1
NR I601 IMidterm IExam IStudy IIGuide IWeeks I1-4 Icontent
Week Topics
1 • Developmental changes I
Review IKennedy Iand IDunphy Ireadings Ifor Iage Irelated Ichanges
Replicative Isenescence Iis Itheory Istates Ithat Icells Ican Ireplicate Ior Idivide Ia Ispecific Inumber Iof Itimes.
IThis Iability Itends Ito Idecrease Iwith Iage.
Oxidative Idamage Iis Ithe Icumulative Iresult Iof Ithe Iaerobic Imetabolism, Iwhich Igenerates Ichemicals
Icalled Ifree Iradicals. IFree Iradicals Imay Iinteract Iwith Iother Ichemicals Iin Ithe Ibody Iand Icause Idamage Ito
Icells.
Telomere Ishortening Iis Ia Itheory Ithat Ilinks Iaging Ito Ia Ireduction Iin Icell Idivision.
IWeakening Iof Ithe Iimmune Iresponse Ileaves Iolder Iadults Imore Ivulnerable Ito Iinfection Iand
Idebilitating Idiseases.
Travel
Increased Irisk Ifor Ithromboembolic Ievents, Ialtitude Isickness Iwith Ieffect Ion Icardiac Iand Icerebral
Ifunctioning, Ieffect Ion Ipulmonary Ifunction Ifrom Iair Ipollution, Idehydration Iand Iinability Ito Itolerate
Itemperature Ichanges, Ianxiety Ir/t Ichange Iof Iplace I(central Inervous Ichanges), Idecreased Ihearing
I(sensory Ichanges), Iincreased Irisk Ifor Iaccidents Idue Ito Idecreased Ivision, Ilonger Ireaction Itimes, Isome
Ivaccines Iare Iless Ieffective Ifor Iolder Iadults.
Routine Iimmunizations Ifor Iolder Iadult’s Ir/t Itravel, IInfluenza, Ipneumococcal, ITd/Tdap, Izoster, IHep IBIfor
Isome, Iand Icertain Ivaccines Ibased Ion Idestination
Yellow Ifever Inot Ieffective Iuntil I10 Idays Ipost Iadministration Iand Iif Ia Iherpes Izoster Ivaccine Ihas Ibeen
Igiven, Ithey Imust Iwait I30 Idays Ito Ireceive Ithe Iyellow Ifever Ivaccine. IIf Ithe Ipatient Ihas Ireceived Ia Iyellow
Ifever Ivaccine, Ithey Imust Iwait I28 Idays Ifor Ia Iherpes Izoster Ivaccine.
Beer’s Criteria
I
The IBeers ICriteria Ifor IPotentially IInappropriate IMedication IUse Iin IOlder IAdults, Icommonly Icalled
Ithe IBeers IList, Iare Iguidelines Ifor Ihealthcare Iprofessionals Ito Ihelp Iimprove Ithe Isafety Iof Iprescribing
Imedications Ifor Iolder Iadults. IThey Iemphasize Ideprescribing Imedications Ithat Iare Iunnecessary, Iwhich
Ihelps Ito Ireduce Ithe Iproblems Iof Ipolypharmacy, Idrug Iinteractions, Iand Iadverse Idrug Ireactions, Ithereby
Iimproving Ithe Irisk–benefit Iratio Iof Imedication Iregimens Iin Iat-risk Ipeople.
