INCONTINENCE
END OF LIFE
SERVICES
NURSING HOME
DRUGS
100
2/4 questions that can be asked to screen for urinary incontinence
What are: 1. do you ever leak urine when you don't want to? 2. do you ever leak urine when you cough, laugh or exercise? 3. do you ever leak urine on the way to the bathroom? 4. do you ever use pads, tissue, or cloth in your underwear to catch urine?
100
the top 3 leading causes of death, and the top 3 actual causes of death
What are: heart disease, cancer, stroke What are: tobacco, poor diet/inactivity, alcohol
100
the name of 2 agencies that provides in-home care/services in Corvallis (apart from Home Health)
What are: Home Care and Elder Services Visiting Angels New Horizons In-Home Care Love, INC Meals on Wheels Interfaith Volunteer Caregivers Mennonite In-Home Care Marquis Home Care Services
100
the use of physical restraint's affect on fall risk
What is increased
100
The intent of the Beers Criteria, and who developed them
What is addressing "potentially inappropriate medication use in older patients;" American Geriatric Society
200
the 4 major types of incontinence
What are: urge stress mixed - most common in women overflow - either bladder outlet obstruction or impaired detrusor contractility
200
the life expectancy of a person at age 75
What is 11.7 years
200
a service that provides rides to non-drivers at a very low cost
What is Dial-A-Bus in Corvallis, Call-A-Ride in Albany
200
the rate of 30 day re-admissions from nursing homes
What is 20% It behooves us all to effect appropriate transitions of care
200
% of preventable adverse drug events in primary care and nursing homes
What is 27% and 42%
300
4 potentially reversible causes of incontinence
What are: 1. impaired mobility 2. impaired cognition/delirium 3. volume overload; excess fluid intake 4. stool impaction 5. atrophic vaginitis 6. previous urologic surgery 7. pelvic organ prolapse 7. sleep disturbance 8. metabolic (hyperglycemia, hypercalcemia) 9. medications
300
documents to prepare as our patients approach the end of life, and their differences
What are POLST and Advance Directive --a physician order vs. a legal document --both forms available in the office
300
1. the agency that would help this 70 year old women: she is mildly demented, partially blind, wheelchair bound, very poor, and her family might be misusing her social security check 2. the type of place she could live in
What is Oregon Cascades West Council of Governments, voluntary association of 3 counties and Siletz Indians, broad range of programs and services: Area Agency on Aging/Aging and Disability Resource Connection Medicaid benefits Veterans Benefits Adult Protective Services 2. assisted living facility
300
placement options if a person needs assistance with eating and transferring, possibly with significant stroke or dementia
What is a nursing home or adult foster home, unlikely assisted living
300
the maximum dose of citalopram and simvastatin in the elderly
What is 20 mg, 40 mg
400
3 potential complications of urinary incontinence
What are: 1. premature nursing home placement 2. decubitus ulcers 3. UTI's, sepsis 4. renal failure 5. psychosocial repercussions: self-esteem, social restriction, depression 6. increased risk of falls
400
hospice options in our area
What are Benton Hospice and Evergreen Hospice (also with a hospice house)
400
a person appropriate for assisted living and not independent living
Who is someone needing: 1. medicine management 2. assistance with activities of daily living 3. assistance with rides/transportation
400
3/5 criteria in a nursing home that predict frailty and increased risk of falls, hospitalization, death
What are: 1. fatigue - question 2. inactivity - calorie expenditure 3. slowness - time to walk 15 feet 4. weakness - grip strength 5. weight loss - >10 pounds, or 5% body weight 3/5 predict 6x risk of mortality at 3 years
400
4 categories of drugs of concern in the elderly
What are: antihistamines muscle relaxants benzo and nonbenzo hypnotics glyburide/chlorpropamide tricyclic antidepressants NSAIDS antispasmodics nitrofurantoin estrogen anti-arrhythmic drugs barbiturates
500
name 3 medicines to avoid, and 2 to treat urinary incontinence
What are: 1. avoid: antiarrhythmics, anticholinergic, antihistamines, antidepressants, muscle relaxants, antipsychotics, antihypertensives 2. treatment: antimuscarinics (side effects), alpha adrenergic, estrogen topical, alpha adrenergic antagonists (tamsulosin), duloxetine, botulinum toxin
500
average life expectancy after: 1. Alzheimer's disease 2. hip fracture 3. CHF >75 yo 4. Myocardial Infarction
What is: 1. 4.2 / 5.7 years (M/W) 2. 5.4 years 3. 3.9 / 4.5 years 4. 11.3 years
500
the office/person I would call if I was worried that a patient was not being treated well in a nursing home, assisted living, or adult foster care home
What is the Office of the Long-Term Care Ombudsman
500
3 behavioral/environmental approaches to problem behavior in a nursing home (NOT THE MEDS)
What are: activities, rehab alarms/sensors increased supervision environmental changes: lighting, pathways, floor design bed design: floor mats, reduced height, call buttons provide orienting stimuli: clocks, calendars, signs seating and position support reassurance, listening, re-directing
500
proven drugs for dementia with agitation
What is NONE. we do trial antiepileptic, antipsychotics, antidepressants, cholinesterase inhibitors NOT BENZODIAZEPINES
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