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CSA 1-6
Passing the Certified Senior Advisor Exam
| Question | Answer |
|---|---|
| What is the difference between Gerontology and Geriatrics? | Gerontology is the study of the human aging process i.e. biological, social and psychological and covers anything from science to humanities. Geriatrics is the medical study of aging. |
| What does a Social Gerontologist explore? | Family relationships Health Economics Retirement Widowhood and the impact of biological processes on these social aspects of aging. |
| Name the 6 ways Gerontologists categorize the aging process. | 1. Chronological Age 2. Functional Age 3. Subjective Age 4. Social Roles 5. Cohorts and Generations 6. Life Stages |
| What are the limitations of measuring only chronological age? | Chronological age reveals very little about the characteristics of people and is seldom a reliable resource or index of one's abilities. |
| How does functional age differ from chronological age and subjective age? How is functional age measured? | Functional age is what people can/are doing while chronological age is just a number of birthdays. Subjective age is how people feel and how they define themselves to themselves. Functional age is measured by Activities of Daily Living (ADLs) |
| Describe at least 5 of the social roles people transition through in their lives. | -Child -Student -Spouse -Parent -Grandparent -Retiree -Widow/Widower -Dependent -Institutional Resident *Each has a different meaning to different people and you can be young or old for all. |
| How do Sociologists define the difference between a cohort and a generation? | They are not the same. Cohorts have experienced the same significant event (marker) during a specific time i.e. baby boomers. Generations describe families and/or a group of people with the same life patterns/values i.e. WWII generation. |
| What is Erikson's theory behind his psychosocial stages of development? | The role of society and its effect on human development. Development occurs beyond childhood. We progress through 8 stages to adapt to the world and ourselves. |
| Describe the experience of Generativity vs. Stagnation that typically occurs in middle adulthood. | Generativity = the desire to give back to society -Raising Children -Productivity at Work -Community Activities Generativity = Positive End Stagnation = Negative End |
| When engaging in a Life Review, what contributes to developing a sense of integrity vs. a sense of despair? | -A positive outlook in most previous stages of development -Seeing meaning in the choices we have made -Remembering and retelling stories |
| What is Geotranscendence and how does an older person achieve it? | Having an understanding of the past, accepting identity including limitations, embracing others and a sense of communion with all things including death. Achieved by participating in decisions as much as possible. |
| Define: Middle Age | Traditionally from age 40-65 |
| Define: Later Adulthood | Generally sometime in your 60s *Some physically decline and some don't! |
| Define: Old Age | Usually age 65+ but there is a great amount of variability. |
| How have the definitions of Middle Age, Later Adulthood and Old Age evolved and changed over time? | They are less distinct from one another and overlap in numerous ways. |
| What are social policies and how have they benefited older adults over the years? | Governments making allocations for social programs like: -Social Security -Medicare -Older American's Act Benefits include: -Pulling them out of poverty -Advocating for them -Protecting them -Supporting their welfare |
| What is ageism and how is it perpetuated in our society? | Discrimination and prejudicial attitudes towards older adults. Perpetuated by: -Media i.e. Grumpy Old Men Movie -Language i.e. "still sharp as a tack" -Healthcare i.e. Exclusion from trials -Employment |
| Give 3 examples of positive ageism. | 1. "You look good for your age" 2. Assumptions that older people are financially well-off 3. Reference to "The Golden Years" 4. "I am having a senior moment" 5. "Youth is wasted on the young" |
| List the 4 major attitudes toward aging. | 1. Age Denial 2. Age Adaptation 3. Age Irrelevance 4. Age Affirmation |
| What is the difference between an attitude or product that is Age Adaptive vs. Age Irrelevant? | Age Adaptive = Adapting to new circumstances i.e. Long Term Care Insurance or Life Alert pendant after a fall Age Irrelevant = Attitudes/products are for all people regardless of age. i.e. eating healthy and/or making good financial investments |
| Name 4 major fears among older adults about aging. | 1. Death and Dying 2. Dependence on others/Losing Control 3. Outliving their financial assets 4. Cognitive Decline |
| Name the common forms of Elder Abuse. | 1. Physical 2. Sexual 3. Emotional/Psychological 4. Abandonment 5. Financial/Material Exploitation 6. Neglect |
| What is identity foreclosure and how does it affect a surviving spouse? | When a widow(er) no longer has the social resources/networks to hand on to their identity. Women-Left reeling "no longer Mr. and Mrs." Men-Often think they would have died first and are not prepared |
| What is a Life Review? | The process of leaving a legacy to family. It's the communication (verbal or written) of one's intangible values. |
| What are the benefits of pursuing an encore career as an older adult? | -Financial -Physical wellbeing -Mental wellbeing -Emotional wellbeing -Staying active -Staying intellectually stimulated -Keeping engaged in a supportive network |
| What are the 8 stages of retirement according to Atchley & Barusch. | 1. Preretirement 2. Honeymoon 3. Immediate Retirement Routine 4. Rest + Relaxation 5. Disenchantment 6. Reorientation 7. Retirement Routine 8. Termination of Retirement |
| What are the challenges with the preretirement stage (1st) of retirement according to Atchley & Barusch? | Concern is financial. Will they have enough funds to sustain life? |
| What are the challenges with the Honeymoon stage (2nd) of retirement according to Atchley & Barusch? | Concerns could be moving and/or finances and the lack there of. Transitions from saving to spending. |
| What are the challenges with the Immediate Retirement Routine stage (3rd) of retirement according to Atchley & Barusch? | Finding a new routine - especially for those who really focused on work. |
| What are the challenges with the Rest & Relaxation stage (4th) of retirement according to Atchley & Barusch? | Boredom and inactivity. |
| What are the challenges with the Disenchantment stage (5th) of retirement according to Atchley & Barusch? | Sense of Loss, Uncertainty, Lack of Purpose |
| What are the challenges with the Reorientation stage (6th) of retirement according to Atchley & Barusch? | Stresses of soul searching, Risks of Major Changes |
| What are the challenges with the Retirement Routine stage (7th) of retirement according to Atchley & Barusch? | Life is too predictable |
| What are the challenges with the Termination of Retirement stage (8th) of retirement according to Atchley & Barusch? | Retirement takes a back seat to other priorities i.e. a sick spouse |
| What are the 5 emotional stages of retirement according to Dychtwald? | 1-Imagination (6-15 yr before)-Fantasizing about retirement. 2-Anticipation (up to 5 yr before)-Exploring interests 3-Liberation (retirement day + 1 yr)-Enjoying retirement 4-Reorientation (2-15 yr after)-Now what? 5-Reconciliation (16+ yr)-Accepting |
| What is the definition of leisure time other than free time? | Leisure time is more than free time. It is any activity enjoyed for its own sake pursued as an end in itself without obligations. |
| What are the ways older adults can find meaning in their lives? | -Human relationships -Service to others -Religion -Leisure activities -Work -Being a grandparent -Intimacy -Staying engaged |
| Describe the role of technology/social media in older adults lives. | Reconnects them to people from their past, bridges the generations, connects families, promotes independence and can facilitate aging in place and general health (telehealth). |
| How are the roles of grandparents changing in today's families? | There is an increase of grandparents who are raising their grandchildren. |
| What is the difference between a multigenerational household and a blended family? | Multigenerational households have 3 or more generations residing in the home (child, parent, grandparent) Blended families are 2 parents living with children they each had previous along with children they had together. |
| Why is it important for professionals to understand the conditions people faced in their early lives and the factors of the era in which they grew up? | To better understand how their clients relate to their families. How they deal with money and how they are likely to adapt to changes in life. What do they hope for? What do they fear? What's missing? |
| What is the difference between a pyramid and a beanpole family structure? | Pyramid-has 2 or 3 generations with many children in each. Beanpole-has 4 or 5 generations with few children in each. |
| How are changes in family structure potentially affecting caregiving and other aspects of older adult's lives? Beanpole vs Pyramid | Changes are more towards beanpole families which means there are less people available to provide caregiving for families. The few will have to do more. Calling on friends and/or neighbors to help. Impacts the need for more services/programs. |
| Identify 3 types of bonds that foster close relationships. | Interdependence -Reciprocal between 2 or more, needs are met better together than alone. Intimacy -Mutual exchange of trust, affection and confidence Belonging -Part of a group with same values/beliefs, free to be themselves. |
| Explain the 4 ways a person's social network provides support. | Emotional -Confiding, comforting, listening Informational -Advice, info i.e. Long Term Care options Instrumental -Housework, errands, personal care, financial support Financial -Direct payments |
| If a client becomes widowed or divorced, how could that affect his/her social support system? | People often assume family is providing support, this is not always the case. They have lost their main support. Men exclusively rely on spouse for support. Women are more likely to be worse off economically. Loss of Role/Identity. |
| How are friendships different than families in providing support for older adults? | Friendships compliment family support. Family support is usually obligatory while friendship support is given freely. Family support is usually expected. Friendship support is characterized by reciprocity. |
| How has social media affected the lives of older adults? | Benefits: -Keeping family close, sharing photos -Saving money -Community and belonging -Sharing knowledge, seminars, forums -Peace of mind Cons: -Can take a long time to learn -Can receive wrong information |
| Why is it important for a professional to have a working knowledge of what constitutes an unhealthy family dynamic? | It helps to determine the best approach to help/work with different clients. |
| What are several characteristics of family conflict? | -High emotions -Intensifying differences -Resistance to outside interventions -Accusations -Hurt feelings -Poor communications skills |
| What are the goals of elder mediation? | -To facilitate a resolution to a problem -To create and action plan bringing everyone together or to at least call a temporary truce -To come up with possible solutions for the older adult |
| How does lack of knowledge about aging and older people affect how older adults are treated? | -Unrealistic expectations -Bad treatment affecting their health/self esteem -Safety risks, missing red flags -Being rushed -Overlooked health concerns |
| What beliefs and behaviors do older adults value? | -Autonomy -Choice -Empowerment -Independence |
| What makes up one's heritage and why is it important? | -Ethnicity -Ancestry -Religion -Culture It influences everything! |
| What are the 5 goals of becoming culturally competent? | -Become self aware (how your views affect clients) -Become aware + accept cultural differences (respect) -Understand the dynamics between you and the other person -Access cultural knowledge (accurate!) -Adapt to diversity of clients (listen and ask) |
| How can sensory changes affect an older adult's interactions? | Adversely. -Miscommunications = Negative responses -Can be left out of conversations -May avoid social situations --Leading to isolation/depression |
| How can professionals make their print materials and websites accessible to older adults? | Print -Easy to read type -Avoid italics + all caps -Bold for emphasis -Adequate spaces between lines -Plain background Web -Function over aesthetics -Black text/White background -HTML Text/Minimal graphics/Lg. Text -Caption graphics/Tables |
| What are some ways to improve in-person communication with other adults? | -Monitor nonverbal behavior -Reduce background noise -Face them/Do not cover lips -Simple words/Short sentences -Visual aids/Write things down -Encourage assistive devices -Approach from front/Eye level -Open ended questions & listen (be silent) |
| Name several factors that professionals can and cannot control in the contexts of communication. | Can Control: -Environment-furniture, time of day, temperature -Relational context-how you relate -Psychological context-personality, needs Cannot Control: -Client's psychological context -Situational context-health, support system -Cultural context |
| How does elderspeak contribute to a breakdown in communication? | Client could think they are incompetent whether they have Dementia or not. They could feel disrespected and demeaned. |
| How should one communicate with a person with Dementia? | -Be patient/supportive -Avoid arguing/correcting -Offer guesses -Ask them to point/gesture -Talk in a quiet place -Approach from front -Eye contact/their level -Use their name -1 question/time -Speak slowly -Wait for response -Repeat as needed |
| What does it mean to be health literate and why is it especially important for older adults? | To comprehend basic health info in order to make appropriate health decisions. It becomes more challenging as we age as health decisions become more complex. |
| What are signs of low health literacy? | -Incomplete/inaccurate forms -Frequent missed appointments -Noncompliance with meds -Lack of follow up with tests/labs -Unable to name meds or what they are for |
| What are strategies for improving health literacy? | -Recognize the problem -Remove communication barriers, hearing or visual -Provide instructions -Nonjudgmental environment -Be alert/Observe -Sensitive to Education level/Cultural Background -Teach back strategies -Do they ask questions? |
| List the factors that have contributed to an increase in life expectancy. | -Declines in death from infectious disease -Improved public health -Better sanitation -Discovery of antibiotics |
| What is the difference between life expectancy and life span? | Life expectancy is the average # of years one is expected to live. Life span is the maximum length of years biologically possible. |
| What is senescence? How is it characterized? How does it affect cells in the body? | Biological process of aging/leads to deterioration. -Declining ability to respond to stress -Increased inability to maintain physiological balance -Increase in age-related diseases Causes cells to stop dividing after about 40-60 divisions |
| What do biomarkers reveal about the body and how might they help researchers who are studying aging? | Substances in the body that can be measured. They indicate certain conditions + can accurately assess biological age. They can show the rate at which age is occurring. Helps researchers by not having to use longitudinal studies that are costly + long. |
