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Part 3 Key Terms
Part 3 Key Terms - Working with Older Adults
| Question | Answer |
|---|---|
| Active adult communities | Communities that are either “age-restricted” and required by federal and state laws to impose minimum ages on residents, or “age-targeted” and able to market to older adults but not required to impose age restrictions. |
| Activity of daily living (ADL) | Six basic personal care activities eating, toileting, dressing, bathing, transferring, and continence. |
| Acute illness | Severe illness with a rapid onset and a generally short duration. |
| Advance care planning | A process of reflection and discussion with family members, friends, and health care providers about the kinds of medical treatment one might want or not want in the circumstance of a medical crisis, serious illness, or injury. |
| Advance directive | Instruction made by an individual, orally or in a written document, concerning medical treatments and personal care to be provided or refused in a future circumstance should the individual be incapacitated and not able to verbalize instructions directly. |
| Advance health care directive | Also called a medical durable power of attorney. A statement made by an individual, usually in a written document, concerning the medical treatments to be provided and decision maker to be appointed if the patient becomes terminally ill or incapacitated. |
| Aging and disability resource centers (ADRCs) | In many states, centers that provide information and advice about local services and supports in the local community. ADRCs are funded through the Older Americans Act (OAA). |
| Aging in place | The ability to live in one’s own home and community safely, independently, and comfortably, regardless of age, income, or ability level. |
| Ambiguous loss | The emotional loss experienced when someone is still alive but, because of changes in his or her health or cognitive status, is “there but not there.” |
| Anticipatory grief | Feelings of grief and loss, as if a person has already died; usually experienced when relating to someone during the dying process. |
| Area agencies on aging (AAA) | State agencies that provide information and coordinate a variety of services for older adults that are provided by local agencies; also called the triple As, they are funded through the Older Americans Act (OAA). |
| Artificial nutrition and hydration (ANH) | Broadly defined, ANH includes provision of fluids or nutrients by any route other than the mouth—for instance, intravenously. ANH is provision of nutrients and fluids using a tube inserted into the esophagus or surgically implanted into the stomach. |
| Assisted-living facilities | Developments that are licensed and regulated to serve people who don’t require full-time skilled nursing care but might have considerable difficulties performing their activities of daily living. |
| Attending physician | Physician with primary responsibility for the care of a patient at a particular time or place of care. The attending physician could be the person’s primary care physician, a hospitalist, nursing facility or hospice medical director, or specialist. |
| Benefit and burden | The comparative likelihood of benefit or burden associated with any medical treatment. |
| Benefit period | Defined length of time used to measure a patient’s use of services for inpatient hospital and skilled nursing facility care, and separately for hospice care. |
| Bereavement counseling | Counseling and emotional support for persons who have experienced the death of a family member or friend. |
| Best interest of the patient | Guideline for use by health care agents, physicians, or hospital ethics committees for determining health care decisions when the person’s treatment wishes are unknown. |
| Board and care homes and adult foster care (sometimes subsumed under assisted living) | Typically, these are converted single-family homes in traditional residential communities. Residents normally share a bedroom and bath with another resident, and the rest of the house is laid out like a traditional home. |
| Capacity (see also Competence) | The ability of a person to (1) understand information, (2) evaluate the information in light of values and goals, (3) make a decision, and (4) communicate the decision. |
| Cardiopulmonary resuscitation (CPR) | Emergency treatment for malfunction or cessation of heartbeat or breathing. |
| Care recipient | Someone who needs help, from a few hours a week to full-time care, with ADLs and IADLs because of illness, cognitive impairment, or changes caused by aging. |
| Caregiver assessment | Asking caregivers about their physical, emotional, social, and cognitive challenges in caring for a care receiver, to determine what help the caregiver needs as well as how to best serve the care receiver. |
| Celebration of life | An event to celebrate the life of a person who has died, or is about to die, usually outside the framework of any religious rite. |
| Chaplain | Member of health care facility staff or team who attends to spiritual distress related to serious illness or end of life for patients and their families. |
| Chronic illness | a long-term health condition that lasts for at least one year and requires ongoing medical attention or limits daily activities. |
| Cohousing | A group of 20 to 40 family residences clustered around a common courtyard or shared green space. The households are anchored by a large, shared common house with a large kitchen and dining room for shared meals. |
| Competence | In the context of health care, ability of an individual to make autonomous decisions about medical treatments and personal care. Competence is a legal determination often made by a judge. |
| Complementary therapy | Nonmedical therapy intended to complement medical therapy—for instance, massage, acupuncture, music, aroma-, pet, or other therapies. |
| Continuing care retirement communities (CCRCs) | Communities that offer a tiered approach to the aging process, accommodating residents’ changing needs. |
