352-264-6750

Haven Hospice 1-800-727-1889

Caregiver Resources Online
by Susie Lyons, MSW, LSCW

Administration on Aging

Alzeimer’s Disease Training

American Academy of Home Care Physicians

American Institute of Stress

Caregiver Newsletter

Department of Elder Affairs

Elder Law, Aging, and Other Internet Resources for Seniors

Mid-Florida Area Agency on Aging – Elder Hotline 1-800-963-5337  Main Office 352-378-6649  Fax:  352-378-1256 and Email:  options@agingresources.org

Seniornet

Social Security

Veterans Administration

Most Dependent to Least Dependent Resource Guide
by Susie Lyons, MSW, LCSW

End of Life Care :

  1. Palliative Care GVAMC � End of Life (2 weeks or less OR symptom management while receiving chemotherapy or radiation treatment).
  2. Inpatient Hospice Care LCVAMC Hospice Unit (last few months of life).
  3. In-home Hospice from a local Hospice (when prognosis is less than 6 months) 24/7 phone access.

Long Term Care in Facility :

•  Funding Sources: Private pay/Medicare/Long Term Health Insurance/Medicaid

•  Community NH (apply for Medicaid with period of spend down. Primary residence, are, some savings not counted as assets

•  Private Pay: Assisted Living Facility (ALF)

•  VA Community Residential Care homes

Short-Term Rehab :

•  VA Geriatric Evaluation and Management (GEM) Intensive Rehab, 3-4 weeks (inpatient)

•  VA Extended Care/Rehab in LC VA NHCU (up to 90 days) less intensive rehab (~$97 co-pay after first 21 days from some people)

Home Based Interventions to Maximize Independence :

•  Advance Illness/Palliative Care Home monitoring with technology

•  Home Based Primary Care (HBPC at home instead of coming out of house to Geri-Firm Primary Care)

•  Lower ADL monitoring Program (LAMP)

•  Home safety evaluation and recommend and procure grab bars, equipment, and access to Home Improvement and Structural Adaptation (HISA Grant), remote monitoring, etc

•  Aid & Attendance claim application thru Vet Service Officer in County where veteran resides.

Special Group of Resources for People Caring for Veteran’s with Dementia

(mid-advanced stages) :

•  Home Health Aid/Homemaker (through Home Health Agency)

•  Either form of Respite:

•  In-patient respite at Lake City VA NHCU twice yearly 13 days each time.

•  In-home respite though VA (2x/mo ~4 hours)

•  In-home respite through Elder Care, Catholic Charities (when available)

•  Adult Day Health Care (Altrusa House open 6:30am � 5:30pm, 2002 NW 36th Avenue, Gainesville, FL 352-377-7708 and (Blessed Trinity 5 SE 17 th St. Bldg L, Ocala, FL 352-671-2823).

Living at Home Alone :

Lifeline 1-800-543-3546 ext 3050 (several companies who offer this service) ~ $38-$40/mo. (free activation coupons available Security Alert through VA that dials 911 immediately. Veteran had to have h/o falls, failed Gait & Balance program.

11/18/08 Susie Lyons, MSW, LC SW

Geriatrics Health Facts

In 1990 4% of the U.S. population was 65 years of age or older; that segment is now more than 13% and it is projected to be over 20% by 2030 – the most rapidly growing age group within the population. {Source: Kyle, L: A Concept Analysis of Healthy Aging. Nurs Forum 2005; 40:45}.

In 2000, 41.6% of adults aged 65+ did not have a high school degree. {North Carolina Study Commission on Aging (2004). Report to the Governor and the 2004}.

More than half (55%) of those ages 55 and older have been diagnosed with arthritis/joint problems. Of those with arthritis, 28% reported that arthritis adverely affected their usual activities and/or the nature and amount of work that they perform (2003). {N.C. Department of Health and Human Resources, Division of Public Health. (2003). The Health of North Carolinians: A Profile, Raleigh, NC).

 Aging & Health A to Z:  Geriatrics – Basic Facts and Information
(http://www.healthinaging.org/aging-and-health-a-to-z/topic:geriatrics/

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