| How do hormones impact the body? | They circulate in the bloodstream and attach/unlock receptors on cells. They regulate growth, metabolism, mood, sexual development. Hormone levels change little w/ aging. Tissues becomes less responsive to hormones. |
| What do the Baltimore Longitudinal study of aging (BLSA) and MacArthur study of successful aging tell us about the aging process? | BLSA -It is possible to differentiate normal aging from disease -Human aging has no single chronological timetable. Variability is normal. MacArthur -Genes contribute 30% of longevity. 70% from lifestyle and habits. |
| What are some of the characteristics that centenarians have in common with each other? | -Longevity runs in family -Healthy weight -Non-smokers -Emotionally stable (less reactive to stress) -High cognitive function -Late fertility (kids after 35) -Having older children (65-82) with low rates of age-related conditions i.e. diabetes, HBP |
| What is proprioception and how does it impact the body? | The body's ability to sense the position of it's limbs without having to look. Important for everyday balance and movements. Declines with age. |
| If floaters persist and don't settle down as they commonly do, what could they be a symptom of? | Retinal detachment. |
| Name the leading cause of vision loss in older adults. | Age related macular degeneration (AMD). |
| What effect does aging have on the heart when it comes to normal and high exertion activities? | The heart is less efficient in pumping blood and extracting oxygen. Normal activities = No real effect High exertion = Can definitely be felt! |
| What is a common effect of medications on blood pressure? Because high blood pressure gives no warning signs, what should older adults do to prevent problems? | Low blood pressure when changing position from lying down/sitting to standing i.e. feeling faint, dizzy, lightheaded. They should regularly monitor blood pressure to avoid illness. |
| What causes aspiration pneumonia? | When food or liquid enter the lungs rather than the stomach. |
| How does aging affect the body's ability to metabolize drugs and alcohol and absorb nutrients? | Liver weight and function decline. Decreased ability to metabolize drugs/alcohol. Small intestine's ability to absorb nutrients is reduced. |
| Which genitourinary condition affects 2/3 of adults but can be successfully treated in about 80% of evaluated cases? | Incontinence. |
| What is the effect of aging on a person's 1. Basic Intelligence 2. Ability to process information and make decisions. | Basic intelligence is usually maintained with age. Processing information and making decisions speed may slow but they are still capable of processing and deciding. Just need more time! |
| How can professionals adapt to client's normal cognitive changes? | -Do not assume cognition is diminished -Avoid speaking too fast -Avoid multiple questions without allowing time for processing -Provide information in writing -Encourage stimulating activities -Support new learning |
| What are some differences between signs of Alzheimer's disease and normal cognitive aging? | AD -Memory loss disrupts daily life -Trouble problem solving -Recalling rules to fav game -Confused w/ time/passage Normal -Occasional forgets names, remembers later -Makes errors -Need help recording TV show -Forgetting day/week, remembers later |
| What are some physical symptoms that may indicate low salt in the body which can be fatal if left untreated. | -Craving for salt/salty foods -Drowsiness -Fatigue -Nausea -Headache -Confusion |
| What is the effect of aging on the body's ability to heal? | Healing is slower. The ability to detect and repair cells declines. Increased risk of cancer. |
| Name some common changes in men as a result of a decrease in testosterone. | Emotional and physical changes occur. -Insomnia -Depression -Decreased motivation -Reduced sex drive -Decreased muscle mass -Lower bone density |
| What is the effect of increased longevity on older adults' dental health? | The can experience a second period of cavity prone years. Older adults experience more cavities than kids under 14. |
| How does positive ageism shift the conversation about aging? | From a focus on deficit and decline to enhancing lives and empowering older adults. |
| What are the differences between acute and chronic illness? | Acute -Rapid onset -Short duration (predictable) -Predictable progression -Common remission -Cured -Rare exacerbations Chronic -Slow onset (3-6mo) -Long duration (uncertain) -Variable progression -Rare remission -Uncured -Common exacerbation |
| Why are older adults affected by chronic disease more than any other group? | Due to the slow progression and long duration of chronic disease. They also have higher levels of inflammatory markers. |
| Describe the various effects of chronic illness on older adults' lives. | -Reduces energy, mobility, quality of life and independence -Neg. affects self image, intimate relationships, visible/non-visible body changes -Increase family pressures -Out of pocket spending, meds, visits -Social Isolation i.e. Dialysis |
| Define chronic pain vs. acute pain | Chronic = 3-6 months or longer, cause unknown, can't be cured Acute = 3-6 months or less, known cause, can be treated/cured |
| What is the common treatment for chronic pain and it's dilemma? | Narcotics. Metabolic processes that break down meds slow as a person ages leaving the patient over/under medicated. |
| Why is inadequate pain management widespread among older adults? | 1. Pain has not been well studied 2. Studies are inconsistent 3. They think pain is normal - leads to underreporting of pain (especially in residential care settings) 4. Some professionals think people are "drug seeking" and prone to addiction |
| How is palliative care different from a traditional approach to pain management? | Traditional = Narcotics Palliative = Traditional interventions with complementary and alternative medicine treatments. Can bring comfort and increase quality of life. |
| What is complementary, alternative and integrative medicine? | Complementary = used ALONG with conventional medicine Alternative = used IN PLACE of conventional medicine Integrative = COMBINATION of both complementary and alternative |
| What are some examples of complementary and alternative medicines? | 1. Acupuncture 2. Chiropractic Treatments 3. Massage 4. Yoga |
| What complicates the process of managing chronic pain? | Many older adults have more than one chronic condition and more than one prescribing physician. Supplements can interact with meds. Polypharmacy and/or the use of more meds than needed. |
| Describe the effect of patient's non-compliance w/ their plan of medical care and what can be done to encourage them to adhere to their plan. | Poses a significant burden on the health care system. Affects the opportunity for positive patient outcomes and increases patient mortality. What can be done - Health education - increasing their health literacy |
| Why is health literacy essential for older adults and what are examples of programs that are in place to support it? | People who take charge of their health, HAVE better quality health. Programs include: -The Stanford University Chronic Disease Self Management Program - "Best Practice" Programs usually at senior centers and run for 6-8 weeks. |
| What is illness? | A unique experience of a disease in a person. It is the perspective of the one experiencing it. Two people can have the same chronic disease, but a different ILLNESS experience. i.e. John and Harry with Type 2 Diabetes at 60 y/o. |
| What are the most common chronic conditions among older adults? | 1. Heart Disease 2. Stroke 3. Cancer 4. Diabetes 5. Arthritis 6. Osteoporosis 7. Incontinence |
| In reference to chronic conditions, generally describe key points to heart disease. | -Leading cause of death in older adults -Most common is heart failure -It includes hypertension (high blood pressure) -Includes hardening of the coronary arteries, angina, heart attacks |
| In reference to chronic conditions, generally describe key points to stroke. | -Risk factors are similar to heart disease -A mini stroke is a transient ischemic attack (TIA) -Arteries in the brain become narrowed (Aneurysm) -Leading cause of serious adult disability in U.S. -Treated with PT, OT and Speech Therapy |
| In reference to chronic conditions, generally describe key points to cancer. | -41% of all Americans will face a cancer diagnosis -21% will die -2nd leading cause of death in 65+ -Men over 60 are 2x more likely to get cancer -Early detection can reduce impact and death |
| In reference to chronic conditions, generally describe key points to diabetes. | -Chronic disease characterized by too much blood sugar -Damages vessels and organs -26.9% of people 65+ have diabetes |
| In reference to chronic conditions, generally describe key points to arthritis. | -Most common cause of disability in the U.S. -Affects nearly 50% of those 65+ -Most common forms are Osteoarthritis or Degenerative Joint Disease -Not a normal part of aging -Can be effectively treated |
| In reference to chronic conditions, generally describe key points to Osteoporosis. | -Progressive disease -Causes bones to become thin/porous and worn -Often called "silent disease" due to no symptoms in early stages -Women are 4x's more likely to get it than men |
| In reference to chronic conditions, generally describe key points to incontinence. | -Relatively common -Not a normal part of aging -Women 60+ are 2x more likely to suffer from it -Under-reported, under-diagnosed and under-treated |
| What is hypertension? | High blood pressure. -Heart works harder to pump blood -Can cause stroke, kidney disease, blindness Higher=systolic The amount of force exerted when the heart pumps blood through the artery Lower=diastolic Force w/in the artery between beats at rest |
| Describe the hardening of the arteries. | -Arteries become clogged (Atherosclerosis) -Accumulate sludge consisting of cholesterol, debris and blood platelets -Narrows the internal diameter of the artery -Less flexible -Prone to blood clots |
| What is angina? | Insufficient oxygen to the heart leading to pain usually when active. Stable angina = chest pain present for at least 2 months, does not happen at rest. Unstable angina = Requires medical attention, happens at rest Nitroglycerin pill under the tongue |
| What is a heart attack? | Acute myocardial infarction-Artery blocked + cuts off blood flow = heart muscle dies -crushing pain, viselike squeezing, heavy weight on chest -profuse sweating, shortness of breath -Different for women, may be no chest pain, back or jaw pain instead |
| What are the treatments for heart disease? | 1. Meds for hypertension 2. Diuretics 3. Meds that increase pumping effect of the heart 4. Healthy lifestyle changes 5. Open heart surgery |
| How does a stroke happen? | Blood flow to the brain is interrupted and brain cells die. 1. Ischemic stroke (most common)-clot interrupts blood supply to part of the brain 2. Blood vessel in brain breaks spilling blood into surrounding space. |
| What is an aneurysm? | A weak or thin spot on an artery wall. Stretches/balloons out over time eventually rupturing and spilling blood onto brain cells. |
| What is hemiplegia, hemiparesis and dysphagia? | Hemiplegia-paralysis on one side of the body Hemiparesis-one sided weakness Dysphagia-trouble eating and swallowing |
| What are some common complications of diabetes? | -Heart disease -Stroke -High blood pressure -Blindness -Kidney disease -Nervous system disease -Lower extremity conditions -Dental disease |
| What are some autoimmune inflammatory processes that can lead to joint deformity? | -Rheumatoid Arthritis -Lupus -Fibromyalgia -Gout |
| What are some common ways to assist clients that might struggle with incontinence? | -Be alert to nonverbal cues -Suggest a break -Meet close to the bathroom -Make sure they know where bathroom is -Keep meetings short -Take breaks |
| How is mental processing affected as a person gets older? | It is typically slowed. It influences daily functioning and plays a role in health and independence. |
| Is there a difference in performance between younger and older adults when the older adult is given extra time to complete a task? | Most often, no. The differences in performance usually disappear. |
| What are 3 types of attention and how are they impacted with age? | Selective-ability to attend to stimuli while ignoring stimuli non-relevant to task. Impact-Slower responding than young Divided-Process 2+ sources info at same time. Impact: Age-related decline Sustained-Maintaining concentration over time. Impact: None |
| What are 3 types of memory? | Working-remembering a string of numbers, but trouble in reverse order Short term-(primary memory) able to recall a phone number after rehearsing it Long Term-Learning how to ride a bike by a lake, but can't recall the lake's name or how old you were |
| What are the 5 sub types of Long Term memory? | Episodic-personal at a particular place/time Semantic-general knowledge of the world, facts Autobiographical-one's personal past Procedural (Implicit)-using a pen, typing Prospective-remembering to remember |
| What are some common conditions that cause memory problems? | -Anxiety -Dehydration -Depression -Infections -Med side effects -Poor nutrition -Psychological stress -Substance abuse -Thyroid imbalance |
| What is the difference between fluid intelligence and crystallized intelligence? | Fluid-ability to perceive relationships, think abstractly, problem solve. Peaks in adolescence, declines progressively after 30 Crystallized-continues to increase throughout life. Applies education, skills, experience with fluid intelligence. |
| Why is a healthy cognitive capacity important to older adults? | It is essential to an older person's active engagement in life! It can help maintain independence and health. |
| How does neuroplasticity relate directly to one's cognitive reserve? | It's the brain's ability to change/adapt to environment. It's a brain built-in safeguard. |
| What are some factors that slow down the decline of one's cognitive reserve? | Engaging in intellectual activities Having higher IQ levels Higher education Occupational attainment Remain socially active |
| What is the difference between mild cognitive impairment (MCI) and Dementia? | MCI is a diagnosis based on a noticeable decline in cognitive function but is not severe enough to interfere with daily functioning and does not meet criteria for Dementia. MCI sufferers do have an increased risk of developing Dementia. |
| List the 6 conditions that cause reversible neurocognitive disorders. | 1. Toxicity 2. Metabolic-Thyroid disease or B12 deficiency 3. Mood-Depression 4. Medication induced 5. Tumors/Brain Trauma 6. Infections-UTI 7. Sensory Impairments-may present as cog. impairment |
| Describe delirium. | -It is not dementia -Linked with changes in meds, new strokes or infection -Dementia increased risk of delirium -Develops over short period of time/fluctuates -May include hallucinations/delusions -Dreams from realty is difficult |
| Explain how the brain changes with Alzheimer's disease. | The brain changes are the accumulation of plaque and the build up of tangles. Plaques and tangles damage and kill nerve cells. Result is the brain can't process information. |
| Name common causes of delirium. | 1. Direct physical consequence of another medical condition 2. Substance intoxication 3. Withdrawal or exposure to a toxin 4. Combination of factors |
| Name 3 common results of vascular cognitive impairment and briefly describe each. | Agnosia-Inability to recognize familiar objects Aphasia-Loss of the ability to speak or understand speech Apraxia-Trouble with physical movement i.e. change in gait |