Exercise in Older Adults
I I I
- OA: Iwalking, Iaquatic, Itai Ichi, Iresistance Iexercises, Icycling
- Anxiety: Iwalking, Ibiking, Iweightlifting,
- Fibromyalgia: IAerobic, Iaquatic, Istrengthening, Itai Ichi, IPilates
- Sleep: ITai Ichi, Iwalking, Iaqua Itherapy, Ibiking
-Preferred Iamount Iof Iexercise: I30 Iminutes Iper Iday Ifor I5 Idays Ia Iweek Iof Imoderate Iexercise; Iif Iweight
Imanagement Iis Ipart Iof Ithis, I60 Iminutes Iper Iday Iis Iadvised I(Can Ibe Icompleted Iin I10 Imin. Iintervals)
,2
Laboratory Changes in Older Adults
I I I I
• Protein Irises Islightly Irenal Ipathology, IUTI, Iaging Ikidney Ichanges
• Specific Igravity: Ilower Imaximum Iin Ielderly: I1.016-1.022-decline Iin Inephrons Iability Ito Iconcentrate
Iurine
• ESR: Iincreases-not Isensitive/nor Ispecific Iin Ithe Iaging Iadult
• Iron Ibinding-decreases
• Hgb: Idecreases-anemia Iis Icommon Iin Ithe Ielderly
• HCT: Islight Idecrease-decline Iin Ihematopoiesis
• Leukocytes: Idrop-drugs/sepsis
• Lymphocytes-T Iand IB Icell Ifall-risk Ifor Iinfection Iis Ihigher-immunization Iencouraged
• Platelets: Ino Ichange Iin Inumber
• Albumin-decline-smaller Iliver-and Ienzymes-protein Ienergy Imalnutrition
• Globulin: Islight Iincrease
• Total Iserum Iprotein: Idecreases Iindicate Imalnutrition, Iinfection Iand Iliver Idisease
• BUN: Iincreases Iand Idecline Iin IGFR-decreased Icardiac Ioutput
• CR: Iincreases-r/t Ilean Ibody Imass Idecrease
• CR Iclearance: Idecreases-10% Iper I10 Iyears Iafter I40-careful Iprescribing Idrugs Ithat Iare Iexcreted Iby
Ikidneys
• Glucose Itolerance: Iincrease Iof I10 Img/dL/decade Iafter I30-diabetes Imore Iprevalent-drugs Ican Icause
Iglucose Iintolerance
• Alk Iphosp: Iincrease-elevations> I2
Geriatric Syndromes
I
• Sleep IDisturbances
• Problems Iwith Ieating Ior Ifeeding
• Incontinence
• Confusion
• Evidence Iof Ifalls
• Skin Ibreakdown
Categories for Aging
I I
• Young I– Iold I= I65–74 Iyears
• Old I= I75–84
• Oldest-old I= I85 Iand Iolder
,3
Comprehensive Geriatric Assessment
I I
Physical IHealth
-Beers ICriteria: Iavoid IPolypharmacy I& IPotentially IInappropriate IMedication Ithe Ielderly/ADR
-STOPP IScreening ITool Iof IOlder IPersons IPrescriptions: Imedications Ithat Imight Ilikely Ineed Ito Ibe
Istopped Ifor Ithe Iolder Iadult
-START IScreening ITool Ito IAlert IDoctors Ito IRight ITreatment: Iincludes Imedications Ithat Ineed Ito Ibe
Iadded.
-MINI INutritional IAssessment IInstrument: Iidentifies Iolder Iadults Iwho Ihave Ior Iat Irisk Iof Imalnutrition
-Nutrition IHealth IChecklist: Iidentifies Iolder Iadults Iwho Ihave Ior Iat Irisk Iof Imalnutrition
Functional Health
I
- KATZ I: IActivities Iof IDaily ILiving IScale
- Lawton Iand IBrody IScale: IInstrumentals Iactivities Iof Idaily Iliving
- Hendrich III IFall IRisk IModel: Iassessment Iof Ifalls, Iuseful Iin Iacute Icare, Iambulatory, Iassisted Iliving,
Iand Ilong-term Icare.
- Timed IGet Iup Iand IGo ITest: Imobility Iscreen
- Tinetti’s IPerformance IOriented IMobility IAssessment Iis Ia Itask-oriented Itest Ithat Imeasures Igait Iand
Ibalance Iabilities
Physiological HealthI
- DSM-5: Idescribes Ithe Icharacteristics Iof Idelirium Iand Imild Ito Imoderate Ineurocognitive Imental
Idisorders
- MMSE IMini IMental IStatus IExamination:
- GDS: ISF IGeriatric IDepression IScale
-Short Iform: Iconsists Iof I15 Iquestions Irequiring Iyes Ior Ino Iresponse. ICan Ibe Icompleted Iin Iany
Ihealthcare Isetting.
