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Published byAlonzo Vickrey Modified over 10 years ago
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Arden L Aylor, MD Geriatrics
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Health Maintenance Quick office screening tools Advance Directives Driving issues Care types Placement
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Primary and secondary disease prevention screening Control chronic medical problems Bi-annual medication review Optimize function: cognitive, auditory, vision, fall screening Assess for adequate support system Discuss and document Advanced Directives
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Auditory - annual Vision - annual Fall risk Cognitive screen
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Vital Signs/ Orthostatic Neurologic assessment Musculoskeletal assessment Medications Footwear Cognitive assessment Functional Reach Test
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Falls in past year? No fallsNo Intervention Recurrent falls Single fall Fall Evaluation Gait & balance problem YesNo
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Single item test: quick screen for balance problems in older adults Interpretation: Score of 6 or less indicates a significant increased risk for falls >70% fall in 3 months Score between 6-10 inches indicates a moderate risk for falls
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MMSE MoCA (Montreal Cognitive Assessment) Clock Score (4-1)
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43 2 1
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Specific rules for older drivers Renewal is every 2 years for those 85 and older Mail, phone, and electronic renewal are not available for those 79 and older Renewal conditions: In person Vision test: At in-person renewals Written test: No Road test: No, unless there is a concern (mental or physical) regarding the driver's ability to safely operate a motor vehicle TxDOT
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Adequate support system Legal Directives Wills Financial Medical Directive DNR/DNI
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Home Health Care is skilled nursing need All Medicare beneficiaries can receive home health Physical Therapy Skilled Nursing Respiratory Care Medical Equipment Infusion Therapy Nursing aid - ADLs No 24/7 care coverage
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Level A: Resident may require minimal assistance with ADL, must be mobile, may receive home health services Level B: Resident may receive full assistance with ADL Resident may be semi-independent and may require the assistance for transfers or to evacuate the facility Resident may receive assistance with medication Level C: Resident receive full assistance with ADL Caregiver 24hrs on sight
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Patients need to go to hospital for nursing home placement
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Skilled Nursing Facility (short-stay): 1-6 months Terminally ill Short term rehabilitation Debilitated post-acute care hospitalization Nursing Home (long-stay): 6 months to years Primarily cognitively impaired Significant impairments of both cognitive and physical functioning Primarily physically impaired
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Verify transfer or admission orders from the transferring facility Perform history and physical within 48 hours of admission Schedule regular reassessments (CMS) mandate: minimum every 30 days x90 days, then every 60 days Texas Department of Aging and Disability Services Revision: 08-5
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Focuses on improving the quality of life of people facing serious illness Emphasis is placed on pain and symptom management Goal is to improve the patients ability to tolerate medical treatments
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Hospice care is end-of-life care Terminal diagnosis with life expectancy <6 months Offering medical, psychological and spiritual support No invasive treatment or PT/OT Goal to help people who are dying have peace, comfort and dignity Where: Home, Nursing Home, Hospital, Hospice respite center
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Advance Directive should be assessed and updated annually Quick screen tools and be helpful in evaluating function Patients need not go to hospital for nursing home placement Palliative offers some degree of therapy Hospice comfort care
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Texas Department of Aging and Disability Services Revision: 08-5.07 American Geriatric Society, 2011 americangeriatrics.org Center for Medicaid and Medicare Services, 2011 cms.gov Trailblazers CMS Texas, 2010 trailblazerhealth.com Federal Government Publication and statistics, 2010 gov/employees/govpubs/Pages/FederalGovernmentPublications.as px TxDOT, 2011 txdot.gov
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