| What are 5 common irreversible neurocognitive disorders? | -Alzheimer's (AD) -Vascular Cognitive Impairment (VCI) -Lewy Body Dementia (LBD) -Parkinson's Disease -Frontotemporal Dementia (Pick's Disease) |
| What causes Vascular Cognitive Impairment (VCI)? | Small strokes that decrease blood flow to the brain. |
| What causes Lewy Body Dementia (LBD)? | Abnormal clumps of protein (Lewy bodies) in the brain. |
| What causes Parkinson's Disease? | The brain's loss of dopamine causing movement problems. |
| What causes Frontotemporal Dementia (Pick's Disease)? | Cell damage that causes tissue shrinkage. |
| What are the 5 main factors that scientists believe increase a person's risk for AD? | -Family History = 1st degree relative -Apolipoprotein E Gene (APOE) = Risk, but not a guarantee -Mild Cognitive Impairment -Cardiovascular Disease = Obesity, Diabetes -Education = Lower education, Higher risk |
| What are some warning signs of AD? | -Memory loss that affects job skills -Difficulty w/ familiar tasks -Problems w/ language -Confused w/ time/place -Poor judgement -Problems w/ abstract thinking -Changes in mood/behavior -Misplacing things -Personality changes -Loss of initiative |
| According to the Alzheimer's Association, what are the 3 main stages of Alzheimer's Disease? | -Preclinical AD = No symptoms -MCI due to AD = Mild but measurable changes, everyday functioning not affected -Dementia due to AD = Changes in memory, thinking and behavioral symptoms impair daily functioning |
| What is sun downing and the typical behaviors associated by it? | A state of confusion that typically occurs at the end of the day and into the night. -Aggressive behavior -Hallucinations/delusions -Pacing/wandering -Impulsive behavior -Attempting to leave -Difficulty understanding others |
| What are the final 4 stages of Dementia due to AD? | 1. Moderate Cognitive Decline (Early) 2. Moderately Severe Cognitive Decline (Moderate) 3. Severe Cognitive Decline (Mod. Severe Dementia) 4. Very Severe Cognitve Decline (Severe) |
| What are some treatments for AD? | -Medications (to delay only) = They don't work for all, they increase # of chemicals in the brain (Cholinesterase inhibitors & Glutamate regulators) -Vitamins/Supplements -Clinical Trials = More than 130 currently ongoing |
| What are some ways to manage behavioral symptoms in AD? | -Behavioral interventions -Monitor personal comfort -Avoid confrontation -Redirect attention -Create a calm environment -Allow adequate rest -Pharmacological Interventions (use with caution) |
| Describe resilience as it relates to older adults. | Resilience is the ability to recover from major changes or to adapt. A positive outlook = more resilient |
| List some problem-focused coping strategies included n the cope inventory. | -Active coping = taking action to remove stressor -Planning = thinking about how to deal -Suppression of competing activities -Restraint coping = withholding coping until it can be of use -Seeking instrumental social support |
| Explain what depressive disorders have in common. | They are characterized by depressed/irritable mood which may accompany physical and cognitive changes impacting the ability to function. |
| What is the DSM-V? | American Psychiatric Associations Diagnostic and Statistical Manual of Mental Disorders |
| What is pseudodemntia? | Memory difficulties in older adults w/ depression that are misinterpreted as Dementia. When depression is treated, the memory improves. |
| How is a major depressive disorder different from a persistent one? | Major = Symptoms last most of the day, Everyday for at least 2 weeks. Persistent = Chronic form of depression where symptoms are present for at least 2 years. Depressed mood more days than not and at least 2 other symptoms. |
| Name the 3 symptoms that indicate Dementia rather than depression. | 1. Difficulty organizing/Losing things 2. Language deficits 3. Incontinence in later stages |
| When could bipolar disorder affect older adults? | Anytime. First time can happen in one's 60's or 70's. |
| Describe a manic episode. | -Being "on top of the world" -Elevated mood w/ inflated self esteem -Decreased need for sleep -Talkative -Increased activity with a goal -Buying sprees |
| What is the difference between an anxiety disorder and normal worries? | Normal worrying is normal. Anxiety disorders are when these normal feelings interfere with daily life or become overwhelming. Often get in the way of functional ability. |
| What are some types of anxiety disorders? | -Specific phobias = Intense/Irrational w/ little threat -Social anxiety disorder = Daily situations -Panic disorder = Repeated bouts of fear/unexpected & w/in minutes -Agoraphobia = Perceived dangerous environment -Generalized anxiety disorder |
| List the 10 personality disorders in the DSM-5. | 1. Paranoid 2. Schizoid 3. Schizotypal 4. Antisocial 5. Borderline 6. Histrionic 7. Narcissistic 8. Avoidant 9. Dependent 10. Obsessive PSSABHNADO |
| List some common mental health disorders among older adults. | 1. Depressive = Most treatable 2. Bipolar = Manic & Depressive Episodes 3. Anxiety = Mostly females 4. Obsessive Compulsive = Uncommon 5. Posttraumatic Stress = PTSD 6. Substance Abuse = Fastest growing in U.S. Alcohol most common 7. Personality |
| What does an initial mental health assessment usually include? | Chief complaint Present illness Relevant History Demographic Info Summary of clinical problems Mental status exam Brief rating scales Health/Mental Health history DSM-5 Diagnosis Patient goals Clinician's goals/plan |
| List the 3 ways to treat mental health problems. | Medication Psychotherapy (Talk therapy) Combination of the two |
| What are the different parts of Medicare and what to do they cover? | Part A = Automatic/costs nothing for all 65+, covers inpatient services subject to rules Part B = Voluntary/Requires enrollment, outpatient Part C = Medicare Advantage, by private companies to those that have A & B Part D = Prescription Drug Plan |
| What are several differences between grief and major depression? | Not knowing underlying cause G=Death D=Unknown Feelings G=Emptiness D=Can't anticipate happiness Timeframe G=Lessens after time D=Everyday for 2 week min Emotions G=Pain, possible humor D=Misery Thoughts of Dying G=Joining dead D=Don't deserve to live |
| How is normal grief different from complicated grief? | Normal grief = process containing expected phases, emotions and behaviors Complicated = Different due to the intensity/extent of those phases, emotions and behaviors |
| List several mediators of mourning. | -Relationship to deceased -Mode of death (violent, sudden) -Historical precedents (past losses) -Personality variables (age, gender) -Social variables (support system) -Concurrent stresses (work, money, family) |
| What is a STUG reaction? | A Sudden Upsurge of Grief Triggered by something. They eventually turn into cherished memories. Anniversaries, Holidays, Places, Fragrances, Foods, Events, Music, Seasons |
| What does cognitive behavior therapy identify? | Behaviors associated with mental health symptoms and focuses on changing these behaviors. i.e. quitting smoking |
| Identify the key factors in healthy aging. | -Healthy eating -Physical activity -Lifestyle |
| What are the signs of nutritional risk? | -Disease -Eating poorly -Tooth loss/mouth pain -Economic hardship -Reduced social contact -Multiple meds -Involuntary weight loss/gain -Needs self-care assistance -80+ |
| How can older adults counter the decrease in their metabolic rate? | -Exercise regularly -Maintain muscle mass through strength training |
| What are the guidelines for a healthy diet in MyPlate for older adults (Tufts University)? | -Plate has 4 sections -3/4 make up veggies, fruits and whole grains -5 servings of fruits and veggies for adequate nutrients |
| Why does an older adult who drinks the same amount of alcohol as a younger adult have a higher blood alcohol content? | They metabolize alcohol more slowly so it stays in the body longer. They also have less water levels so can't dilute alcohol to the same degree. |
| Why is obesity a significant concern for older adults? | It increases the risk for all leading causes of death i.e. heart disease, stroke, Type 2 Diabetes, etc. Has a large impact on health and increases medical costs. |
| What is the Body Mass Index (BMI) and how is it used? | It is used to determine if someone is overweight or obese. BMI > 25 = Overweight BMI > 30 = Obesity |
| When does malnutrition usually occur in older adults? | During illness. Numbers go up for those in hospitals and LTC communities |
| What types of exercise are especially beneficial for older adults? | -Flexibility -Balance -Strength training -Aerobics |
| What is obstructive sleep apnea, symptoms and risk factors? | -When an individual stops breathing or makes gasping noises -Symptom = Loud snoring -Risk Factors = Male and Obesity -Leads to excessive sleepiness and impaired function |
| Name the 3 types of risk factors for falls. | -Biological = mobility, chronic health issues, vision changes -Behavioral = inactivity, med side effects, alcohol -Environmental = home hazards, pets, incorrect size of assistive devices |
| What is the chronic disease self-management program and how can it help older adults' efforts to be healthy? | -State funded, at senior centers, usually 6-8 weeks -To empower older people and more effectively manage their health -Focus on eating well, exercising, managing symptoms and living well |
| Describe the risk factors and warning signs for older driver safety. | Risk factors = Reduced strength/coordination/flexibility, meds, slower visual processing, impaired hearing, neck pain/stiffness, leg pain Warning signs = Confuses gas/brake, ignores stop signs, weaves/straddles lanes, no blinkers, drives too fast/slow |
| What are some programs and resources to assess and support older driver safety? | AAA & AARP w/ American Occupational Therapy Association Educational Program = CarFit Driver safety courses |
| Describe the physical and cognitive benefits of creative engagement among older adults. | Physical = Fewer Dr. visits, fewer falls, lower meds, lower depression Cognitive = increases memory, increases intellectual processing, improves word recall and problem solving *Music can reduce chronic pain, depression and anxiety* |
| Give several examples of new and traditional types of creativity. | -Social/Interpersonal = clubs, discussion grps -Musical -Spatial = draw, sculpt -Bodily/Kinesthetic = walk, golf, bike -Logical/Mathematical = puzzles -Verbal/Linguistic = tell stories, write -Intrapersonal = read, journal, meditate -Naturalistic |
| Describe some pros and cons of naturally occurring retirement communities (NORCS). | Pros-Lasting relationships, Aging in place, safety, low cost Cons-No immediate medical care, not for round the clock care, usually cannot sell on the open market |
| What is place attachment and how could it affect some older adults? | A special bond between people and specific places. Older adults might feel anxiety when away from it. They can lose their sense of identity. It is one of the most difficult emotional hurdles for those thinking of moving. |
| What type of reverse mortgage is insured by the federal government? | A Home Equity Conversion Mortgage (HECM). Only via FHA-approved lenders. |
| List some difficulties of aging in place in the suburbs | -A car is required (never learned or have to stop) -Linked to poor physical health -Far from shopping, etc -Original reasons for living there might be gone (good schools) -High taxes, insurance, utilities -Older, outdated homes |
| Where do most older adults tend to live? | In their own homes. Metro areas, mainly older suburbs. "Architecture of Isolation" -Florida, Maine, W. Virginia, Vermont and Montana |
| What are some push and pull factors that influence older persons into moving? | Push -Divorce/Remarriage -Death of spouse/Caregiver -Loss of income -Health status/Cognitive change -Neighborhood changes/crime -Help w/ ADLs -Home not adapted Pull -Climate -Retirement -Recreation/Amenities -Friends/Family -New construction |
| Identify several factors that affect older adults housing decisions. | -Income/Assets -Household arrangements -Education levels -Racial/Ethnic backgrounds -Religion -Personality -ADLs -Family for help -Professionals -Past Finances/Housing -Quality of life -Affordability -Equal Opportunities |
| Describe how home modifications and universal design principles can help older adults age in place in their traditional built homes. | -Create flexibility -Proactive ways to increase function and avoid accidents/falls -Universal=designs that anyone, regardless of age, size or ability can live/visit -No step entries -Single floor living -Reachable controls/switches -Wider doorways |
| Give examples of assistive devices that help older adults live independently and age in place in their own homes. | Communication Devices=videophones, TTY, text phones Listening Devices=hearing aids Voice/Switch activated controls Devices for Blindness=Talking computer Lifting Devices=Transfer benches Memory/Organization=Pill organizer w/ alarm |
| What is the purpose of Home and Community Based Services (HCBS) and who provides them? What are some benefits of in-home services? | Allow people to live in homes safely-Care, Shopping, Respite, PT Provider=Private Pay, Non-profits, Religious Orgs, Gov. Programs The difference between truly fulfilling life & one of deprivation, ill health & lonliness. Keeps people of of LTC homes. |
| What does a geriatric care manager do for older adults? | Helps them learn what resources are available and which will meet their needs best. They help contract with local providers. They meet w/, assess, develop a plan and follow up. Can also help fill out forms. |
| Describe several transportation options available for older adults. | Paratransit/Dial a ride Public Transportation Volunteer programs (Nat'l Volunteer Trans. Center and Rides in Sight) Concierge Transportation voucher programs (need to qualify) Private (Uber, Lyft) |
| Discuss several characteristics of active adult housing. | "Lifestyle Housing" -Organized around social/recreational activities w/ amenities, but no care. -Age restricted/Age targeted -Cohousing/shared housing -Accessory Dwelling units (ECHO) ie. granny flats -IL -HUD assisted housing (housing + services) |
| Describe housing for less active and more dependent adults with examples. | Residents need more supervision/help with ADLs, but not skilled care. "Service enriched", personal care homes. Each state regulates it's own versions. -AL, Board & Care homes, Adult Foster Care, CCRC, Nursing Homes |
| Discuss several examples of new models of housing for older adults. | -Village Movement (200+ up and running) -WHO global network of age-friendly cities and communities -Certified renovation packages -Minka Homes/Communities -People centered approaches -Socio medical -New urbanism -Residential normalcy |
| What does the people-centered approach to long-term care in nursing homes mean? | You look at the person first. People are treated with respect/dignity and have choice. They make decisions about their care. |
| The definition of home has four dimensions; what are they? | -Shelter -Convenience -Security -Assistance i.e. smart homes |
| How is the Americans w/ Disability Act different from the fair housing act? | Fair housing= Protects impaired older renters from discrimination 4+ Dwelling units Must allow reasonable modifications Americans w/ Disabilities Act= For commercial places, restaurants, auditoriums, barbers, laundromats and IL, AL, CCRC and LTC |
| Describe the purpose of Medicaid waivers and give some examples. | Allows states to provide Long term services & support (LTSS) in home and community settings (medical and non medical) Home health aides Case management Personal care Adult day services Rehab Respite Care Custodial Care |
