AT A GLANCEGlossary
|0.1||Welcome to the UCSF AGRC course in Geriatrics and Gerontology|
|0.3||Overall Course Goals|
|0.6||Why Take This Course?|
|0.7||The Multifaceted Face of Aging: 3 Cases|
|0.8||Discussion of the Three Preceding Cases|
|0.9||How To Use This Course|
|0.10||Where To Start?|
|0.12||How to Start--Case 1|
|0.13||How to Start--Case 2|
|0.14||Reflection on Two Cases|
|1.||Demography And Epidemiology|
|1.1||The Changing Face of Aging: Objectives|
|1.2||Local and Regional Variations Among Older Adults in the United States|
|1.3||Implications of an Aging Society for Health Care Needs and Resources|
|1.4||Common Chronic Conditions Associated with Advanced Age|
|2.||Biology and Physiology of Aging|
|2.1||Introduction and Background|
|2.1.1||Table of Contents|
|2.1.2||Module Learning Objectives|
|2.1.5||Historical View of Aging|
|2.1.7||What is the Truth about Aging?|
|2.1.8||When Pathologies are Attributed to Aging|
|2.1.9||Aging or Disease?|
|2.1.10||Understanding Age-Related Changes|
|2.2||Theories of Aging|
|2.3||Physiological Changes with Aging|
|3.||Socio-cultural And Psychologicial…|
|3.2||Social Theories of Aging|
|3.2.2||Modernization Theory (II)|
|3.2.3||Criticisms of Modernization Theory|
|3.2.5||Role Theory (II)|
|3.2.6||Criticisms of Role Theory|
|3.3||Psychological Development In Late Life|
|3.4||Ethno-Cultural Issues And Age-Stratified Societies|
|3.6||Dependent Elders: Special Concerns|
|3.6.1||Adult Guardianship in Euro-American Societies|
|3.6.6||Ageism and Therapeutic Nihilism|
|3.7||Cultural Views of Death|
|4.||Assessment Of The Geriatric…|
|4.2||Domains of Assessment: Functional Assessment|
|4.3||Domains Of Assessment: Psychosocial Health And Functioning|
|4.3.1||Informal Caregiving Support Network|
|4.3.2||Abuse and Neglect|
|4.3.4||Spiritual and Cultural Assessment|
|4.4||Special Considerations In Assessment|
|5.||Health Care Policies|
|5.2||The Policy-Making Process|
|5.3||Financing Health & Long Term Care|
|5.4||Quality Of Care Issues In Long Term Care|
|5.5||Need And Access Across The Spectrum Of Care|
|6.||Exploring Age-Related Body…|
|6.1.3||The Cardiovascular System|
|6.1.4||Can These Changes Be Modified?|
|6.1.5||Sodium and Activity|
|6.1.7||What Can We Do About The Process?|
|6.1.8||Links to Theories of Aging|
|6.1.13||Pulse Wave Velocity|
|6.1.14||Additional Functional Changes|
|6.1.16||Response to Stress|
|6.1.17||Congestive Heart Failure|
|6.1.18||Diastolic Versus Systolic Heart Failure|
|6.1.20||Case 3: Points To Consider|
|6.1.22||Review Question 1|
|6.1.23||Review Question 2|
|6.2.1||Case 1: Mr. Jones|
|6.2.3||Hypothalamic-Pituitary and Hypothalamic-Pituitary-Adrenal Axis|
|6.2.5||Why Does Growth Hormone Decrease?|
|6.2.6||Why is Growth Hormone Important to Our Clinical Practice?|
|6.2.7||Is This Good Clinical Practice?|
|6.2.8||Case 2: Discussion|
|6.2.9||CRH, Adrenocorticotropic Hormone/Corticotropin (ACTH), and Cortisol|
|6.2.10||Aging, the Stress Response, Cortisol, and Cognitive Function|
|6.2.13||The Adrenal Medulla|
|6.2.16||Case 3: Clinical|
|6.2.18||What Causes These Changes?|
|6.2.19||Can These Changes Be Prevented?|
|6.2.20||What Do We See Clinically?|
|6.2.22||Should Age-Related Changes in Carbohydrate Metabolism Be Treated?|
|6.2.23||Summary Case and Evaluation Questions|
|6.2.25||Review Question 1|
|6.2.26||Review Question 2|
|6.3.1||Setting the Stage|
|6.3.2||Setting the Stage 2|
|6.3.3||Overview and Background|
|6.3.4||What Happens with Age?|
|6.3.6||The Physical Barriers|
|6.3.7||Acid Contents of the Stomach|
|6.3.10||The "Natural Killer" and the "LAK"|
|6.3.13||What Happens to Specific Immunity With Age?|
|6.3.14||The Immune Response|
|6.4.2||Case 1 Continued|
|6.4.3||The Inter-Relationship of the Muscle and Skeletal System|
|6.4.4||Muscle Changes and Function with Age|
|6.4.5||Changes in Muscle with Age|
|6.4.7||What Are The Physiologic Processes That Cause These Changes?|
|6.4.8||What Is The Impact Of These Changes On Function?|
|6.4.10||Interventions to Minimize Changes|
|6.4.12||Joints, Tendons, and Ligaments|
|6.4.13||Differences in Cartilage Between Aging and Osteoarthritis|
|6.4.14||Skeletal Changes With Age|
|6.4.16||Many Factors Influence Bone Health|
|6.4.18||General Changes in the Bone with Age|