| CPR directive | An advance directive initiated by a person and cosigned by a physician as a medical order indicating refusal of cardiopulmonary resuscitation. |
| Cremains | Material resulting from cremation of a human body and the container in which it is placed. Colloquially referred to as ashes but typically of a denser, heavier consistency, which may include chunks of bone or teeth. |
| Cremation | Means of final disposition in which the body is incinerated. |
| Death with Dignity Act | Law passed in Oregon in the 1990s authorizing and regulating physician-aided death of persons who wished to end their lives prior to the natural conclusion of their terminal illness. |
| Declarant | A competent individual who executes a living will. |
| Default process for medical decision making | Process, outlined in state law, to determine delegation of decision-making authority for an incapacitated person in the absence of an advance directive or medical durable power of attorney. |
| Disposition of remains/the body | Handling of a deceased person’s body, which may include embalming, traditional or green burial, cremation, interment, or whole body donation. |
| Do-not-resuscitate (DNR) order | Physician’s order, inserted into a patient’s medical chart, stating that if the patient’s heart or breathing malfunctions or stops, cardiopulmonary resuscitation should not be administered. |
| Domains of care | Care directed toward easing distress in different aspects of a person’s life. |
| Durable medical equipment (DME) suppliers | Suppliers that provide home care patients with products ranging from respirators, wheelchairs, and walkers to catheter and wound-care supplies. |
| Elasticity of housing | Residences that are built or modified to adapt to accommodate changing needs as the resident ages. |
| Ethical and religious directives | A comprehensive code of ethics governing medical treatment and care in facilities operating under the aegis of the Catholic Church. |
| Ethical will | Documentation or communication of one’s intangible legacy of values, life lessons, or moral tenets. |
| Euthanasia | An act intended to cause, hasten, or fail to medically prevent the death of another person, justified by relief of the person’s suffering or removal of a class of “substandard” individuals from society. |
| Exacerbation | Episodes of sudden worsening or intensity of a chronic disease often requiring emergency attention, hospitalization, and/or intensive life-sustaining treatments. |
| Existential suffering | Suffering experienced by an individual whose personal integrity is threatened by illness, injury, or other external circumstances and manifested as despair, extreme isolation, or emotional or spiritual agony. |
| Family caregiver | Someone who provides unpaid care to another who requires help with ADLs and IADLs, from a few hours a week to living with the care receiver full time. |
| Family dynamics | How a family operates together. Generally, different members of a family play different roles, learned while growing up in that particular family, and they interact in ways that differ from how they might interact outside the family. |
| Family meeting | An opportunity for all family members (and sometimes extended family and friends) to express their perceptions of what is happening, their needs, ways to solve problems, and ways to plan for future care. |
| Family-centered approach | Including family caregivers as a core part of health care and long-term care; recognizing, respecting, assessing, and addressing the needs of family members. |
| Financial stress | One of the greatest burdens of caregiving. Long-term care is expensive, and the resources of both the caregiver and the care receiver can be seriously drained by prolonged needs for care. |
| Five Wishes | An “omnibus” (all-purpose) advance directive legal in many states. Addresses appointment of a medical durable power of attorney, preferences for certain aspects of medical treatment and personal care, funeral/memorial instructions, and personal legacy. |
| Funeral | Social or religious ritual conducted to honor a decedent whose body or cremains are present. |
| Funeral director | Individual licensed by the states to arrange or prearrange funeral services. |
| Funeral home | A commercial establishment in the business of arranging and conducting funerals. |
| Funeral rule | Trade rule issued by the Federal Trade Commission requiring funeral homes to disclose prices and prohibiting certain deceptive and unfair practices. |
| Futile treatment | Treatments that are administered solely to sustain or prolong life without contributing to cure, control of the underlying disease, or meaningful recovery of the patient. Also termed nonbeneficial treatment. |
| Geriatric care manager | Professional who can be brought in to help be the ears and eyes for long-distance caregivers, helping them prioritize, strategize, and manage their responsibilities. |
| Goals of care | The intended outcomes of care according to the person receiving the care. |
| Green burial | The practice of burying a body directly in the ground without embalming or other accoutrements of traditional, commercial burial. |
| Health care agent or proxy | Individual officially appointed in an advance directive or medical durable power of attorney to make health care decisions on behalf of another person when that person is not able to make or express his or her own decisions. |
| Home care aides | Home care aides are trained to provide help with ADLs, such as dressing, bathing, getting in and out of bed, and using the toilet. They may also prepare meals. They usually are not certified. |
| Home funeral | Funeral conducted at home with the body present. |
| Hospice bounce | A dramatic but typically temporary improvement in function following admission to hospice care. |
| Hospice care | Medical treatment and personal care of persons diagnosed with a terminal illness and their families. Hospice care focuses on relieving suffering—physical, emotional, spiritual, and mental—as well as addressing practical challenges. |
| Hospice medical director | Physician employed or contracted by a hospice agency to supervise the medical treatment and care of the hospice patients. |
