- National Partnership for Women & Families
- John A. Hartford Foundation Report: Redesigning Hospital: Care to Prevent Functional Decline in Older Adults: The ACE Unit Innovation
Couldn’t find what you were looking for in our Need to Knows? We have compiled additional reference tools here to inform patients and caregivers on a variety of healthcare issues. The following programs and organizations are designed to provide support to patients and caregivers on local and national levels.
Please note NICHE does not recommend and/or endorse any of the products, services or content found on any third party websites.
Alcohol abuse or misuse in older adults can cause physical, mental and emotional problems, contributing to stroke, heart disease, depression, social isolation, stomach/intestine problems, fall risks and cirrhosis of the liver.
Alcohol Use Screening
The Short Michigan Alcoholism Screening Instrument – Geriatric Version (SMAST-G) identifies older adults with alcohol problems. Scores of two or more “yes” answers indicate an alcohol problem and the need for help.
1. When talking with others, do you ever underestimate how much you drink?
2. After a few drinks, have you sometimes not eaten or been able to skip a meal because you didn’t feel hungry?
3. Does having a few drinks help decrease your shakiness or tremors?
4. Does alcohol sometimes make it hard for you to remember parts of the day or night?
5. Do you usually take a drink to relax or calm your nerves?
6. Do you drink to take your mind off your problems?
7. Have you ever increased your drinking after experiencing a loss in your life?
8. Has a doctor or nurse ever said they were worried about your drinking?
9. Have you ever made rules to manage your drinking?
10. When you feel lonely, does having a drink help?
Acute Care for the Elderly (ACE) units meet the special needs of older adult patients. ACE units differ in size and admission rules, but nurse-to-patient staffing ratios are typically better then in other units.
ACE Unit Goals:
• Maintain the patient’s pre-admission function level
• Prevent and/or reduce falls, skin breakdown, delirium, functional decline, immobility and more.
ACE units share common themes:
• Pride in care
• Patient improvement
• Reduction in hospital length of stay
• Higher nurse to patient staffing ratios
• Higher patient satisfaction than regular hospital floors
Cystitis (sis-TI-tis) is inflammation of the bladder. Typically, a bacterial infection (called a urinary tract infection) causes the inflammation. A bladder infection can be painful and annoying, and it can become a serious health problem if the infection spreads to your kidneys. (Source: Mayo Clinic)
The cystitis decision aid is a simple rule for use by your healthcare provider. It helps him or her decide whether to prescribe antibiotics or order a urine culture for adult women with acute cystitis symptoms. A simple three item decision aid could significantly reduce unnecessary antibiotic drug prescriptions and urine culture testing.
Functional Decline is a worsening in physical and/or mental ability and can be a result of hospitalization, severe illness, extended bed-rest and reduced participation in daily activities.
There are many tools that healthcare providers use to measure the day-to-day functioning ability of their patients. These tools check functioning and performance of daily living activities such as bathing, dressing, toileting, medication use, shopping and finances.
Below are a number of strategies used by hospitals to positively impact the function and quality of life in older adult patients:
• Checking physical, psychological and functional status at admission
• Encouraging activity during hospitalization such as exercise and rehabilitation therapies
• Avoiding bed rest orders
• Minimizing/avoiding use of physical restraints and use of mobility restricting devices such as indwelling catheters
• Optimizing nutrition and hydration
• Obtaining medication history
• Starting early functional goal setting and discharge planning with patient and family
• Implement picture systems to improve communication among all parties involved in the care and help patients with mental impairments to perform daily living activities independently
As people age, changes in hearing, vision, smell, touch and taste may occur. Risk factors include growing older, exposure to frequent/excessive noise and diseases. These changes can affect your quality of life and ability to interact with your family and friends and your surroundings.
Several common conditions affect hearing in older adults:
• High frequency hearing loss – hinders the ability to hear high pitched sound
• Impacted ear wax – causes hearing loss, pain and dizziness
• Sensorineural deafness – causes sounds to seem too loud, problems following conversations, problems hearing in noisy areas, problems hearing women’s voices
• Assessment for impacted earwax
• Use of a pocket amplifier
• Using a lower tone of voice by loved ones and friends to compensate for high-frequency hearing loss
• Use of written instructions
• Proper hearing aid care
Many of the conditions causing hearing loss are treatable. With treatment, you can experience optimal hearing, talk with your family and friends and stay safe in your surroundings.
Medications that are safe in younger persons aren’t necessarily safe in the older adult. The Beer’s criteria provide guidance for physicians and pharmacists to prevent the use of potentially inappropriate medications in adults over 65 years of age.
Ask your healthcare provider if any of your drug prescriptions are on the Beers list. If one or more of them is on the list, request alternatives.
As people age, they need to maintain a careful diet that includes protein, vitamins, minerals and healthy fruits and vegetables. Proper nutrition is essential in longevity, quality of life and thinking ability. Older adults need 1200 mg of calcium a day, 1.5 to 2 servings of fruit, 2.5 cups of veggies, 6-7 ounces of whole grain and .5 grams of protein per pound of body weight. Sodium, cholesterol, and sugar should be limited.
