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1.5 CE Test Hours: Original Research: New Acute Symptoms in Older Adults with Cognitive Impairment: What Should Family Caregivers Do?

Contrada, Emily

AJN, American Journal of Nursing: March 2019 - Volume 119 - Issue 3 - p 41
doi: 10.1097/01.NAJ.0000554007.38895.37


  • Read the article. Take the test for this CE activity online at
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  • This activity is also provider approved by the California Board of Registered Nursing, Provider Number CEP 11749 for 1.5 contact hours. LPD is also an approved provider of CNE by the District of Columbia, Georgia, and Florida #50-1223. Your certificate is valid in all states.


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New Acute Symptoms in Older Adults with Cognitive Impairment: What Should Family Caregivers Do?


To present the details of a study conducted to assess the frequency with which family caregivers of cognitively impaired older adults sought prehospital guidance from health care professionals.


After completing this continuing education activity, you should be able to

  • describe the background context useful in understanding the authors’ study of family caregivers of cognitively impaired older adults seeking prehospital guidance from health care professionals.
  • summarize the results of the authors’ study.
  1. The home-based primary care (HBPC) program offered by the Veterans Health Administration (VHA) relies on an interdisciplinary team to
    1. ensure that appropriate community resources are accessible.
    2. provide companionship to homebound older patients.
    3. deliver an alternative to outpatient clinic visits.
  2. The VHA HBPC program's aim is to
    1. prevent hospitalization and institutionalization of veterans in long-term care facilities.
    2. intervene when family caregivers question recommended courses of action.
    3. educate family caregivers on recognizing changes that indicate an acute illness.
  3. Enrollment in the VHA HBPC program has been shown to decrease
    1. the need for urgent care.
    2. overall Medicare costs.
    3. symptomatic variability.
  4. Data cited by the Agency for Healthcare Research and Quality (AHRQ) indicates that, for some older adults with cognitive impairment, better outcomes result from treatment
    1. at long-term care facilities.
    2. at less acute levels of care.
    3. through ED triage.
  5. Daiello and colleagues reported that, compared with Medicare beneficiaries without cognitive impairment, those with such impairment have
    1. about the same risk of hospitalization.
    2. a slightly lower risk of hospitalization.
    3. a substantially higher risk of hospitalization.
  6. In a study by Bynum and colleagues of Medicare beneficiaries, by how much did dementia increase the risk of hospitalization?
    1. about threefold
    2. nearly fourfold
    3. more than fivefold
  7. In the VHA HBPC program, family caregivers who seek guidance on addressing a clinical problem can interact with HBPC providers
    1. through electronic messaging.
    2. via 24/7 telephone triage.
    3. by meeting with them in the ED.
  8. The process of problem recognition involves first
    1. identifying patterns.
    2. labeling the phenomenon.
    3. becoming aware of new evidence.
  9. In the authors’ study, family caregivers sought guidance from health care staff before what percentage of unplanned acute care encounters?
    1. 20%
    2. 22%
    3. 26%
  10. Which of the following presenting clinical issues was one of the most common among the cognitively impaired patients for whom family caregivers sought guidance?
    1. falls
    2. altered mental status
    3. circulation problems
  11. In the authors’ study, family caregivers interacted most often with
    1. VHA telephone triage nurses.
    2. outpatient clinic staff.
    3. HBPC staff.
  12. The most frequent advice that both HBPC staff and VHA telephone triage nurses gave to family caregivers who sought guidance was to
    1. go to the ED.
    2. see a provider in the clinic.
    3. try self-care recommendations.
  13. Of those patients who were advised to go to the ED and did so, the majority were
    1. sent home the same day.
    2. admitted to the hospital.
    3. referred to a lower level of care.
  14. Of the following days of the week, health care staff were most likely to be contacted by family caregivers on
    1. Mondays.
    2. Wednesdays.
    3. Saturdays.
  15. Of all the unplanned acute care encounters in the authors’ study, 25% were for reasons the AHRQ considers
    1. not justifiable.
    2. potentially preventable.
    3. significantly emergent.
  16. Among all the unplanned acute care encounters, the most common potentially preventable clinical issue was
    1. pneumonia.
    2. heart failure.
    3. urinary tract infection.
  17. Dening and Hibberd reported that many family caregivers of loved ones with dementia do not accept help until
    1. the need becomes pressing.
    2. they become dissatisfied with primary care services.
    3. they decide that long-term care placement is inevitable.
  18. In the authors’ study, of those patients whose caregivers sought guidance, what percentage had symptoms of altered mental status?
    1. 7%
    2. 18%
    3. 29%
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