| Who is the typical family caregiver and typical care recipient? | Daughter (woman) providing care to mother or spouse (most often white, 49+, married and juggling work and caring for family and older adult). Most care recipients are women. Nearly 1/2 are 75+ |
| Explain why a family-centered approach to caregiving is important. | It improves outcomes and the continuous care for the older adult. |
| Discuss how a geriatric care manager can help a long distance caregiver. | Being the eyes/ears for them. Helping prioritize/strategize and manage responsibilities Keeping them up to date on health Access to safety hazards/cleanliness Consider/Communicate driving abilities Refer to community resources |
| What is a caregiver assessment and why is it important? | Provides info about how to help care recipient and primary caregiver. It helps identify the support the caregiver needs to improve outcomes and continuity of care for recipient. |
| What is caregiver burden? | Negative reaction to the impact of providing care on one's social, occupational and personal roles. |
| Give two examples of ambiguous loss. | -Loss of a future planned due to illness -Loss of your best friend in a spouse due to illness/death -A football player now needing to use a walker |
| How does anticipatory grief affect the grieving process? | Waiting for someone to pass and have already started the grieving, when the person actually dies, grief might not be as intense. Can affect family members and relationships. |
| Why is financial stress one of the greatest burdens of caregiving? | Options for care/respite depend on finances. There is almost never enough funds to do all the needs to be done. |
| Describe three common areas of conflict related to the care recipient's independence. | Money=Might not want to spend it on their needs, less financially prepared (baby boomers) Driving=Denial there is a problem, Dr. sometimes needs to be the "bad guy" Who is in control?=Parenting the parents-they are still adults/should be treated as such |
| What are two major issues facing the caregiver for a person with Dementia? | Declining Cognitive Skills/Decision Making=Fine balance between when to make their decisions and when they still can. Disruptive Behavior=subject to combative behavior when trying to do personal care |
| Name two of the greatest needs that caregivers have. | Information=Support groups, resources Assistance=Family, friends, neighbors, social support, respite |
| What is respite care? | Caregiver assistance that prevents burnout. Someone comes into home or recipients goes to a program giving the caregiver a break. |
| List some community resources for caregivers. | Area Agencies on Aging (AAA) Veteran's Administration Nat'l Family Caregiver Support Program Program for All-Inclusive Care for the Elderly (PACE) Raise Family Caregiver's Act Eldercare Locator |
| What are examples of family dynamic issues in a caregiving situation? | "Parachute in" siblings When people provide care out of duty/obligation or by default "The responsible one"-it's not fair There is always someone doing more than others |
| Describe the purpose of a family meeting. | Opportunity for ALL family members to express perceptions, needs, problem solving, plans for care (present and future). NOT a way to fix the family. |
| What is advance care planning? | Process for adults to say their wishes for medical/financial care in serous illness/incapacity or at end of life. Who is the decision maker and what medical treatments are acceptable |
| What are advance directives? List examples | Forms that document a person's wishes/choices. Written records of decisions and instructions. Medical and durable power of attorneys Living will CPR Directive or DNR Omnibus AD=Encompasses all 3 above 5 wishes |
| At minimum, what two decisions should be mad before a health crisis occurs? | -Who will make decisions -What treatments are acceptable/not-acceptable |
| Discuss life sustaining treatment in the context of treatable and untreatable ailments, including iatrogenic suffering | Interventions include: Mech. Ventilation, Art. Nutrition/Hydration, Cardiac Support, Dialysis (in treatable these are great, in untreatable ie. very old age, advanced disease, might not help and can lead to suffering) This is iatrogenic suffering. |
| What should be considered when selecting a health care agent? | Treat it like selecting a guardian for kids. Person must be willing (emotionally, logistically, etc) to take on the role. Spouses not always the best choice. Same age, same accident Kids not always good. Inheritance Professionals can be paid to help. |
| What is the definition of capacity or competence in the medical context? | Capacity=clinical determination Competence=legal status Need to be able to: -Understand/provide consent -Evaluate -Make decision -Express decision Assume capacity unless incapacity is shown. |
| Explain the purpose of Medical Durable Power of Attorney. | -Officially appoints a decision maker in your stead -Activated only when capacity is compromised or surrendered -Agent must act as the principal would |
| Explain the purpose of a Living Will. | -Typically used to refuse life sustaining treatment w/ terminal illness or permanent unconsciousness. MA and MI don't use. -"Declarant" must provide options for Artificial Nutrition/Hydration (ANH) |
| Explain the purpose of a CPR Directive | -Out of hospital DNR -Cardiopulmonary Resuscitation Directive -Intended for people advanced illness/likely not to survive/recover from attempt -Older you are the less likely to survive. 9.6% average. TV glorifies and simply not accurate. |
| What are the 5 wishes? | -12 page booklet that meets legal requirements in 42 states 1. Decision maker 2. Medical treatment I want/don't want 3. How comfortable I want to be 4. How I want to be treated 5. What I want loved ones to know |
| How are advance directives subject to "failure", i.e. limited? | -Kept in a safe-deposit box w/ no easy access -Family/Physician unsure of where/if it exists -Limited in application i.e. apply only to CPR -Outdated, doesn't reflect current wishes, agent might be dead -Few legal sanctions if not followed |
| Why is the POLST different from advance directives? | POLSTs are intended for the already seriously ill or elder/frail. Quickly communicate key treatments for CPR, ANH, etc. on one form. Does not replace Living Wills Dr., NP or Assistant needs to complete Medical orders |
| What are the advantages of a POLST? | -More effective -Kept up to date with changing conditions -Present when needed -Allows choices i.e. full treatment/comfort based -Accepted everywhere that POLST program is in place -Carries great authority |
| List three questions common to almost all cultures when planning a funeral. | -What kind of ceremony? -How will the body be placed at its final resting place? -Who will make the arrangements? |
| What are funeral homes required to do by the federal trad commission's funeral rule? | Disclose their prices. Combined or separate for caskets, outer burial containers and gerneral price listings. |
| Identify advantages and cautions to pre-need funeral arrangements. | Advantages -Settling financial arrangements to spare family the trouble. Cautions -Control of funds -Length of time -Person signing won't be present at fulfillment -Inflation on costs -Funeral home could go under -Scam investments -Portability |
| List several types of death and funeral benefits. | -SS Death Benefit -Burial/Headstone for Honorably discharged military (no cost) -Whole life insurance policy/Pension systems |
| How has the landscape of aging and the end of life changed over the past 100 years? | 100 yrs ago death was from infections, accidents and most happened at home. Today people live longer. We've pushed death away, but road is still hard longer & costly. People pass from chronic conditions like Heart Disease and ususally in Nursing homes. |
| Define trajectories of illness and list five. | They map the decline of illness/dying in shape/duration. 1. Sudden death trajectory 2. Terminal illness trajectory 3. Major Organ failure trajectory-chronic 4. Frailty trajectory-Failure to thrive 5. Catastrophic event trajectory-Stroke, heart attack |
| Identify the criteria to enroll in hospice. | Governed by Medicare certification process -Physician must certify illness is terminal -Likelihood of death within 6 months -Forego treatments intended to cure -After 6 months can enroll for additional 90 days (twice), every 60 days after that |
| Discuss the goals of hospice care. | -Maintain comfort, independence and control, relationships and quality of life for as long as possible. -Ensure a peaceful and painless death -Ease the stress of terminal illness i.e. pain, fatigue, nausea, etc. |
| Who is included in the hospice care team? | -Physician -RN -Certified nurses aide -Social worker -Chaplain -Trained volunteers -PT, OT, Speech therapists and Dieticians as needed |
| What is the principal problem in obtaining a timely hospice referral? | The Medicare benefit requirement is a 6 month prognosis. Predicting length of life to timing of death is hard. Dr. says 6 months, it's usually less due to overestimating survival. |
| What is the goldilocks quandary w/ hospice care? | When is the time "just right" for hospice? Ideally not too soon so that they miss out on effective cure therapies but not so late that suffering is severe and families/caregivers are in ruin. |
| Recognize examples of mandatory services in Medicaid. | -Physician services -Hospital services (inpatient and outpatient) -Labs/X Rays -Federally qualified health centers/rural clinics -Nursing facility services (21+) -Home health care for eligible -Transportation |
| Recognize examples of optional services in Medicaid. | -Clinics -Dental -Prosthetics -Eyeglasses -Rehab -Therapies -Case management -HCBS -Raspatory Care for Ventilator dependent -Personal Care -Hospice -Private Nursing |
| In general, describe the two ways that Medicaid delivers services to people: Fee for Service and Medicaid Managed care. | Fee for Service: States reimburse providers for the services they deliver. Medicaid Managed care: States pay Private Ins. Plans/Groups a set amount each month for each beneficiary who enrolls in the plan. |
| What do Medicaid home and community based service's waiver programs do for people who qualify for Medicaid nursing home benefits? | -They provide Long term services -Enable people to stay in their home/delay moving to LTC -Waitlists are common Services may include: -Case management -Homemaker services -Home health aid -Personal care -Adult day care -Respite care |
| What are the qualifications for PACE? | -55+ -Live in PACE service area -Certified to need nursing home level care |
| What are several key differences between Medicare and Medicaid? | Medicaid=Fed/State partnership Medicare=Federal program Caid=financial needs based Care=Health insurance based on work/paid into Caid=eligibility differs Care=Same everywhere Care=no custodial care Caid=yes Caid=no premiums Care=yes |
| What does "spend down" mean? | Shifting assets above the $2000 countable resource requirement into exempt resources to qualify for Medicaid. Legitimate way. |
| What is the purpose of the community spose resource allowance? | Prevents spousal impoverishment by protecting a certain amount of funds. Assets are pooled. Spouse keeps 1/2 of nonexempt, countalbe resources within a range. |
| What is the purpose of the monthly maintenance needs allowance? | Depending on how much spouse has, they can keep a portion of the institutionalized spouses income as monthly maintenance needs allowance (MMNA) Feds set limits/maxes. |
| What are the 3 main categories of eligibility for Medicaid? | Categorically eligible Medically needy Nursing home eligible |
| What is the purpose of the 60 month Medicaid look-back period? | To deter people from transferring assets to qualify sooner for Medicaid nursing home benefits. |
| What is the purpose of estate recovery? | Federal law requires states to seek recover for Medicaid payments for certain LTC costs for deceased 55+. ie. Nursing home/LTC services, HCBS, Hospital/prescriptions drugs while in nursing home, anything else covered by Medicaid. |
| What are the 2 eligibility requirements for most VA benefit programs? | -Qualifying service record -Wartime service |
| What are the 3 levels of VA pension benefits? | -Basic Pension (pays the least) -Pension w/ Housebound -Pension w/ Aid and Attendance (pays the most) |
| What are the 4 requirements for Level Basic Pension? | -Qualifying service record (90 days active service during war, discharge other than dishonorable) -Age/Disability Criteria (must have one: 65+, Perm/total nonservice connected disability, receiving SSDI or SSI) -Financial new worth test -Income test |
| What is the purpose of the net worth test for VA pension benefits? | To determine if a veteran is eligible for a VA pension benefit. Net worth cannot be more than the VA set limit. Same as Medicaid's Community Spouse Resource Allowance. |
| What is the purpose of the income test for VA pension benefits? | To determine the amount of pension funds the veteran/spouse is eligible to get. Non countable income= SSS Welfare Charitable gifts Other VA benefits Certain medical benefits |
| What is the purpose of the 3 year look back period for VA pension benefits? | To make sure countable assets have not exceeded the max net worth limit by transferring assets. |
| Which type of unreimbursed medical expenses can be deducted from income when a veteran first applies for a VA pension? | -Medical insurance premiums (including hospitalization, LTC and Medicare Part B. -Cost of Long Term Care at home, AL/IL residence, Nursing home or adult day care center. |
| When applicants for a VA pension are approved, do they get the minimum or max amount of benefits? | The maximum amount for which they are eligible. |
| What is the eligibility requirement for service-connected disability compensation? | An established disease or disability as a result of military service by medical exam/documentation. |
| What is presumptive disability? | A list of certain disabilities that the VA automatically presumes resulted from military service. ie. Type 2 diabetes from Agent Orange in Vietnam. |
| Is a disability rating based on how severe the disability is today or when it first occured? | Based off of today. |
| Who receives dependency and indemnity compensation? | A surviving spouse, child or parent of a service member who died while on active duty, training or inactive duty training. |
| Why should veterans seek expert advice before enrolling in the VA health and medical benefits program? | To compare the pros/cons of all health plans for which they are eligible. It could cost more money in the long run. |
| What are the eligibility requirements for VA health and medical benefits? | -Served in active military -Other than dishonorable discharge -Reservists need to have been called to active duty and completed the term -Enlisted after Sept 7, 1980 or Active Duty after Oct 16, 1981=Two years uninterrupted or full active duty term. |
| Does the VA offer Home and Community based services to eligible veterans? | Yes. Must have clinical need and available services in the area. -Geriatric eval -AL -VA Nursing homes -Medical foster homes -Adult Day health -Hospice/Palliative -Respite care -Skilled home health care -PACE |
| Are all veterans eligible for VA nursing home benefits? | No. Must have one: -Service-related condition -Service-connected Disability of 70%+ -Service-connected Disability of 60%+ and unemployable |
| Why should an eligible veteran compare VA pension benefits with Medicaid Long-term care benefits? | -Needs change -Both options are complex -Could qualify for both, one or use one after the other -Receiving from one could cause denial or penalty of the other -Add'l VA pension could put over Medicaid's income limit resulting in loss of Medicaid. |