According to the National Institute on Aging:
Women over 50…
• Not active – need 1600 calories per day
• Somewhat active – need 1800 calories per day
• Very active – need 2000 calories per day
Men over 50…
• Not active – need about 2000 calories per day
• Somewhat active – need 2200 calories per day
• Very active – need 2400 to 2800 calories per day
As age increases it is very important to have enough fiber in the diet to keep the bowels regular; lower the risk of heart disease, stroke, diabetes; improve skin health; aid in weight loss and boost immune system and overall health. Women over 50 need at least 21 grams of fiber a day and men need at least 30 grams.
As people age their metabolism slows, their digestion changes, their senses are dulled and they may take medications that change appetite and tastes. Loneliness and depression, death or divorce and living on a limited budget can also affect diet.
Malnutrition is a serious health issue in older adults caused by eating too little food, taking in too few nutrients and having digestive problems related to aging. Malnutrition causes fatigue, depression, weakened immune system, anemia, weakness, as well as digestive, lung, heart and skin problems. Different difficulties older adults struggle with that can lead to malnutrition are a loss of appetite, difficulty chewing or dysphagia, dry mouth, an aversion to “healthy food,” and not being able to shop or cook their own food.
To prevent malnutrition older adults should:
• Eating nutrient packed foods such as avocados, sweet potatoes, nuts and seeds, fruits and vegetables, eggs and fish
• Having flavorful foods available
• Snacking between meals
• Eating with company as much as possible
Senior meal delivery plans such as “Meals on Wheels” are also options.
Often people think pain is just part of the natural process of aging, but there is an underlying problem behind pain complaints and they should be taken seriously. People over the age of 65 often experience chronic pain from problems like arthritis, poor circulation, shingles, bowel diseases or cancer.
Pain Medication Safety Issues and Risks
Some things to be aware of when taking pain medications:
• Older patients handle pain medication differently than younger patients
• How pain medication is administered to older adults can be a challenge
• There are risks of side effects from all drugs, including over-the-counter analgesics
• Precautions must be taken to ensure that all medicines are out of reach of children and that they are disposed of properly
Palliative care is a medical specialty focused on meeting the unique needs of patients who suffer from serious, chronic, life-threatening illnesses. Palliative care specialists provide expert treatment of symptom management such as pain, discomfort and stress that can occur with a serious illness. A palliative care team consists of a doctor, nurse and social work specializing in palliative care. Teams may also include massage therapists, pharmacists, chaplains and nutritionists. The palliative care team works with a patient’s physician and provides care along with whatever treatment the patient is already receiving (for instance, chemotherapy). Palliative care specialists are on call to answer any questions and concerns of patients and their families about treatment options, medical decisions and care.
What Is Important?
• Many patients need palliative care – As older adults live longer, many more people are living with serious and chronic illnesses and need relief from pain and symptoms to help maintain their quality of life. These illnesses can be complex and patients need help coordinating their care.
• Palliative care works – Palliative care helps patients get the best possible care when suffering from severe illness. It is most effective in relieving pain and distressing symptoms, increasing patient and family satisfaction with their care and creating smooth transitions between hospitals and other healthcare settings.
How Does Palliative Care Help Patients and Their Families?
• It makes patients feel better throughout illness by:
– Vigorously treating pain and symptoms such as nausea, fatigue, depression and anxiety
– Keeping patients as comfortable, active and independent as possible
– Benefitting patients at all stages of illness, while simultaneously receiving treatment or any other medical care
• It helps patients and families to navigate the medical system by:
– Assisting patients and families in making decisions about care and treatments, and then following through and ensuring that care is received
– Providing answers, assistance and emotional support to patients and families making difficult medical decisions
– Identifying services to support patients after leaving the hospital
Throughout the aging process, the lens of the eye may become thicker and yellow. These changes may affect how one sees colors and the difference between two colors. For instance, the color blue may appear darker and harder to tell apart from black. And it may become hard to tell where an object ends and its background begins, making it hard to see curbs or steps.
Color combinations that may confuse the eye are:
There is some evidence that black type on yellow paper may be easier to read if color perception is an issue.
A pressure ulcer, commonly known as bedsore, is an area of skin that breaks down when you stay in one position for too long without shifting your position. It can also be caused by friction, which can cause pain, infection, loss of mobility and poor recovery. It most often develops on parts of the skin that cover bony areas of the body, like heels, ankles, hips and tailbone. Patients with a medical condition that limits their mobility and confines them to a wheelchair or bed for long periods of time are at high risk for developing pressure ulcers.
Sleep problems include excessive sleepiness, difficulty falling or staying asleep, sleep apnea, insomnia and restless leg syndrome. As you age, medical conditions and medications may cause sleep problems.
Pittsburgh Sleep Quality Index
The Pittsburgh Sleep Quality Index measures the quality and patterns of your sleep. Patents will provide answers related to the following subjects when your health care provider uses this tool:
• Sleep quality
• Time it takes to fall asleep
• Sleep duration
• Total sleep time vs. time in bed
• Sleep disturbances
• Use of sleep medication
• Daytime problems related to nighttime sleep