-PHQ-9 IPatient IHealth IQuestionnaire
, 4
Socioenvironmental Supports I
-Lubben ISocial INetwork IScale I-6 Iitem Iversion
• Important Icontribution Ito Ifamily Iand Ifriendship
• Helps Iidentify Ipatients Iat Irisk Ifor Isocial Iisolation Iwho Ican Ibenefit Ifrom Iintervention
• Include Ithe Ifollowing Igeriatric Iassessment Ito Ihelp Iimproves Ipatient’s Isocial Isupport
■ Is Ithere Iany Ione Ispecial Iperson Iyou Icould Icall Ior Icontact Iif Iyou Ineed Ihelp? I(If Iyes, Iidentify.)
■ In Igeneral, Iother Ithan Iyour Ichildren, Ihow Imany Irelatives Ido Iyou Ifeel Iclose Ito Iand Ihave Icontact Iwith
Iat Ileast Ionce Ia Imonth? I(Number.)
■ In Igeneral, Ihow Imany Ifriends Ido Iyou Ifeel Iclose Ito Iand Ihave Icontact Iwith Iat Ileast Ionce Ia Imonth?
I(Number.) IAdditional Isocial Iand Ieconomic Iresources Iare Iassessed Iby Iexploring Ithe Ifollowing:
MIDTERM ISTUDY IGUIDE IFOR INR I601-AGING IADULT I66
■ Living Isituation
■ Housing
■ Transportation
■ Income
■ Assets
■ Degree Iof Ifinancial Iburden Iresulting Ifrom Ihealth Iconcerns IQuality Iof ILife IMeasures:
-Medical IOutcomes IStudy-Short IForm I36:
• looks Iat Iphysical, Imental, Iand Isocial Idomains
➢ GOLD Istandard Ifor Iquality Iof Ilife Iinstruments Ibecause Iof Iits Ilongevity, Iapplicability, Iand Iease Iof
Iadministration Iand Ianalysis.
NR I601 IMidterm IExam IStudy IIGuide IWeeks I1-4 Icontent
Week Topics
1 • Developmental changes I
Review IKennedy Iand IDunphy Ireadings Ifor Iage Irelated Ichanges
Replicative Isenescence Iis Itheory Istates Ithat Icells Ican Ireplicate Ior Idivide Ia Ispecific Inumber Iof Itimes.
IThis Iability Itends Ito Idecrease Iwith Iage.
Oxidative Idamage Iis Ithe Icumulative Iresult Iof Ithe Iaerobic Imetabolism, Iwhich Igenerates Ichemicals
Icalled Ifree Iradicals. IFree Iradicals Imay Iinteract Iwith Iother Ichemicals Iin Ithe Ibody Iand Icause Idamage Ito
Icells.
Telomere Ishortening Iis Ia Itheory Ithat Ilinks Iaging Ito Ia Ireduction Iin Icell Idivision.
IWeakening Iof Ithe Iimmune Iresponse Ileaves Iolder Iadults Imore Ivulnerable Ito Iinfection Iand
Idebilitating Idiseases.
Travel
Increased Irisk Ifor Ithromboembolic Ievents, Ialtitude Isickness Iwith Ieffect Ion Icardiac Iand Icerebral
Ifunctioning, Ieffect Ion Ipulmonary Ifunction Ifrom Iair Ipollution, Idehydration Iand Iinability Ito Itolerate
Itemperature Ichanges, Ianxiety Ir/t Ichange Iof Iplace I(central Inervous Ichanges), Idecreased Ihearing
I(sensory Ichanges), Iincreased Irisk Ifor Iaccidents Idue Ito Idecreased Ivision, Ilonger Ireaction Itimes, Isome
Ivaccines Iare Iless Ieffective Ifor Iolder Iadults.