| Recognize the burial and memorial benefits available to eligible veterans? | -Burial at one of the 100+ Nat'l cemeteries operated by VA -Most costs of gravesite, opening/closing of grave, gov. headstone, burial flag, Presidential memorial certificate -Spouse/kids/parents can be buried in VA Nat'l cemetery for qualified Vets. |
| Are veterans' surviving spouses eligible for VA benefits? | Yes, generally. -legally married -same household for at least one year prior to vet's death -cannot remarry (divorced are not eligible) |
| If a veteran's discharge was neither dishonorable nor honorable, is the veteran eligible for VA benefits? | VA makes the decision on a case by case basis. Encourage to apply. |
| What are the top concerns when choosing a hospice? | -Quality/fit between hospice and family values -Frequency of nursing and other visits -Payment -Additional, practical help provided -Cultural/religious approaches |
| How can a patient and family know which hospice agency to choose? | -National Hospice locator -Ask questions: -What services provided? -What is not covered? -How often are visits? -Get recommendations from Drs, hospitals and/or nursing communities |
| What is palliative treatment? | -Relatively new in U.S. -Way to address needs of critically/chronically ill w/ pain/symptom management, spiritual comfort, specialized medical care for any age and any illness -Can still seek curative treatments |
| Explain how hospice care and palliative care are similar and different. | All hospice=palliative. Not all palliative=hospice. Alike Team of profs Cmfrt rather cure Relieve pain Support fam Diff Pall=work w/ curative therapies Pall=begins at diagnosis Pall="both-and" rather than "either-or" Pall=no terminal requirement |
| What is the main difference between the traditional model of care and the integrated, palliative care model in terms of focus and timing? | Traditional=Focus is a cure, when that fails, abrupt shift to hospice. "There's nothing more we can do" Integrated=Begins right away, natural evolution as things progress, gradual increase as needs develop |
| What are three types of palliative care programs? | 1. Hospital based-advanced illness, exhausted from side effects, teaching hospitals 2. Pre-Hospice-clarifying goals or care/pain management 3. Palliative care in Long Term Care-Nursing homes develop their own programs, vary greatly 4. Outpatient |
| List the eight ethical principles that the healthcare profession follows with special attention to patient's right to refuse treatment and physician's right to refuse to honor patient wishes. | 1. Maximize benefit/Minimize harm 2. Patients right to informed consent 3. Competent adult/substitute 4. Advanced decisions 5. Providers right to refuse wishes 6. Stop treatment that won't change outcome 7. Refuse treatment 8. Death definition |
| When does a provider have the right to refuse a patient's wishes? | -Illegal -Medically inappropriate -Conflict w/ provider's personal/organizational ethics (generally obligated to inform/refer unless request violates religion/ethics) |
| What is the definition of death under the 8 ethical principles for healthcare professionals? | Irreversible cessation of circulatory/respiratory/all functions of the entire brain including brain stem functions. If any part of the brain continues to keep systems running (respiration, ciculation), you are not dead nor brain dead. |
| Recognize the different meanings or interpretations of the term euthanasia. | -Simply means good death -Some prefer merciful death -Some think of "active killing" w/ brutal motives, ridding the world of the sick (the holocaust)=this form is illegal and never used with palliative/hospice care |
| Identify the four types of end-of-life choices. | -Active -Passive -Voluntary -Involuntary Active/Involuntary=Illegal/Immoral Passive/Voluntary=Legal/Ethical |
| Why is voluntary stopping eating and drinking (VSED) ethically questionable prior to end-stage illness? | Someone who stops eating and drinking while the body is still robust and functioning will experience hunger and thirst to uncomfortable degrees. Could be considered irrational suicide. |
| Why is it important to balance burdens vs. benefits when managing a serious or life-threatening illness? | To maintain clarity at all decision points. Will it hurt more than help? Will it improve quality of life? |
| Explain the reasons for starting or withdrawing artificial nutrition and hydration (ANH). | Starting=forestall death. Nursing homes (strict regs)-prevent skin breakdown, maintain weight, improve nutrition, prevent aspiration pneumonia Withdrawing=can increasing suffering/death, overwhelms kidneys, liver + lungs, painful swelling, fluid/lungs |
| What is the difference between sedation in palliative care and total sedation? | Palliative=relieve symptoms and carefully monitored ie. mild sleep aid for insomnia Total sedation=to unconsciousness and maintained until natural death occurs. |
| Explain the ethical justification for total sedation, including the rule of double effect. | Clear intention to relieve symptoms, not cause death, understand risk of death. Double effect=actions intended for good have foreseeable bad outcome -intended good cant happen another way -bad effect possible/not certain -proportionate to good effect |
| Why is total sedation ethically debatable? | -Most agree/relief of severe symptoms in terminally ill/dying is ethical -Fine line/intentions of good, bad results (rule of double effect) -Blurred lines=patient is too far from death and could cause death (euthanasia) |
| List 5 end of life options. | 1. Medical aid in dying (MAID)=active/voluntary 2. Voluntary stopping eating and drinking (VSED)=active/voluntary 3. Refusing, withholding & withdrawing treatment 4. Total sedation 5. Self-deliverance/Determined death |
| Describe Medical Aid in Dying (MAID) | -Physician assisted suicide -Legal in 10 states -Must be terminally ill and within 6 months of death -Must be mentally competent -Lethal dose of sedatives/self administered |
| Give examples of sources of existential suffering that dying persons may experience. | -Despair -Extreme isolation, absent communication w/ providers -Emotional/spiritual agony -Loss of independence/control -Anxiety, uncertainty of it all -Deception, family withholding info -Frustration, can't participate in life -Anticipitory grief |
| According to David Kuhl, what to dying people want? | -Candor and sincere communication -Physical touch and social connectedness -Some sense of control/independence -Reconciliation w/ estranged or help coming to terms -Hope -Awareness of meaning of life/death |
| Identify several tasks of dying (Byock 1996). | -Completion of affairs -Completion in relationships/community -Meaning about one's life -Love of self -Love of others -Relationships w/ family and friends -Finality of life |
| How can professionals help dying people with the tasks of dying (Byock 1996)? | -Advance care planning conversations/completions -Tying up financial/legal affairs -Listening to stories/facilitate recording -Encourage ethical wills -Redirect frustrations -Encourage clear communication from family/medical -Add'l resources |
| What did retirees say was the most frequent reason for them to retire? | When they feel they have enough money and when they are eligible for pensions/SS. What actually happens are health problems, disability and involuntary job loss. |
| Explain the difference between a defined benefit and a defined contribution plan. | Defined benefit=promise income for life, managed by employers who bear all the risk. Defined contribution=Managed by employee who determines how much to invest, manages funds while working and in retirement. Higher risk of running out of funds. |
| According to Belteam, what are three phases of retirement, based on activity and health? | GO-GO=(55-69) want to maintain existing life and are capable. "Honeymoon phase" SLOW-GO=(70-84) Settled into routine, travel less, less active, sleep more NO-GO=(85+) Final stage of retirement, death/spouse, deterioration, limited choices. |
| What does the term decision decade mean and why is it important? | Critical period for savings/successful retirement. "Retirement RED ZONE" 5 years before=Funds highest of life, home is paid off, most expand lifestyle instead of savings, will pay for it later. 5 years after=expanding con't, used to that lifestyle |
| Discuss how increasing longevity has affected individual ability to save for retirement in terms of balance, complexity and inflation risk. | Balance=Ratio of accumulation vs. spending, longer spending period than before Complexity="Sandwich" people, paying for kids and parents, saving is harder Inflation risk=Loss of purchasing power over time, income needs to match inflation |
| What are the key financial concerns for older adults in the middle income group? | -Outliving assets -LTC insurance is for this group -Financial market volatility (4.5% withdrawal rule) -Multiple retirement income streams -Financially supporting family |
| What does the 4.5% withdrawal guideline mean in terms of financial planning for retirement? | It's the maximum amount that retirees should withdraw from retirement accounts to minimize outliving their funds. |
| What is the purpose of a cash flow statement? | To determine whether inflows exceed outflows (surplus) or expenses exceed inflows (reduced savings and/or additional borrowing). It's a tool for solving spending problems. |
| What is the purpose of a net worth statement? | To determine net worth. A snapshot of assets, liabilities and net worth. Wealth is defined by net worth. |
| List the 7 steps in the financial planning process. | 1. Gather info 2. Identify goals 3. Identify client situation/possible options 4. Develop recommendations 5. Present recommendations 6. Implement approved recommendations 7. Monitor the plan |
| Explain the 4 strategies for managing risk. Acronym ARRT | Avoidance=not taking part Reduction=Installing alarm system, wearing helmets, diet/exercise Retention=Accepting risk and doing nothing Transfer=Property, LTC, Liabilty insurances to protect |
| Why are life settlements, accelerated benefits and viatical settlements important to older adults? | They can offer turning life insurance into cash when they need it the most. |
| How do life settlements work? | (Senior settlements) Policies no longer needed/wanted 65+to sell Policies go to investors for cash 250k+ only |
| How do accelerated benefits work? | (Living benefits) -Policy proceeds paid to insured person before death -For special events, terminal illness, LTC need -50-80% of policy's value -Remainder paid after death |
| How do viatical settlements work? | (Like life settlements) -Have to have terminal illness -Expected death within 2 years, certified by physician -Certification with 12 months that need help with 2 ADLs for 90 days or supervision from dementia |
| What is Medicare? | -Part of Social Security program -Health insurance for 65+, certain disabled, anyone w/ end stage renal disease -Qualify by paying into while working -No custodial care |
| What is Medicaid? | -Combined state/fed health insurance -Based on financial need -Covers LTC |
| What are VA Health and Medical benefits? | --Qualified veterans have access to largest integrated healthcare system -Only pays for VA-enrolled physicians -LTC=VA Housebound benefit and VA Aid/Attendace benefit |
| What is the difference between Long Term Care planning and Long Term Care insurance? | Planning=Everything from services, supports, finances, where to live, how you will navigate legal/family dynamics. Insurance=Pays for the cost of custodial care services Adult Day Care Home Health Care AL Nursing Home Care |
| Who establishes a qualified retirement plan? | Employers. Defined benefit plans including money purchase plans and defined contribution plans like: 401 (A), 401 (k), Roth 401 (k), 403 (b), Governmental 457, Profit sharing, Stock bonus plans, Keogh plans for self employed/unincorporated businesses |
| What does it mean when a retirement plan is tax-deferred? | Also called Qualified Retirement Plans It means the plans are funded with earnings from working before the money is taxed. "Pre-tax" funds are exempt from income tax while inside the plan. |
| Who establishes an individual retirement account (IRA)? | Individuals (working Americans only) -Tax-advantaged way to save and self-direct investments -Traditional IRA (Tax-deferred) -Roth IRA (After tax dollars) -Spouse IRA (can be traditional or Roth) |
| What is the penalty-free period for making withdrawals from traditional IRAs? | The period between 59.5-72 (income tax but no penalty) -Late withdrawal, after 72=50% penalty -Early withdrawal, before 59.5=10% income tax penalty -Exception=Direct rollover, Purchase 1st home (Trad IRA), Total disability, Health ins. premiums |
| How is a Roth IRA different from a traditional IRA? | Traditional -Tax deferred -Contributions reduce taxable income -Contributions/Earnings not taxed until withdrawn Roth -After tax dollars -Do not reduce taxable income -Withdrawals of contribs/qualified earnings not taxed -Any age w/ earned income |
| How is a Roth 401(k) plan different from a Roth IRA? | IRA -Tax free distributions -Owned 5 yr hold period (Jan 1st of tax yr contributions started, doesnt apply to contributions, withdraw anytime, applies to earnings/converted funds -At least 59.5 401(k) -Must follow 401(k) rules -RMD at 72 if retired |
| What are the two main requirements for making withdrawals from a Roth IRA? | -Be at least 59.5 -Own and fund the Roth IRA for the required 5-year holding period. |
| Explain what a Roth IRA conversion is. | Convert all or portion of Trad IRA, 401k, 403b or Gov 457 to a Roth IRA. -IRS considers it a rollover -Roth IRAs have no Required Beginning Date or RMD, funds can con't to grow -Conversions, you must pay income tax on -No need for funds for 5 yrs |
| What is an annuity? | Contract between a person (buyer) and insurance company. Provides income for the life of the owner (person) and sometimes the survivor/spouse. Earnings are reinvested and funds are tax-deferred until paid out. |
| What is the difference between an immediate and a deferred annuity? | Immediate=No accumulation period (single premium annuity) Deferred=Most annuities are. They have an accumulation period (no distributions made). Owner receives payments many years after paying premiums. |
| What is the difference between a fixed and a variable annuity? | Fixed=Guarantees a minimum fixed rate of return. Seller absorbs investment risk. Owner has inflation risk. Can have far less purchasing power after 15-20 years. Variable=Owner assumes risk. Tax deferred investment/hope is that longterm will do better |
| What are 6 annuity payout options. | Period certain- Straight life- Refund annuity- Life income w/ guaranteed payment to beneficiary- Life income w/ period certain- Joint Life and Survivor- Once liquidation starts, payout options cannot be changed. |
| List some questions older adults should ask when considering an annuity or any other investment. | How much retirement money do I need? Access to $ for emergencies? For long term care? Can I afford to lock up funds for years? How long can I leave $ in the annuity? Can I take $ out if I need it? Surrender charge period? How long is interest rate? |
| What is a reverse mortgage? | -62+ are eligible -Turns home equity into cash that can be used for any purpose. -Similar to selling home/home equity loan -Opposite of traditional mortgage |
| How is a reverse mortgage different than a traditional mortgage? | Traditional= -Purchasing home -Little to no equity -Owes more -Makes payments -Equity grows -Falling debt Reverse= -Generating income -Substantial equity -Owes little -Receives payments -Equity declines -Rising debt |