| Hospice residence | Health care facility specifically built to care for hospice patients. Most hospice residences are decorated and appointed in a more homelike fashion than are nursing facilities or hospitals. |
| Hospitalist | Physician employed or contracted by a hospital to provide care to patients in the hospital. |
| Housing Plus Services | An umbrella term coined by the National Low Income Housing Coalition to describe combined housing and service initiatives. Housing Plus Services refers to permanent affordable housing that incorporates various levels of services with housing. |
| Iatrogenic suffering | Suffering caused by medical treatments or professionals in their efforts to cure or control disease. |
| Incapacity | A person’s inability, as determined by a physician, to make and/or express his or her own health care decisions. |
| Instrumental activities of daily living (IADLs) | Shopping, cooking meals, performing household tasks such as laundry, managing money, using the telephone, taking medication; activities needed for independent living. |
| Integrated model of care | An approach to care that initiates palliative care at the same time as and alongside treatments intended to cure or manage disease and prolong life. |
| Interdisciplinary team | A team of health care providers addressing a person’s distress from various perspectives in order to provide comprehensive care. Members typically include a physician, nurse, social worker, chaplain, and other therapists or specialists as required. |
| Interested person | Person with an interest in the care of another person, typically family members and close friends but can also include professional associates and advisors. |
| Intubation | Insertion of a tube into a person’s trachea to provide ventilation or mechanical respiration. |
| Licensed practical nurse (LPN) | Licensed practical nurses (known as licensed vocational nurses [LVNs] in California and Texas) exist in most states. LPNs usually have two years of training and have passed state or national boards. |
| Life-sustaining treatment/procedure | Medical treatment or procedure used to prolong life without reversing underlying medical conditions. This could include blood transfusion, CPR, mechanical ventilation, renal dialysis, and artificial nutrition and hydration, among other treatments. |
| Living will | Document signed by a competent person stating, typically, that life-sustaining treatment should be withheld or withdrawn when the person is determined to be in a terminal condition and is unable to make his or her own health care decisions. |
| Long-term services and supports (LTSS) | Services and supports used by individuals of all ages with functional limitations and chronic illnesses who need assistance to perform routine daily activities such as bathing, dressing, preparing meals, and administering medications. |
| Mechanical respiration/ventilation | Breathing or oxygenation of blood assisted by a machine or device that forces air into a person’s lungs. |
| Medical aid in dying (MAID) | A legally defined process whereby terminally ill patients with decisional capacity and a prognosis of six months or less may request and obtain lethal medications to end their lives. |
| Medical durable power of attorney | Legal document prepared by an individual authorizing another person to make health care decisions on the individual’s behalf should the person become unable to make or express his or her own decisions. |
| Medicare certification | A designation conferred on a health care facility or agency indicating that the facility or agency has met certain standards of patient care and operations. |
| Medicare hospice benefit | A comprehensive benefit provided by Medicare covering all costs of hospice care for qualified Medicare beneficiaries. |
| Memorial service | Social or religious ritual to honor a decedent without the person’s body or cremains being present. |
| Mercy killing | Intentional act of causing a person’s death on the basis of the apparent or supposed suffering the person is experiencing. |
| National Healthcare Decisions Day | April 16, set aside for the contemplation, discussion, and preparation of advance directives. |
| Nursing home | Facility that provides private or semiprivate rooms, meals, personal care, nursing care, and medical services to those in need of specialized medical care. |
| Occupational therapists (OTs) | Therapists that help people improve their ability to perform tasks of daily living. OTs may prescribe physical exercises or other activities to improve cognitive function. |
| Palliative care | Medical treatment and personal care focused not on curing a disease or condition, but on treating pain, physical symptoms, and emotional and spiritual distress of a person with serious, chronic, or advanced illness and the person’s family. |
| Palliative care consult | A consultation, usually between a patient and a palliative care interdisciplinary team, to determine the patient’s goals of care and devise a medical treatment and care plan consistent with those goals. |
| Palliative sedation | The use of any sedating agent to relieve symptoms, carefully titrated to balance the degree of sedation with the severity of symptoms. |
| Persistent vegetative state | Condition resulting from catastrophic injury to the cerebral cortex, resulting in permanent unconsciousness even though the person might appear to be awake and asleep at times. |
| Personal care contracts | Legal contracts that formalize the arrangement of payment to family members to be caregivers, so as to lesson tension within a family. |
| Personal emergency response systems (PERS) | The key to many older individuals living at home is getting help quickly if an emergency occurs. Also called a medical emergency response system or medical alert system. |
| Physical therapists (PTs) | Therapists who help restore function, improve mobility, relieve pain, and prevent or limit permanent disabilities of patients suffering from injuries or disease. |
| Place attachment | Emotional or affective ties to a place. This attachment is generally thought to be the result of a long-term connection with a place. |
