Chapter 5

Question 1

Define the concept of a disease trajectory.

Answer 1

Concept that recognizes that chronic illnesses have multiple phases

Question 2

Describe the 7 phases of the trajectory model of chronic illness.

Answer 2

1. Onset: s/s are present, disease is diagnosed
2. Stable: Illness course and symptoms controlled by tx plan, pt is able to maintain everyday activities.
3. Acute: Active illness w/ severe symptoms unrelieved. Hospitalization may be needed for management.
4. Comeback: Gradual return to an acceptable way of life.
5. Crisis: Life threatening situation occurs, emergency services are necessary.
6. Unstable: Unable to keep symptoms or disease course under control. Life becomes disrupted while pt works to regain stability. Hospitalization is not required yet.
7. Downward: Gradual and progressive deterioration in physical or mental state. Accompanied by increase in disability and symptoms. Continuous change in everyday life activities.
8. Dying: Pt has to relinquish everyday life interests and activities, let go, and die peacefully. Includes weeks, days, and hours preceding death.

Question 3

Describe the 7 tasks of people with chronic illnesses.

Answer 3

1. Preventing and managing a crisis: Understanding potential for crisis and how to prevent or modify the threat (adhering to prescribed medical plan. Knowing s/s of onset, crisis, and exacerbation as well as create a plan for each).
2. Carrying out prescribed tx plan: maybe challenging (degree of difficulty) or impacts lifestyle (time consuming)
3. Controlling symptoms: Modifying lifestyle or living situation to maintain safety (encourage independence in decision making and collaborate w/ HCP)
4. Reordering time: change schedule and or eliminate activities.
5. Adjusting to change in the course of disease: including the chronic illness and adjusting to the necessary lifestyle changes.
6. Preventing social isolation: pt may choose to withdraw or others may withdraw from pt.
7. Attempting to normalize interactions with others: managing symptoms to take focus off of disability/disfigurement

Question 4

Describe the key factors that impede health care access in rural older adults. (5)

Answer 4

*#1: transportation
*Limited supply of healthcare workers and facilities
*Lack of quality health care
*Social isolation
*Financial limitations

Question 5

Describe the impact homelessness has on the mortality of older adults. (4)

Answer 5

*Homeless older adults face higher mortality rates due to lack of housing and limited access to aging network services.
*They are at increased risk of health problems, as they often avoid shelters and meal services, fearing institutionalization.
*Providing care requires a coordinated effort involving various professionals and services, including outreach, primary care, Medicare/Medicaid, pharmacies, and senior centers.
*Long-term care placement is often chosen over homelessness, particularly for those with cognitive impairment.

Question 6

Describe how homeless older adults are more at risk for health problems. (2)

Answer 6

*Not many networks specializing in both older adults and homelessness
*Less likely to utilize shelters and meal services (may be due to fear of institutionalization)

Question 7

Describe the 5 manifestations and physical characteristics of a frail older adult.

Answer 7

*To be properly diagnosed, must have three or more of the of these characteristics
1. Unintentional wt loss (10lbs or more in year)
2. Self-reported exhaustion
3. Weakness (measured by grip strength)
4. Slow walking speed (decreased from baseline)
5. Low level of physical activity

Question 8

Define elder mistreatment. (2)

Answer 8

*Intentional acts of omission or lack of compassion by caregiver or “trusted other” that causes harm or serious risk for harm to a vulnerable older adult.

*May occur in community or long-term care setting

Question 9

Outline the 6 factors that make community-dwelling older adults at risk for elder mistreatment.

Answer 9

• Physical or cognitive dysfunction that leads to an inability to perform ADLs
• Psychiatric disorders (ex. Dementia, depression, etc.)
• Alcohol misuse
• Decreased social support
• Living with a large number of household members besides spouse
• Low income

Question 10

Describe the 7 types of elder mistreatment.

Answer 10

1. Abandonment: desertion of older adult (OA) by person who is responsible
   Manifestations: OA reports being abandoned, desertion of OA in hospital, SNF, mall, etc.
2. Financial: denying access to personal resources, stealing money or possessions
   Manifestations: living situation is below financial status, low level of personal resources, Sudden change in finances, sudden asset transfer.
3. Neglect: failure to provide basic needs or physical aids.
   Manifestations: reported from OA, untreated infection or pressure injuries
4. Physical: slapping, striking, restraining, incorrect positioning.
   Manifestations: bruises, B/L injuries, repeated injuries, burns, multiple ER visits at multiple different ERs
5. Psych: Berating, harassment, intimidation, threats, isolation
   Manifestations: depression, withdrawn behavior, agitation, ambivalent
6. Sexual: non consensual sexual contact
   Manifestations: OA report, unexplained vaginal/anal bleeding, bruising, unexplained STIs
7. Violation of personal rights
   Manifestations: sudden inexplicable change in living situation

Question 11

3 factors that precipitate placement in a long-term care facility

Answer 11

1. Rapid deterioration of function
2. Caregiver stress burnout
3. Alteration in or loss of family support system

Question 12

Describe the cascade disease pattern and how it impacts the health of older adults. (3)

Answer 12

1. Adult w/ preexisting condition (ex. insomnia)
2. Adverse event occurs d/t or r/t condition (ex. Takes sleeping meds, causing pt to become lethargic, leading to the patient falling)
3. This event leads to progressive deterioration (ex. Decrease in activity or mobility leads to pneumonia)

Question 13

Describe how pre-existing conditions and deconditioning influence the outcomes of rehabilitation of older adults.

Answer 13

*anxiety
*fear or concern about falling
*Poor nutrition and financial issues
*older adults often lose function because of inactivity and immobility.
*lack of motivation to stay fit