| With a reverse mortgage, which costs does a homeowner still pay? Does the homeowner keep the title to the home? | Must continue to pay: -Property taxes -Repairs -Property insurance -Homeowners association dues Homeowners keep the title. |
| Explain how a reverse mortgage load is repaid. | When borrower sells house, dies or moves out for more than 12 months (i.e. LTC). Death=Family must pay back loan Sold=For more than loan amount, $ goes to person's estate. For less than loan amout, government pays shortfall. |
| What are factors to consider w/ a reverse mortgage? | Total costs. -FHA mortgage insurance premiums -Closing costs (Title insurance, appraisal/recording fees) -Origination fees -Interest -Loan servicing fees |
| What is the difference between accumulation and distribution periods? | Accumulation=time between entry into the work force and retirement Distribution=After retirement when accumulated funds are withdrawn for living expenses. |
| What is the Dow Jones industrial average? | The index of 30 large, well known companies whose shares are traded on the NY stock exchange. |
| What does post-retirement investment management seek to do? | Provide retirees with a combination of growth in value and steady income. Reserving principle and tax advantages. |
| Why is the time horizon important for older investors? | Longer time horizon=Greater potential for growth Poor investments can impact lifestyle. Some investors believe in time diversification (annual returns become more certain as horizon lengthens). Others believe it's a fallacy. SEEK PROFESSIONALS |
| How does increased life expectancy relate to older adults investment goals? | -Might need to con't investing well into retirement -Most likely cannot afford risky assets -Inflation can hinder quality of life |
| What is the goal of asset allocation? | Reduce risk and potentially increase gains. Not putting all of your eggs in one basket. Investment strategy that divides assets among several classes. -Stocks -Bonds -Cash -Money market securities -Real Estate -Insurance |
| What is an asset class? | Assets with similar return, risk and liquidity characteristics. -Equities (Stock) -Debt (Bonds) -Cash Equivalents (Savings acct./Certification of deposit) |
| What are the 3 simplest asset class categorizations? | Equities (Stock) -High return, risk, liquidity Debt (Bonds) -Med. return, Low to High risk, Low to high liquidity Cash Equivalents ( Savings accts/Cert of deposit) -Low return, low risk, highest liquidity (purchasing power risk) |
| What are general guidelines for building a diversified financial portfolio? | 60/40 mix (for Medium risk tolerance) -60%=diversified common stocks -35-40%=bonds -5%=cash equivalents Equity Portion -Common stock of 14-18 companies across 4-7 industries Invest across countries -Combo of Domestic/Foreign-avoid home country bias |
| What are the 2 most common types of investments? | STOCKS -Potential for growth -Represent ownership -Does well when company does well BONDS -Income -Loan made by bond holder (investor) to company that issued bond (no ownership) -Fixed income securities (lending $ w/ promise to repay interest) |
| What is the glide path in a target date mutual fund? | Gradual rebalancing into less risky assets over time. Target date fund=relevant to retirement -Mix of equity/debt -Shifts allocation from equities to debt by certain date -Usually matches retirement date -401k default option |
| List two most common pitfalls for older investors. | -Sales people who present ambiguous titles or misrepresent themselves -Uninsured products -Inadequate disclosure about products -Misleading fund names -Lack of clarity in account statements |
| List steps to wise investing. | -Define financial objectives -Interview financial professionals -Understand the investment -Resist pressure to act -Be wary of strangers |
| What is the benefit of using a financial advisor who has a fiduciary duty to his/her clients? | They act in the utmost good faith and in a manner to be in the best interest of their clients. Highest standard of customer care under law. Care and loyalty. |
| What does the Securities Investment Protection Corp (SIPC) protect? | Investors. From loss up to a certain amount if their broker/dealer suffers financial failure. |
| What must an individual have to qualify for social security retirement benefits? | -A job -40 work credits (10 years of work) -62+ -Earn 4 credits/year |
| When both spouses are eligible for retirement benefits, which of the two benefits does a spouse recieve? | The higher of the two. Spouses benefit may be up to 0% of the worker's benefit. It it reduced if spouse is younger than full retirement age. |
| What are some of the qualifications a divorced spouse must meet to receive benefits based on the former spouse's record? | 62+ Spouse's primary beneficiary Marriage at least 10 yrs. Ex spouse not married Ex spouse own benefit=less than spousal benefit Divorced 2+ yrs=not receiving benefits (SS/Disab). Divorced >2 yrs=IS recieving benefits (SS/Disab) |
| How much can a widow(er) or qualified ex-spouse receive in survivor benefits? | Full retirement age=100% if it exceeds their own Reduced benefit if younger (50 y/o if disabled or w/in 7 years of worker's death) |
| What is the primary insurance amount? | Piece of SSA used to calculate monthly retirement benefits. 35 years (average) of highest earnings. AIME=Average indexed monthly earnings Using AIME, PIA is calculated. |
| What factors should be considered in deciding the age to start collecting social security benefits? | Unique to each person -Age -Ability -Desire to continue working -Financial needs -Family needs -Quality of life -Early/Full/Delayed Retirement |
| When a person who receives social security retirement benefits also works and earns income, how does that affect the person's monthly retirement benefit? | -Benefits may be reduced -Earnings cannot be over annual limit (unless at full retirement age) -Under retirement age=$1 deducted for every $2 above -Year of full retirement=$1 for every $3 above -Full retirement age=no limit |
| When are social security benefits subject to federal income tax? | When you have income from other sources in addition to SS -Wages, Interest, Dividends, Self-employment income -Anywhere from 50-85% of SSI can be taxed. |
| What are the eligibility requirements for social security disability benefits? | -Severe or total disability -Physical or mental -Medically determined -Expected to continue for at least one year or result in early death -Inability to work for at least one year -Continuously disabled for 5 calendar months to be paid |
| Recognize the 5 steps the SSA uses to determine disability. | Current employment -Can sustain gainful activity? Severity of Medical condition -Impact work functions for 1 year? Compassionate allowances -Certain impairments on SSA list Ability to do previous work - Ability to do other work -Learn new work? |
| When are social security disability benefits paid? | After 5 calendar months of being continuously disabled. |
| What does the Supplemental security income (SSI) program do? | -Safety net for those w/ low incomes -65+ or blind/disabled at any age -Provides monthly income for basic needs (food, clothing, shelter) -Exclusively needs based. |
| What is a representative payee? | -Person/organization receives SS/SSI payments for a person who cannot manage benefit $. -Must use funds for person's needs and save the rest -Separate accts is best -Not the same as POA |
| Name some common tax concerns among older adults. | Are SS benefits taxable? How does working affect SS? How are distributions from tax-deferred plans taxed? Are reverse mortgages taxed? (No. it's a loan) Can I deduct caregiving expenses? Are life insurance distributions before death taxed? |
| What are types of IRS filing statuses? | -Single -Married -Filing jointly or separately -Head of household -Qualifying widow(er) with dependent child or decendent |
| Recognize the answer to: Is my income taxable? | All income (money, good, property, services) is taxable unless exempt i.e. gifts, inheritances, certain life insurance proceeds, certain VA benefits, reverse mortgage funds, worker's comp and medical expenses reimbursements not deducted |
| Recognize the answer to: Do I need to report income from my hobbies? | $400+ is taxable and subject to self-employment tax. |
| Recognize the answer to: Do I need to file a federal tax return? | No-if adjusted gross income < standard deduction for filing status. You should= -Eligible for a refund of withheld federal income tax -Eligible for a refundable credit ($ paid directly to taxpayer) -Hobby income $400+ -Received $ from med. sav. acct. |
| Recognize the answer to: Should I use the standard deduction or itemize? | Depends on: -Adjustments -Deductions -Tax credits -Filing status -Major life event |
| Recognize the answer to: When do I need to file taxes? | Deadline=April 15th Extension=October 15th |
| Recognize the tax answer to: What if my spouse dies? | -Joint return by the end of the tax year -Surviving spouse signs on behalf of deceased -Attach form 1310 to claim a refund |
| What are some common errors by older tax payers? | -Don't take the higher standard deduction for 65+ -Don't correctly calculate their taxable SS benefits -Pay more than needed on qualified dividends income, generally taxed lower at capital gains rate. -Mistakes in the SS # of dependents |
| Describe how the basic federal tax formula works. | Total income -Exclusions/non taxable income =Gross income -Adjustments =Adjusted Gross income -Stan deduction/Total itemized deduction =Taxable income X Marginal tax rate =total fed income tax -payments/credits =refund/$ due |
| Is there a limit on the amount of itemized deductions a person can take each year? | No limit. |
| Is it better for older adults to take the standard deduction or to itemize their deductions? | Things change-variables Standard=3 amounts (easier) -Amount set by law (same for all ages) -Add'l deduction for 65+ -Add'l deduction for blind Itemized=expenses paid all year -Medical -Taxes paid -Interest paid -charitable contributions |
| What are some qualified medical deductions on tax return? | Health insurance premiums Copays Medical/dental above 10% AGI Glass/contacts/lasik Wheelchairs, walkers, canes Rehab Ambulance Institutional care Acupuncture Transportation for medical care Reasonable home mods for medical |
| What is taxable income? | What remains after standard or itemized deductions are substracted from adjusted gross income. |
| what does the alternative minimum tax (AMT) do? | Ensures that high-income taxpayers pay at least the minimum amount of tax. -1969 by congress for those that used legal strategies to reduce/avoid paying taxes -has changed a lot through the years and is complicated. |
| Are people who earn income outside of the US required to report it? | Yes. |
| What determines whether a profit from selling an asset is taxed as a short or long term capital gain? | SHORT -Property held for 12 months or less -Taxed at ordinary tax rates LONG -Property held for 12+ months (12 months and one day) -Taxed at lower capital gains rates |
| What is the cost basis? | The amount originally paid for an asset. It is used to determine the amount of capital gains tax. |
| Explain how section 121 helps homeowners who are selling their homes keep some or all of their profits. | Exclusion from capital gains/home up to 250k for single. 500k for married filing jointly -Owned home principal residence for at least 2 of last 5 yrs before sale-doesnt have to be consecutive -Both spouses meet 2-of-5 yr test (1 may own) -Every 2 yrs. |
| What type of property does the section 131 exchange apply to? | Investment/Commercial property. You can exchange commercial property or "like kind" for use in business, trade or investing. -Exchange a warehouse for an apartment building or Farm for rentable raw land |
| What are common medical expenses that older adults can deduct if they itemize on the federal income tax return? | -must exceed 10% of AGI -Home health care -AL -LTC -Home mods for disabilities --Entrance/exit ramps --Widening doorways --Installing handrails --Modifying stairwells --Lifts |
| Which expenses are deductible for services received in continuing care retirement communities? | -Portions of entry fees -Monthly fees that cover prepaid healthcare and medical expenses *Anything reimbursed by Medicare, Medicaid, LTC insurance are not tax-deductible.* |
| Which expenses are deductible for services received in assisted living residences? | -Direct and substantial medical care w/ certification they need help with at least 2 ADLs or supervision due to Dementia. *Anything reimbursed by Medicare, Medicaid, LTC insurance are not tax-deductible.* |
| Which expenses are deductible for services received in nursing homes? | -Entire cost including meals and lodging if they are there primarily to receive medical care. -Personal reasons can deduct medical care but not meals/lodging *Anything reimbursed by Medicare, Medicaid, LTC insurance are not tax-deductible.* |
| When can an older adult be claimed as a dependent by his/her adult child or other tax payer? | -No one pays more than 1/2 -Each pays more than 10% -Together they pay more than 1/2 of dependent's support -Each meets all other criteria to claim -Family decides who takes credit using form 2120 -Other family signs waiver |
| List some ways to legally avoid taxes. | -Charitable gifts of appreciated property -Convert Short Cap Gains to Long Cap Gains -Sell investments w/ higher cost basis -Choose state/municipal gov. investments -Invest in US Gov securities -Gift income producing assets (lower tax bracket) |
| What is IRS form 2848? | Power of Attorney and Declaration of Representative. -Authorizes another person to represent tax payer before IRS. Does not have to be the person who prepared the return unless unlicensed. |
| What is IRS form 8821? | Tax Information Authorization. -Allows another person to receive info about his/her tax records and authorizes IRS to correspond with said person. Does not give authority to represent tax payer, only to assist. |
| What is a consent to disclose statement? | Authorizes the preparer to discuss taxpayer's confidential matters with others, otherwise they are prohibited. |
| What does the taxpayer advocate service do? | (TAS) -Independent program in IRS -Ensures prompt/fair management of problems not resolved via normal channels -Each state has at least one -Goals=to protect taxpayer's rights -Listens and addresses concerns -Cannot reverse legal determinations |
| What is the purpose of estate planning? | Comprehensive approach centering around health, safety and well being of older adults. -Plan for personal care -Manage personal affairs -Leave a legacy -Reduce fed/state taxes for assets transferred to heirs |
| What is non-titled property? | Personal assets with not legal documentation of ownership. -Watches -Jewelry -China -Books -Silver -Pets |
| Recognized the legal documents used in estate planning. | Helpers if incapacitated: -POA for financial and medical -Revocable/Irrevocable Living Trusts Distributing assets after death: -Wills -Property titles, Titles w/ right to survivorship -Trusts -Revocable Life Ins. trusts -Beneficiary designations |
| What types of family problems may occur when a legal helper is appointed? | -Friction when family questions agent's actions -Family un-qualified to be an agent want the position anyway -Oldest/First male appointments are not always best |
| Who creates a revocable living trust? Who manages the assets and the administration/settlement of a trust? | A grantor, settlor or trustor creates. A trustee manages. |