|6.4.19||Factors Influencing Whether a Fracture Will Or Will Not Occur|
Module 5: Health Care Policies
5.1: Module Objectives
Upon completion of this module, participants will be able to:
5.2: The Policy-Making Process
Major Policy-Making Processes: Legislative ActionsThere are four major avenues through which public policies are made: (1) legislative, (2) administrative, (3) budgetary, and (4) judicial. Legislative actions are taken by elected representatives of the public (state legislators or Congress). At the national level, districts are established for the public to elect members of the House of Representatives and the Senate. Bills passes by the legislative branch must be signed by the head of the executive branch (the governor at the state levels or the President at the national level).
5.3: Financing Health & Long Term Care
Sources for Financing Long Term Care I
Medicare and Medicaid (called MediCal in California) are the primary public programs that pay for long term care.
Total expenditures for long term care were $150.8 billion in 2003. Almost three-quarters ($111 billion) was spent on nursing homes, with the remainder providing funds for home health.
The Centers for Medicare & Medicaid Services (CMS) (note: this link will open in a new browser window; close it to return here) provides national statistics on health care expenditures, data on Medicare and Medicaid, all CMS manuals, regulations, transmittal letters to states, descriptions of the programs, internet guide to nursing home comparisons, etc.
5.4: Quality Of Care Issues In Long Term Care
Nursing Facilities and Quality of CareAbout 18,000 nursing facilities in the U.S. provide care to 1.63 million adults with disabilities that require nursing care (NCHS, 2002). Approximately 90% of these individuals are aged 65 years or and older, with younger persons with severe disabilities comprising the remaining 10% (NCHS, 2002). Most need assistance with bathing, dressing, and toileting and have many chronic and/or acute illnesses that require 24-hour nursing care services. Nursing homes must comply with state licensing laws in order to provide services and comply with federal regulatory standards if they want to provide care to individuals qualified for Medicare and Medicaid services. The federal rules require periodic surveys of nursing facilities for compliance with these requirements. Since the early 1970s, there have been studies by the US Senate about poor quality of nursing home care (US Senate Special Committee on Aging, 1963-1974). In 1983, when President Reagan planned to deregulate nursing facilities, Congress asked the Institute of Medicine (IOM) to conduct a study about nursing home regulation. The Institute published its report entitled Improving the Quality of Care in Nursing Homes in 1986 (IOM, 1986).
5.5: Need And Access Across The Spectrum Of Care
Demand for Long Term Care Facilities
The supply of long term care beds in the U.S. has changed over the last decade. Between 1990 and 2000, there was a 9% increase in the number of nursing home beds in the U.S. However, between 2000 and 2002, there was a reduction of approximately 41,000 beds. For residential care facilities, the number of beds nearly doubled between 1990 and 2002. The number of ICF/MR beds steadily declined between 1990 and 2002, resulting in a decrease of nearly 38,000 beds.
Even though the elderly population has increased substantially in the last few years, nursing home occupancy rates are declining. Between 1997 and 2003, there was a steady decrease in the nursing home occupancy rate. Nationally, over 1 million beds are available in licensed supportive housing including residential care and assisted living, foster family homes, group homes, and social rehabilitation facilities (Harrington et al., in press). An equal number probably live in unlicensed boarding homes (Newcomer & Maynard, 2001). Little is known about supply and demand for residential care. Although there was a rapid increase in the number of assisted living facilities in the 1990s, some of the growth replaced existing facilities or consolidated facilities under large corporate ownership or management.
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