Routine Iimmunizations Ifor Iolder Iadult’s Ir/t Itravel, IInfluenza, Ipneumococcal, ITd/Tdap, Izoster, IHep IBIfor
Isome, Iand Icertain Ivaccines Ibased Ion Idestination
Yellow Ifever Inot Ieffective Iuntil I10 Idays Ipost Iadministration Iand Iif Ia Iherpes Izoster Ivaccine Ihas Ibeen
Igiven, Ithey Imust Iwait I30 Idays Ito Ireceive Ithe Iyellow Ifever Ivaccine. IIf Ithe Ipatient Ihas Ireceived Ia Iyellow
Ifever Ivaccine, Ithey Imust Iwait I28 Idays Ifor Ia Iherpes Izoster Ivaccine.
Beer’s Criteria
I
The IBeers ICriteria Ifor IPotentially IInappropriate IMedication IUse Iin IOlder IAdults, Icommonly Icalled
Ithe IBeers IList, Iare Iguidelines Ifor Ihealthcare Iprofessionals Ito Ihelp Iimprove Ithe Isafety Iof Iprescribing
Imedications Ifor Iolder Iadults. IThey Iemphasize Ideprescribing Imedications Ithat Iare Iunnecessary, Iwhich
Ihelps Ito Ireduce Ithe Iproblems Iof Ipolypharmacy, Idrug Iinteractions, Iand Iadverse Idrug Ireactions, Ithereby
Iimproving Ithe Irisk–benefit Iratio Iof Imedication Iregimens Iin Iat-risk Ipeople.
Exercise in Older Adults
I I I
- OA: Iwalking, Iaquatic, Itai Ichi, Iresistance Iexercises, Icycling
- Anxiety: Iwalking, Ibiking, Iweightlifting,
- Fibromyalgia: IAerobic, Iaquatic, Istrengthening, Itai Ichi, IPilates
- Sleep: ITai Ichi, Iwalking, Iaqua Itherapy, Ibiking
-Preferred Iamount Iof Iexercise: I30 Iminutes Iper Iday Ifor I5 Idays Ia Iweek Iof Imoderate Iexercise; Iif Iweight
Imanagement Iis Ipart Iof Ithis, I60 Iminutes Iper Iday Iis Iadvised I(Can Ibe Icompleted Iin I10 Imin. Iintervals)
,2
Laboratory Changes in Older Adults
I I I I
• Protein Irises Islightly Irenal Ipathology, IUTI, Iaging Ikidney Ichanges
• Specific Igravity: Ilower Imaximum Iin Ielderly: I1.016-1.022-decline Iin Inephrons Iability Ito Iconcentrate
Iurine
• ESR: Iincreases-not Isensitive/nor Ispecific Iin Ithe Iaging Iadult
• Iron Ibinding-decreases
• Hgb: Idecreases-anemia Iis Icommon Iin Ithe Ielderly
• HCT: Islight Idecrease-decline Iin Ihematopoiesis
• Leukocytes: Idrop-drugs/sepsis
• Lymphocytes-T Iand IB Icell Ifall-risk Ifor Iinfection Iis Ihigher-immunization Iencouraged
• Platelets: Ino Ichange Iin Inumber
• Albumin-decline-smaller Iliver-and Ienzymes-protein Ienergy Imalnutrition
• Globulin: Islight Iincrease
• Total Iserum Iprotein: Idecreases Iindicate Imalnutrition, Iinfection Iand Iliver Idisease
• BUN: Iincreases Iand Idecline Iin IGFR-decreased Icardiac Ioutput
• CR: Iincreases-r/t Ilean Ibody Imass Idecrease
• CR Iclearance: Idecreases-10% Iper I10 Iyears Iafter I40-careful Iprescribing Idrugs Ithat Iare Iexcreted Iby
Ikidneys
• Glucose Itolerance: Iincrease Iof I10 Img/dL/decade Iafter I30-diabetes Imore Iprevalent-drugs Ican Icause
Iglucose Iintolerance
• Alk Iphosp: Iincrease-elevations> I2
Geriatric Syndromes
I
• Sleep IDisturbances
• Problems Iwith Ieating Ior Ifeeding
• Incontinence
• Confusion
• Evidence Iof Ifalls
• Skin Ibreakdown
Categories for Aging
I I
• Young I– Iold I= I65–74 Iyears
• Old I= I75–84
• Oldest-old I= I85 Iand Iolder
,3
Comprehensive Geriatric Assessment
I I
Physical IHealth
-Beers ICriteria: Iavoid IPolypharmacy I& IPotentially IInappropriate IMedication Ithe Ielderly/ADR
-STOPP IScreening ITool Iof IOlder IPersons IPrescriptions: Imedications Ithat Imight Ilikely Ineed Ito Ibe
Istopped Ifor Ithe Iolder Iadult
-START IScreening ITool Ito IAlert IDoctors Ito IRight ITreatment: Iincludes Imedications Ithat Ineed Ito Ibe
Iadded.