| What is a guardian? What is a conservator? | Guardian -appointed by court to manage personal/medical affairs of person (any age) w/ severe impairment and is responsible for well being/daily needs. Conservator -Guardian of assets (financial/legal affairs) of person with incapacity |
| What is the order of legal precedence with estate planning legal documents? | 1. Property titles 2. Beneficiary designations 3. Trusts 4. Last will and testament |
| What is the definition of probate assets? | Items that a person can legally pass to others via a will or state intestacy laws because he/she is the sole owner and no beneficiary is named. i.e. checking/savings accts, personal possessions, Life insurance/retirement accts. |
| What is the purpose of a pour-over will? | Works together w/ a revocable living trust for any assets not already in the revocable trust to be transferred into the trust so that the revocable trust instructions are in effect. *All wills go through probate* |
| What are the four benefits of a trust? | -Reduce estate taxes -Manage assets for minors -Protect assets from income taxes for adult heirs -Ensure that trust beneficiaries who receive Medicaid can continue to financially qualify for those benefits (irrevocable trust) |
| What is the inheritor's disclaimer? | People who receive an inheritance from an estate can disclaim part or all of the interest in it. Inheritance would pas to the next in line. -Can reduce estate taxes, inheritance tax and/or income tax. |
| When there is no estate plan, who determines if a person is incapacitated and what happens if the decision is yes? | The court. They will appoint a guardian or conservator. |
| What is probate? | Legal process where a court makes sure property is distributed after death with good title and correct beneficiaries. |
| Why are designated beneficiaries important? | -Directly affect estate planning -Complex consequences for giver's estate/beneficiaries -Can generate excess income/taxes -Loved ones w/ reduced benefits -Reduce long term value of accounts |
| Explain the difference between designated, non-designated and contingent beneficiaries. | Designated: -Must be an individual/group of individuals, trust w/ beneficiary Non-designated: -Charities, lump sum, not taxes no matter how large the sum Contingent: -Next in line after primary beneficiary |
| List the three components of the US estate tax system. | 1. Estate Tax 2. Gift Tax 3. Generation-Skipping Transfer Tax |
| What does a taxable estate include? Are most estates taxable? | All assets owned/controlled by a decedent including: -Real/personal property -Jointly/tenants-in-common/Community property -Household goods -Retirement plans -Trusts -Interests in businesses Most estates will not owe tax (lifetime exclusion=10mil) |
| Describe how the annual gift exemption tax works. | Can give away all the property they want during lifetime. Subject to gift tax. Exemptions are; -Annual gift tax exclusion-each gift, no limit # people -Unlimited exempts for hospitals, educational -between spouses=excess is applited to lifetime estate |
| What is the carryover basis for gifts? | When gifts are given, the asset + it's cost basis transfer to the recipient. When recipient sells, must pay capital gains tax on difference between sale price and donor's basis. Donor's basis=Carryover basis |
| What is the basis step-up for gifts made after a donor's death? | Cost basis bumps up to fair market value at the time of death. Pay less in capital gains. Most important tax aspect! |
| In deciding which assets to leave to one's heirs, what is the main difference between equal and equitable? | EQUAL -Everyone receives same -Deemphasizing difference between receivers -Evidence suggest harmony, avoiding conflict, not always ie. how to divide a special book EQUITABLE -Acknowledge differences w/ recipients -Contribution-needs-characteristics |
| Why are ethical wills important to some people? | -Way to affirm the past and be positive about future -Allows people to express their universal values -Opens the door to forgiveness/healing -Sense of life completion -Values for future generations |
| When and how should ethical wills be written? | WHEN -Anytime! -Transitions, turning points, challenging times -Special milestones, births -Loss, illness, natural disasters HOW -Blank sheet of paper -Structured writing exercises -Outlined structure w/ phrases to edit (easiest) |
| Provide examples of what it means to have respect for older adults when working with them. | -Supporting them making own decisions -Offering guidance to avoid harmful choices -Creating comfortable environment -Listening, giving resources -Giving time to digest new info -Encouraging questions |
| What three factors must be present for informed consent to be legitamate? | -Must be able to understand consequences of actions -All facts about product/service must be disclosed, language clear and opportunity to ask questions/get answers -Process must be voluntary. Right to accept/refuse terms. No coercion. |
| Why is belief in personhood important in working with clients with Dementia? | -Vital to develop meaningful relationships. -Provides opportunities to make their own choices -Many times they have capacity to situationally make their own decisions. |
| What is the difference between competency and capacity? | Competency=Legal term/status Capacity=Concept used in clinical settings Both refer to whether or not somone can give informed consent. |
| When working with a person with Dementia, what question should one ask to quickly get a sense of the person's decision-making ability in any given situation? | What harm could it do? |
| What does it mean to say that decisions that affect a person w/ Dementia are often a choice between the least of two harms? | There are no good outcomes, just better outcomes given the options. |
| Why is it important to minimize a power differential? Provide some examples of how to reduce it. | Minimizing the power differential minimizes client's vulnerability, fosters autonomy and builds mutual trust. HOW -Sit next to, not across -Listening -Care & Share -Ask open ended questions |
| Why is it important to maintain professional boundaries when working with clients? | Boundaries protect clients and professionals. Boundaries allow professionals to be objective. Mutually agree to defined roles, expectations & responsibilities. W/out=risk of violating trust |
| What are some ways to ensure that a client understands what is being discussed? | -Easy to understand words -Divide info up -Slow down -Go over one at a time/line by line -Ask Questions: Can you tell me what your understanding is? -Watch for vision/hearing impairments -3rd party observer |
| What steps can professionals take to help a client if they suspect cognitive impairment? | -Validate your concerns-See client at different times/days, family present -Check for understanding- -Document client actions and directions-take notes -Plan, if possible for competency issues-talk about it beforehand |
| Why is it important for a professional to document discussions and decisions made with a client? | -Any doubts of capacity, you are prepared -Documenting goes a long way in protection of client -Ensures clarity and eliminates mistakes |
| The CSA code of professional responsibility's 3 parts are? What do they focus on? | Standards Rules Disciplinary Standards FOCUS ON -Competence -Honesty -Trustworthiness -Fairness -Professionalism |
| What are the factors that make ethical planning more challenging when working with other adults? | -Shorter time horizon=Less time to recover/sensitivity to risk -Complex situations, more relatives/voices w/ interest in decisions -Likelihood of health problems -Questions of mental capacity |
| What are key guidelines for practicing preventive ethics? | -Thoroughly consider -Communicate -Document (in advance and after) -Reasoning for advice given -Truth telling -Good record keeping -Clear communication on reasons for difficult decisions |
| Recognize the seven steps of ethical decision making according to the Josephson Institute of Ethics. | 1. Stop & Think 2. Clarify Goals 3. Determine Facts 4. Develop Options 5. Consider Consequences-"Pillarize" your options 6. Choose Wisely 7. Monitor & Modify |
| How should a professional broach the subject of cognitive impairment with a client who shows possible signs of it? | -Check for repetition -Ask open ended questions -Ask how they are feeling -Watch for consistent responses -Be aware of other factors -Same age, relate it to your own life -News, Movie with memory change -Brochures available -Document |
| What group of people commits most of the financial exploitation of older adults? | -Sons and Daughters -Siblings -Close associates-Family, caregivers, friends and neighbors make up 40%! |
| Why do professionals working with older adults often fail to get involved when they suspect financial abuse? | -Definitions to identify, remedy, prevent are inadequate -State laws not standardized, lack of clarity -Nat'l justice/social systems lack funding -Avoid adverse publicly -Compromise professional relations |
| How do scam artists psychologically exploit older adults? | They take advantage of their polite, trusting nature. -Fear=greatest motivator, high returns, no risk -Overconfidence=Too smart to be scammed -Shame="Groomed" victims less likely to report |
| What tips can professionals give to older adults to help them protect themselves from scams? | -Don't make financial decisions on a too-good-to be-true offer -Learn to spot persuasion tactics -Develop refusal script -No-one is "too smart" to be scammed -Ask why am I so lucky? |
| List several warning signs of an investment scam. | -Guarantees-all investments carry risk -Unregistered products -Overly consistent returns -Complex strategies-no question is too silly -"Secret" Clubs/"Exclusive" Groups -Missing Documents -Pushy salespeople/Claims of urgency (take your time!) |
| How do abusers use powers of attorneys to exploit older adults? | POAs can be forged/improperly obtained. Can be used to steal money and assets. Can use trickery to get them to sign deeds, fradulent docs. |
| How can older adults protect themselves from improper use of Powers of attorneys? | -Understand what powers they are handing over -SOLE legal authority, TOTAL control, ALL assets -List 2 parties as co-agents -Choose someone not dependent on them for $ -Use and Attorney/Professional if no family |
| What can you do to help an older adult who is a victim of financial abuse? | -Contact local APS Agency for referrals to Law Offices -Contact Police/Sheriff/Prosecutor in county -Contact Nat'l Academy of Elder Law Attorneys -Free legal help (Older Amer. Act) -Eldercare locator |
| What constitutes Medicare fraud? | When a person/group/company bills Medicare for services/goods that older adults never received. To do so, need Medicare # and Social Security #. |
| Give examples of how older adults can protect themselves from Medicare fraud and what to do if they suspect they have been a victim. | -Guard personal info -Closely examine paperwork (bills, summaries) -Be aware of providers/suppliers -Suspicious charges=Call Medicare -Use stop Medicare fraud website |
| Recognize various other types of financial scams against older adults. | Charity Scams=Natural Disaster Relief Counterfeit Prescription Drugs Magazine Subscription free offers, sweepstakes, "Junk Mail" Jury Duty Scams Online Romance-Love at first sight The Grandparent Scam=Child arrested, in hospital Auto/Home repair |
| Where can older adults or those concerned about them report suspected financial crime? | -Contact local police -Contact State Consumer Protection Agency -Contact their banks, CC companies -90 day initial fraud alert on credit report (severe cases=7 years) -stopfraud.gov |
| List several signs that an older adult may be a victim of financial exploitation by family, caregiver or friends. | -New "best friends" -Unusual fear/submissive to caregiver -Isolation from family/community (never left alone w/ others) -Withdrawn behavior -Misses appts. -Forgets to pay bills -Changes in spending/financial management (Changes POA to stranger) |
| What are the different Medicare plans? | Original Medicare -Part A=Hospital ins. -Part B=Medical ins. -Part D=Prescriptions -Medigap Supp. Medicare Advantage Plans=Part C -Alt to Orig -Part A /B -Add'l services Part D=Private Ins. Co -Prescription drugs -Local/mail order pharmacies |
| What is the difference between Medigap insurance and Medicare Advantage? | Medigap=supplemental -fills in cost sharing gaps in original Medicare -exclusion=LTC services, eyeglasses and dental Medicare Advantage=Alternate to Original Medicare -Parts A & B -Other services not covered by Orig. (prescription drugs, vision & HHC |
| What is the penalty for delaying Part B? | Permanent 10% penalty added monthly premium for each full year delayed. Even if enrolling during general enrollment period. Special enrollment period w/ no penalty -continue working -covered under employer's group plan -employer has 20+ employees |
| What are the three main enrollment periods for Medicare? | Initial Enrollment Period (IEP) -to turn 65 (7 mo window) General Enrollment Period (Jan1-Mar 31 each year) -Part B only Special Enrollment Period for Older Workers -8 mo after employer's plan stops (retirement) -2 mo after for Medicare Advantage |
| When is the open enrollment period to change your Medicare plan? What changes are options? | Oct 15-Dec 7 each year. -Original Medicare to Medicare Advantage (vice versa) -Medicare Advantage to same/different insurance company Medicare Advantage open enrollment period (MA OEP)=Jan 1-Mar 31 each year *Only one election* |
| What are some specific situations for special enrollment periods for changes? | -Change of residence (outside Medicare Advantage service area) -Contract violations (provider violates) -Medicare Advantage Plan Trial Period --12 months --Can go back to Original w/ Medigap within the 12 months |
| How often do Medicare beneficiaries owe the Part A Hospital insurance deductible? | It is NOT annual and they increase each year. You pay each time you are admitted as an inpatient if you are discharged and followed by at least 60 days before another admission. |
| What does Medicare Part A cover? | -90 day inpatient hospital (+60 day lifetime reserve)/post hospital skilled nursing facility (SNF) -Limited Home Health Care -Hospice -Semi-Priv Rm & Board (Priv if medically needed) -Reg. Nursing serv. -Surgical/Recovery facility -Hospital drugs |
| Breakdown the first 150+ days of Part A coverage. | 1-60=Owe deductible before coverage begins 61-90=Owe coinsurance for each day 91-150=60 Lifetime reserve days, owe coinsurance for each day (2x amount for 61-90) After 150=Coverage ends (unless 60 day break in between) |
| What conditions need to be met for Medicare Part A to cover skilled nursing facility care? | -SNF takes Medicare -Dr. certifies need -Hospitalized for 3 midnights (day of discharge doesn't count) -Enters SNF w/in 30 days of discharge -Skilled care/rehab daily -Care in SNF=Hospital care |
| What is not covered under Medicare Part A? | -Convenience items (phones, room surcharges) -Private Duty Nursing -Blood Transfusions (1st 3 pints) -Custodial Care -Foreign Travel Care -Services paid by other goverment agencies (Veteran's admin) |
| Recognize Part A coverage issues. | -Premature discharge in hospitals -Observation status in hospitals --Does not count to 3 day minimum --Puts them in "part B"=out of network for scrips -No "improvement standard" --Key=don't need for skilled rehab |
| What are examples of services or items excluded from original Medicare Part B? | -Routine physicals -X-rays -Massage -Routine eye/hearing exams -Eyeglasses (except after cataract surgery) -Hearing aids -Dental -Most prescriptions -FT in home Private nursing -Personal comfort items (AC) |
