A single or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person. There are seven different types of elder abuse: physical abuse, sexual abuse, emotional abuse, financial/material exploitation, neglect, abandonment, and self-neglect.
Difficulties an individual may have in executing activities. “Activity Limitation” is part of the International Classification of Function model (ICF) which includes a biopsychosocial approach to health and includes biological, individual, and social factors.
An individual’s ability to obtain appropriate health care services. Barriers to access can be financial, geographic, organizational, and sociological. Efforts to improve access often focus on providing/improving health coverage.
As required by the Americans with Disabilities Act (ADA), removal of barriers that would hinder a person with a disability from entering, functioning, and working within a facility. Required restructuring of the facility cannot cause undue hardship for the employer or organization.
A series of basic activities necessary for independent living at home or in the community.
ADLS include: Personal hygiene, Dressing, Eating, Toileting, Maintaining continence, and Transferring/Mobility. The level of independence is based on whether someone can perform these activities on their own or they need help from a family caregiver.
(Also see: Instrumental Activities of Daily Living)
Care that is generally provided for a short period of time to treat a certain illness or condition; medical treatment rendered to individuals whose illnesses or health problems are of a short-term or episodic nature.
Administration for Community Living (ACL)
Part of the US Department of Health and Human Services created to support older adults’ ability to live where they choose and participate fully in their communities.
Adult Day Programs/Services
Programs/services to provide support and structured activities for older adults who do not fully function independently but who do not require 24-hour nursing care.
A written document in the form of a living will or durable power of attorney prepared by a competent person and specifying what, if any, extraordinary procedures, surgeries, medications, or treatments the patient desires in the future if the patient should become incompetent to make such decisions.
Adverse Drug Reaction [ADR] (Adverse Drug Event [ADE])
An unwanted response or injury resulting from a medical intervention related to a drug (prescribed or over-the-counter [OTC]). The onset of unwanted effect(s) may be immediate or may take days or months to develop. ADEs include medication errors, ADRs, allergic reactions, and overdoses.
The process of discussing, determining, and/or executing treatment directives and appointing a proxy decision-maker. These decisions are made based on personal values, preferences, and discussions with loved ones.
Advocate (Patient Advocate; Patient Navigator)
An individual who helps guide a patient through the healthcare system. A patient advocate helps patients communicate with their healthcare providers so they get the information they need to make decisions about their health care.
Healthcare that addresses the older adult’s unique needs and wants. It is care that is based on what research shows to be the most important aspects to address at each patient encounter - the 4Ms: What Matters, Medication, Mentation, and Mobility.
Physiologic changes that occur with aging in all organ systems or a condition that is most commonly found in older adults.
The stereotyping and discrimination against individuals or groups on the basis of their age. Ageism can take many forms, including prejudicial attitudes, discriminatory practices, or institutional policies and practices that perpetuate stereotypical beliefs.
Aging and Disability Resource Connection (ADRC) Georgia Resource
A program managed by the AAAs where people of all incomes and ages can get information on the full range of long-term support options and public long-term support programs and benefits.
(Also see: Area Agency on Aging (AAA))
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.
The act, action, or an instance of moving about or walking; used most often in medical contexts.
Health services provided on an outpatient basis, in contrast to services provided in the home or to persons who are inpatients. While many inpatients may be ambulatory, the term ambulatory care usually implies that the patient must travel to a location to receive services which do not require an overnight stay.
Annual Wellness Visit (AWV)
A Medicare-covered yearly screening appointment with a primary care provider (PCP) to create or update a personalized prevention plan. The AWV is not a head-to-toe physical exam.
A set of commitments and actions designed to optimize the treatment of infections, reduce adverse events, prevent the emergence of resistance, and lead to better outcomes associated with antibiotic use.
A local (city or county) agency, funded under the federal Older American Act (OAA) that plans and coordinates various social and health service programs for persons 60 years of age or more. The network of AAA offices consists of more than 600 approved agencies and are found in every state.