-MINI INutritional IAssessment IInstrument: Iidentifies Iolder Iadults Iwho Ihave Ior Iat Irisk Iof Imalnutrition
-Nutrition IHealth IChecklist: Iidentifies Iolder Iadults Iwho Ihave Ior Iat Irisk Iof Imalnutrition
Functional Health
I
- KATZ I: IActivities Iof IDaily ILiving IScale
- Lawton Iand IBrody IScale: IInstrumentals Iactivities Iof Idaily Iliving
- Hendrich III IFall IRisk IModel: Iassessment Iof Ifalls, Iuseful Iin Iacute Icare, Iambulatory, Iassisted Iliving,
Iand Ilong-term Icare.
- Timed IGet Iup Iand IGo ITest: Imobility Iscreen
- Tinetti’s IPerformance IOriented IMobility IAssessment Iis Ia Itask-oriented Itest Ithat Imeasures Igait Iand
Ibalance Iabilities
Physiological HealthI
- DSM-5: Idescribes Ithe Icharacteristics Iof Idelirium Iand Imild Ito Imoderate Ineurocognitive Imental
Idisorders
- MMSE IMini IMental IStatus IExamination:
- GDS: ISF IGeriatric IDepression IScale
-Short Iform: Iconsists Iof I15 Iquestions Irequiring Iyes Ior Ino Iresponse. ICan Ibe Icompleted Iin Iany
Ihealthcare Isetting.
-PHQ-9 IPatient IHealth IQuestionnaire
, 4
Socioenvironmental Supports I
-Lubben ISocial INetwork IScale I-6 Iitem Iversion
• Important Icontribution Ito Ifamily Iand Ifriendship
• Helps Iidentify Ipatients Iat Irisk Ifor Isocial Iisolation Iwho Ican Ibenefit Ifrom Iintervention
• Include Ithe Ifollowing Igeriatric Iassessment Ito Ihelp Iimproves Ipatient’s Isocial Isupport
■ Is Ithere Iany Ione Ispecial Iperson Iyou Icould Icall Ior Icontact Iif Iyou Ineed Ihelp? I(If Iyes, Iidentify.)
■ In Igeneral, Iother Ithan Iyour Ichildren, Ihow Imany Irelatives Ido Iyou Ifeel Iclose Ito Iand Ihave Icontact Iwith
Iat Ileast Ionce Ia Imonth? I(Number.)
■ In Igeneral, Ihow Imany Ifriends Ido Iyou Ifeel Iclose Ito Iand Ihave Icontact Iwith Iat Ileast Ionce Ia Imonth?
I(Number.) IAdditional Isocial Iand Ieconomic Iresources Iare Iassessed Iby Iexploring Ithe Ifollowing:
MIDTERM ISTUDY IGUIDE IFOR INR I601-AGING IADULT I66
■ Living Isituation
■ Housing
■ Transportation
■ Income
■ Assets
■ Degree Iof Ifinancial Iburden Iresulting Ifrom Ihealth Iconcerns IQuality Iof ILife IMeasures:
-Medical IOutcomes IStudy-Short IForm I36:
• looks Iat Iphysical, Imental, Iand Isocial Idomains
➢ GOLD Istandard Ifor Iquality Iof Ilife Iinstruments Ibecause Iof Iits Ilongevity, Iapplicability, Iand Iease Iof
Iadministration Iand Ianalysis.