| Which non-physician providers must accept assignment all the time? | -Physician assistants -Nurse Practitioners -Nurse Anesthetists |
| When a healthcare provider accepts assignment with Medicare, what does it mean? | -Providers cannot bill patients for excess charges. -Only Medicare approved amount. -Medicare will pay 100% for most preventative services. |
| Recognize Part B coverage issues. | -Durable medical equipment/supplies (DME) --Ask about assignment! -Ambulance services --Other modes of transportation available? --Must go to nearest facilty |
| What do Medigap plans do? | -Sold by private insurance companies -Fill the gaps in original Medicare --Deductibles --Coinsurance --Excess charges --Non-covered services |
| What does a guaranteed issue right to a Medigap policy mean? | -6 month open enrollment period that starts when you turn 65 and enrolled in Part B. -Must sell policy at best available rate regardless of health status -Cannot deny |
| What are some keypoints in regards to Medigap? | -Must be enrolled in Parts A/B (Original) -Only need one policy -Illegal to sell to Medicaid recipients -Pays to shop around -Guaranteed renewable-must pay premiums -Guaranteed issue right (6 mo, 65) -Pays 2nd to Medicare -Crossover claims |
| Who are dual eligibles? | People with Medicare and full Medicaid benefits. |
| How are Medicare Advantage plans different from Original Medicare in terms of benefits and costs? | -An alternative -Benefits via private health plans (HMO/PPO) -Advantage covers dental/vision, annual physicals, some non-skilled in home care, housekeeping & respite -Copays are = or less than original -Annual out of pocket spending limits |
| What are the 6 main types of Medicare Advantage programs? | -Health Maintenance (HMO) -HMO w/ point of service (POS) option (higher copays with out of network) -Preferred Provider Organization (PPO) -Private Fee For Service (PFFS) -Special Needs Plan (SNP) --Live in LTC -Medical Savings Acct (MSA) |
| When is Medicare's open enrollment period each year? | October 15-December 7 Annual Election Period (AEP) Coverage starts Jan 1st of Ensuing year. |
| When is Medicare Advantage open enrollment period each year? | January 1-March 31 (MA OEP) -coverage starts 1st of the following month after switch |
| What are some key points in regards to Medicare Advantage (Part C)=Choose | -Alternative, not supplemental -Medigap is not for those on Med. Adv. -Must live in defined service areas -Cost sharing charges paid out of pocket (unless dual eligible) -Uses 5 star system to rate plans -Annual changes |
| What are the 5 items rated on Medicare Advantage's 5 star system to rate plans? | -Screening tests/Vaccines -Chronic Conditions -Experience/Satisfaction -Complaints -Customer Service |
| Generally describe Part D coverage. | -Voluntary, stand alone prescription plan -Higher incomes pay more -Must offer standard drug coverage/Medicare --Deductible (pay 100%) --Initial coverage (Copay) --Gap-donut hole-coinsurance (25%) --Catastrophic coinsurance (5%) -No over counter |
| What is a waiver of liability? | Protects Medicare beneficiaries from liability for denied claims if they did not/could not know. Providers must submit a demand bill **Appeal all denied claims** -w/in 120 days (Original) -w/in 60 days (Advantage + Part D) |
| Why is it important to know the differences among various credentials? | -Growing need for new, diverse products/services and many new credentials are popping up. -Products/Services overlap -Some "professionals" don't have best intentions -Credentials for marketing tools -True credentials have 3rd party test/assessment |
| What is the difference between a credential and a designation? | Credential=Proof by a body (School, gov. agency) -Licenses, Certifications, various degrees -Can be accredited/non-accredited -Associated with Educational Accomplishments Designation=The actual acronym/mark (CPA, MD, RN) |
| What are the key components of a licensure program? | -Predetermined education/standard criteria within that profession -Demonstration of knowledge by passing exam -Agreement to follow guidelines established |
| What are some general characteristics of a certification program? | -3rd party -Award certification once demonstration of standards -Requirements=Education/Experience -Assessment/Exam -Abide by Standard of Conduct -Sometimes license is bare minimum and certification shows higher expertise. |
| What is the difference between a certification program and a certificate program? | CERTIFICATION -Awarded by 3rd program -Result=Designation -Pass exam -Has a limit -Code of conduct CERTIFICATE -Awarded by program -Result=Documents for records -Complete program -Good for life -No enforcement |
| Are people or institutions and organizations accredited? | People are NOT accredited. Only institutions are. |
| What is the purpose of accreditation for a professional credential? | To demonstrate that the body providing credentials have adhered to a set of standards while developing/maintaining its programs. |
| What are the general requirements a certification program must meet to become accredited? | -Recertification -Ownership for use and withdrawal -3rd party independence --separation by firewall -Job/practice analysis -Objective exam/assessment -Impartial Organizational Structure |
| Define: Positive Ageism | Language or images couched in positive terms that can have ageist connotations. "Over the Hill" birthday card. |
| Define: Ageism | Discrimination and prejudicial attitudes toward older adults. |
| Define: Cohort | Group of people who have experienced the same significant life event/marker within a specified period of time. Factors include: -Age -Race -Gender -Ethnicity -Economic class -Size i.e. Baby boomers, Silent generation |
| Define: Generation | 1. Description of families i.e. generations of grandparents, children, grandchildren 2. Group of people having distinct life patterns or life values and a collective identity that separates from other generations. i.e. WWII and Post WWII generations |
| Define: Subjective Age | How old people feel and how they define themselves to themselves. |
| Define: Functional Age | Determined by what people can and are doing. |
| Define: Chronological Age | Simplest way to categorize age. Measured by counting the years one has existed or number of birthdays on has had. |
| Define: Age Irrelevance | Behaviors where age is irrelevant. Managing money wisely, eating healthy (lots of people plan for everything EXCEPT living a long life! |
| Define: Age Adaption | Approaching age with acceptance. With advancing age comes changes in the body, social life, and financial conditions. These changes call for a change in behavior. ie. LTC insurance or adding name to an AL waitlist. |
| Define: Age Denial | Age denial is extremely powerful and can lead people to reject any kind of professional service if it means they have to identify as old. -Society's prejudice (billion $ industry botox, wrinkle creams) |
| Define: Age Affirmation | Hopes, dreams and events directly linked to chronological age. Goals that are age-affirmative: -Retirement travel -Pension eligibility -Creative/Social pursuits (more time) |
| Define: Identity Foreclosure | Being stripped of your identity and being forced to see yourself differently. Widows no longer have the social resources to hand on to their identity. |
| Define: Pyramid Family | AKA=Horizontal Family Two or three living generations with many siblings and kin within a generation. |
| Define: Beanpole Family | AKA=Vertical Structure Four or five living generations with only few siblings and kin within a generation. |
| Define: Elderspeak | Infantilizing communication by simplistic vocabulary, shortened sentences, slowed speech, elevated pitch/volume and innappropriate terms of endearment. i.e. baby talk, "sweetie pie" |
| Define: Health Literacy | The degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions. |
| Define: Cultural Competence | The understanding, acknowledgement + respect of heritage in order to support in ways consistent to their values, beliefs and preferences. Heightened sensitivity to cultural norms. What is acceptable to personal space, eye contact + hand gestures. |
| Define: Life Expectancy | The average number of years one can expect to live. |
| Define: Life Span | The maximum length of years that a person can be expected to live. *Approximately 6x the length from birth to maturity. |
| Define: Biomarkers | Accurately access biological age and predict future health. They show the rate at which age is occurring. |
| Define: Chronic Illness | Long term with remissions and exacerbations. Uncertain trajectory w/ no limits on its duration. Disease process rather than an incident. |
| Define: Acute Illness | Rapid onset and rapid remission. i.e. Pnuemonia |
| Define: Cognitive Capacity | The total amount of information the brain is capable of retaining at any given moment. |
| Define: Cognitive Function | The brain's ability to execute various processes like: -Thinking -Reasoning -Remembering -Decision Making |
| Define: Cognitive Reserve | The brain's ability to be resilient in the face of attack. A build in safeguard. |
| Define: Sundowning | A state of confusion that typically occurs at the end of the day and into the night. |
| Define: DSM-5 | A text guide listing all mental health disorders called the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders. It aids in the accurate diagnosis and treatment of mental disorders. |
| Define: Pseudodementia | Memory issues in depressed older adults that are misinterpreted as dementia. When the depression is treated, memory improves. |
| Define: Anticipatory Grief | Emotional reactions to an anticipated loss. i.e. common experience for families dealing with AD. |
| Define: Residential Normalcy | The personal impact of where one lives. Under optimal conditions they live comfortably and enjoy their active lives, feel in control of their surroundings despite mobility limitations. They are still safe and have accessibility. |
| Define: Aging in Place | A range of housing and services, a continuum of options that support older people as the age and change. Used to be when older person's preference was to stay in their homes and never move. Now it has expanded to include all types of housing. |
| Define: Place Attachment | A deep connection to a home. A special bond between people and specific places. |
| Define: Continuum of Care | The range of housing and services for older adults. Starts with general community housing (their home) and ends with nursing homes. |
| Define: Activities of Daily Living (ADLs) | Routine physical actions that healthy people perform without help. -Bathing -Eating -Dressing -Toileting -Continence -Mobility (transferring from bed to chair) |
| Define: Instrumental Activities of Daily Living | Additional activities that are important to a person's self sufficiency. -Transportation -Housework -Laundry -Shopping -Meal prep -Managing finances -Using the phone -Taking meds -Arranging outside services |
| Define: Family Unit of Care | The primary family caregiver and care recipient. Separate from other family even though they may share caregiving. |
| Define: Family Centered Caregiving | Important approach to caregiving. The primary family caregiver is the core member that plans/manages the health care of the recipient, but their needs are recognized, respected, assessed and addressed. Improves outcomes for recipient. |
| Define: Caregiver burden | Negative reactions to the impact of providing care on social, occupational and personal roles. Can be a precursor to depressive symptoms and declines in caregiver health. |
| Define: Ambiguous Loss | A feeling of loss because things are not the way they used to be. |
| Define: Role Inversion | When an adult child becomes the parent. **The parent will always be the parent.** |
| Define: Cash Flow Statement | Shows household cash inflows and outflows for a period of time, usually one month. |
| Define: Net Worth Statement (Balance Sheet) | A snapshot of a couple/person's assets (what they own), liabilities (what they owe) and net worth (what they have). Networth=Assets less Total Liabilities |
| Define: Defined Benefit Plan | These plans gather funds into a pool that the company manages for employees. The payments are a lifetime source for retiree. Employer funds the plan and carries all the investment risk. |
| Define: Defined Contribution Plan | These plans give employees ability to contribute to accounts at any age while working. Employees fund/manage/carry risk, before/during retirement. Employers match funds. Funds belong to employee after vesting reqs. Employer match=tax deduct. Portable. |
| Define: Required Beginning Date (RBD) | When people must start taking distributions from retirement plans. *No later than RBD* April 1st of the year after they turn 72. If still working and on employer's plan, April 1st after year of retirement. |
| Define: Required Minimum Distribution (RMD) | Required minimum amount that people must annually withdraw on their plan starting at 72. Determined by IRS and based on age and amount of money in accounts. IRS provides a schedule each year. |
| Define: Estate | Everything a person owns or controls at the time of incapacity or death. -Money -Property -Investments -Personal/Business assets Also includes debt. -Mortgages -CC Balances -Estate/Income taxes |
| Define: Incapacity | The lack of physical or mental ability to take action that has legal significance. -Coma (Obvious) -Moderate Dementia (Subtle) |
| Define: Intestacy | When a person who dies without an estate plan that contains a trust or at the very least a will relinquishes control of the distribution of his/her assets to state law. |
| Define: Informed Consent | A legal condition where a person can give consent to allow something to happen based off of full understanding of the facts. Implies that the person has been informed of all risks/potential alternatives. |
| Define: Continuum of Incapacity | Attorney speak: It affects an older person's ability to make informed decisions. Cognitive testing can help determine. |
| Define: Personhood | A status that is bestowed upon a human by others in the context of relationships and social being. It implies recognition, respect and trust. |
| Define: Beneficence | Doing the most good! |
| Define: Non-maleficence | Doing the least harm! |
| Define: Autonomy | The concept that individuals should reign over themselves. Adults can and should make their own decisions to live their lives. |
| Define: Competency | Legal term. All or nothing. Cannot be partially competent. You are competent or incompetent. Legally incompetent=cannot give informed consent. Legal guardian or conservator makes decisions. |
| Define: Capacity | A person has the cognitive ability to give informed consent or make a voluntary decision about a problem. Used in clinical/professional settings. |
| Define: Power Differential | The difference between expert and client that results in vulnerability of the client. |
| Define: Magical Thinking | When paying clients project their hopes/fears/desire to be guided/taken care of onto the professional they hire. A cognitive pattern. ie. Projection, unreasonable blame. |
| Define: Designation | Actual acronym or mark of an earned credential. (RN, MD, CPA, CSA) |
| Define: Certification Program | Operated by 3rd party certification body. ie. American Bar Association, Nat'l Elder Law Foundation. Certification is awarded after demonstrating criteria is met. |
| Define: Certificate Program | Based on education/training course or series of courses. Certificates=One course Diploma=Entire series of courses |
| Define: Accreditation | The body maintaining the certification program has adhered to a set of standards. ICE=Institute for Credentialing Excellence ANSI=American National Standards Institue |
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