(Also see: Older Americans Act)
Assessment tools are tests and measures used to evaluate the patient’s presenting problem, confirm a diagnosis, determine its severity, and aid in identifying specific treatment options. An age-friendly provider uses appropriate assessments, makes referrals, and communicates with the patient’s care providers.
Group residences, where older adults or adults with disabilities live in individual apartments but receive some personal-care services, including shared meals, day and night supervision, assistance with medications, and other benefits, which vary according to state regulations.
Tools to maintain or improve an individual’s functioning and independence to facilitate participation and to enhance overall well-being. They can also help prevent impairments and secondary health conditions. Examples of assistive devices and technologies include wheelchairs, prostheses, hearing aids, visual aids, and specialized computer software and hardware that increase mobility, hearing, vision, or communication capacities.
(Also see: Durable Medical Equipment)
The right of patients to make informed decisions about their medical care without their health care provider trying to influence the decision. Patient autonomy allows for health care providers (HCP) to educate the patient but does not allow the HCP to make the decision for the patient.
Coordination and stability of the body in space. Normal balance depends on information from the vestibular system in the inner ear, from other senses such as sight and touch, from proprioception and muscle movement, and from the integration of these sensory data by the cerebellum.
The connection between the health and well-being of the body and the mind.
A healthcare provider’s assessment of an individual’s ability to understand the significant benefits, risks, and alternatives to proposed health care and to make and communicate a health care decision; Capacity differs from competency which is a legal determination.
(Also see: Competency)
Deliberately organizing patient care activities and sharing information among all the participants concerned to achieve safer and more effective care and outcomes.
An individual who oversees assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s comprehensive health needs through communication and available resources to promote patient safety, quality of care, and cost-effective outcomes.
A document that establishes client goals, identifies activities or action steps needed to achieve these goals, expected dates for each action step, and any resources or support needed to meet the client’s needs.
A set of actions designed to ensure the coordination and continuity of health care as individuals transfer between different locations or different levels of care within the same location or from one healthcare provider to another. It includes logistical arrangements, education of the patient and family, and coordination among the health professionals involved in the transition. Representative locations include (but are not limited to) hospitals, sub-acute, and post-acute nursing facilities, the individual’s home, primary and specialty care offices, and long-term care/retirement communities.
Individuals such as family, friends, and unskilled care providers who provide varying degrees of ongoing assistance with everyday tasks on a regular or daily basis. Informal or unpaid caregivers (family members or friends) provide the majority of long-term care provided in people’s homes.
An all-encompassing term used to describe the physical, emotional, and financial toll of providing care.
Emotional support and guidance provided for families, partners, and other caregivers who are providing care for another individual.
A person who is 100 years of age or older.
Pain that lasts for more than three months and/or beyond the expected healing time period. It may or may not be associated with an identifiable cause, can happen anywhere in the body, and may present as musculoskeletal, neurologic, visceral, or referred pain. It often interferes with daily life and can lead to depression and anxiety. Increasing age is associated with a greater incidence of chronic/persistent pain.
Thinking skills, including language use, calculation, perception, memory, awareness, reasoning, judgment, learning, intellect, social skills, and imagination.
When a person has trouble remembering, learning new things, concentrating, or making decisions that affect their everyday life. Cognitive impairment ranges from mild to severe. With mild impairment, people may begin to notice changes in cognitive functions, but still be able to do their everyday activities. Severe levels of impairment can lead to losing the ability to understand the meaning or importance of something and the ability to talk or write, resulting in the inability to live independently.
Community Care Services Program (CCSP)
A Medicaid home- and community-based waiver services program that provides community-based social, health, and support services to eligible consumers as an alternative to placement in a nursing home.
Determined by a judge who rules on the ability of an individual to participate in legal proceedings or make decisions which have legal consequences. Differs from Capacity which can be assessed by a healthcare provider.