| POLST paradigm | An approach to documentation and communication of a person’s preferences regarding certain life-sustaining treatments in the form of portable, actionable medical orders rather than “just” advance directives. |
| Pre-need arrangements | Arrangements made for disposition of a body, funeral, or memorial in advance of the person’s death, sometimes structured with an agreement to deliver specific goods and services in exchange for prepayment. |
| Principal | A competent individual making an advance directive or appointing a health care agent by medical durable power of attorney. |
| Prognosis | Length of time a person is expected to survive with a serious, advanced, or terminal illness. |
| Psychosocial and spiritual suffering | Distress related to serious or advanced illness affecting or manifesting in a person’s mental state. |
| Registered nurse (RN) | Professional nurses who often supervise the tasks performed by LPNs, orderlies, and nursing assistants. They provide direct care and make decisions regarding plans of care for individuals. |
| Rehabilitation services | Services that seek to maximize patients’ quality of life and restore them to the highest possible level of function. |
| Release of information | Allows the doctor and caregiver to talk to each other, share information, and plan together for care, if the care receiver is no longer capable of doing so alone. |
| Remains | Body of a deceased person. (Cremains are remains of a cremated body.) |
| Residential normalcy | A theory that describes the personal impact of where one lives. |
| Respite care | Occasional care provided by a third party for the purpose of relieving family caregivers for a period of a few hours to several days. |
| Role inversion | Role change in which the child becomes the caregiver (but the parent is still the parent). |
| Rule of double effect | An ethical rule in which actions that are intended for good, but have foreseeable and possibly bad outcomes, are permissible when the good effect is intended and cannot be achieved another way. |
| Sandwich generation | Adults who are caring for both children at home and elderly parents at the same time; might also be juggling work or career. |
| Self-deliverance/self-determined death | A deliberate self-killing without the sanctioned assistance of any medical personnel in order to end a life of current or anticipated suffering, usually as a result of an incurable disease or irreversible impairment. |
| Smart homes | Homes that can be fitted with an array of advanced electronic and technological features that control standard functions such as temperature, as well as specialized devices that do such things as automatically call 911 if someone falls in the bathroom. |
| Social support | Network that provides people with a sense of being loved, cared for, esteemed, and valued. |
| Social workers | Help people solve personal and family problems. They often see clients who face life-threatening diseases or social problems. Also assist families that have serious domestic conflicts, including those involving elder abuse. |
| Speech and language pathologists | Sometimes called speech therapists. Therapists who assess, diagnose, treat, and help prevent speech, language, cognitive, communication, voice, fluency, and related disorders. They also work with people who have difficulty swallowing. |
| Surrogate decision maker | The person legally authorized to make decisions on behalf of another incapacitated/incompetent individual. The surrogate decision maker may hold a medical durable power of attorney, be a designated guardian, or otherwise be legally appointed to the role. |
| Telehealth service providers | Some agencies are developing telehealth services for the homebound. Through telehealth, a nurse can read an older adult’s vital signs over the telephone. |
| Telephone reassurance and friendly visitors programs | Provides a regular friendly and familiar voice to people who live alone. If a volunteer calls the home of an older adult and there is no answer, the volunteer calls an emergency contact person to verify the well-being of the individual. |
| Terminal illness | An illness that is incurable or irreversible and will eventually cause a person’s death. A terminal illness is specifically one that will take a person’s life within six months if the illness is allowed to run its natural course. |
| Total pain | A concept recognizing that pain is not solely a physical sensation but may manifest in a person’s emotional, psychological, spiritual, or social dimension or in all dimensions all at once. |
| Total sedation | Sedation to unconsciousness maintained until natural death occurs for terminally ill patients suffering severe and intractable symptoms that have not responded to other less extreme interventions. |
| Trajectory of illness | Course of decline described in terms of its shape and duration. Each trajectory has different patient experiences, medical and personal responses, and family/caregiver challenges. |
| Triangulation | A process when interacting with several people in which a person ends up taking sides with one person against another. |
| Urn | Container used to hold cremains. |
| Visitation | Practice common in the Roman Catholic tradition in which a reception is held at the funeral home the day or evening before the funeral for friends and family to gather and view the deceased person in an open casket. |
| Voluntarily stopping eating and drinking (VSED) | Action taken by a person in the context of terminal illness, usually with the intent of hastening or not impeding natural death from the illness. |
| Whole body donation | A process whereby a living person may donate his or her whole body after death for the purposes of medical or forensic research. |
| Whole brain death | Complete cessation of activity in all parts of the brain, including the brain stem. Whole brain death constitutes legal death, even if other means can be employed to continue respiration and cardiac function and deliver nutrients. |
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