(Also see: Capacity)
Comprehensive Medication Review (CMR)
A patient-centered review and consultation of the current medication therapy regimen. The pharmacist reviews all current medications with the resident and provides the resident a medication list with consultation points. Prescriber communications are sent as necessary. The CMR is required for Medicare Part-D participants. Eligible members should receive a CMR annually and after being discharged from the hospital.
Comprehensive Geriatric Assessment
A systematic evaluation of older persons by a team of health professionals consisting of data gathering, team discussion, development, and implementation of a care plan, with monitoring and revision as needed.
Also known as life plan communities, CCRCs are a housing option for older people who want to stay in the same place through different phases of the aging process. CCRCs offer differing types of housing and levels of care based on the individual's needs
An ongoing process of openness, self-awareness, and incorporating self-reflection and critique after willingly interacting with diverse individuals.
A type of long-term care consisting of any non-medical care that can reasonably and safely be provided by non-licensed caregivers. Custodial care can take place in a person’s home or in a nursing home.
An acute, fluctuating, and frequently reversible disturbance of mental function. The etiologies of delirium are diverse and multifactorial. Often, delirium reflects the pathophysiological consequences of an acute medical illness, medical complication, or drug intoxication.
The progressive decline of cognitive functioning and behavioral abilities to such an extent that it interferes with a person's daily life and activities. These functions include memory, language skills, visual perception, problem-solving, self-management, and the ability to focus and pay attention.
The process of tapering, stopping, discontinuing, or withdrawing medications, with the goal of managing polypharmacy and improving health outcomes.
A common but serious mood disorder that affects how a person feels, thinks, and handles daily activities, such as sleeping, eating, or working. Depression is characterized by a combination of depressed mood, loss of interest or pleasure, changes in weight and sleep, psychomotor agitation or retardation, fatigue, feelings of worthlessness or guilt, difficulty concentrating, and recurrent thoughts of suicide or death. To be diagnosed with depression, the symptoms must be present for at least two weeks.
A sensation or illusion of movement (such as spinning, rotating, tilting, or rocking), unsteadiness, lightheadedness, or disequilibrium. It may be accompanied by gait imbalance.
A thorough evaluation of the drug (medication) regimen by a pharmacist, with the goal of promoting positive outcomes and minimizing adverse consequences associated with medication. The review includes preventing, identifying, reporting, and resolving medication-related problems, medication errors, or other irregularities in collaboration with other members of the interdisciplinary team. Each resident in a skilled nursing facility should receive a DRR once a month.
Total discontinuation of operating a motor vehicle for productive, social, spiritual, or any other purposes. Driving cessation could be voluntary or involuntary, with or without loss of a driver's license. A Certified Driving Rehabilitation Specialist (CDRS) can offer support in making a driving cessation determination. Resources include MyMobility Plan.
Person who is a Medicare beneficiary who also qualifies for Medicaid benefits.
Equipment which can withstand repeated use. Examples of DME include hospital beds, wheelchairs, ventilator oxygen systems.
(Also see: Assistive Devices/Technologies)
Care given to people who are approaching death and have stopped treatment to cure or control their disease. End-of-life care includes physical, emotional, social, and spiritual support for patients and their families. End-of-life care aims to control pain and other symptoms so the person can be as comfortable as possible.
Evidence-Based Medicine (Practice)
An interdisciplinary approach using an integration of best research evidence with clinical expertise and patient values.
Evidence Based Program (EBP)
Programs that promote health and prevent disease among older adults and meet the criteria established by the ACL/AoA for evidence-based programs funded through the Older Americans Act Title III-D. EBP’s have been rigorously tested in controlled settings, proven effective, and translated into practical models that are widely available to community-based organizations. Examples include Tai Chi for Arthritis and the Chronic Disease Self-Management Program.
Failure to Thrive (Adult)
A state of decline that is multifactorial and may be caused by chronic concurrent diseases and functional impairments. Manifestations of this condition include weight loss, decreased appetite, poor nutrition, and inactivity.
An event which results in a person coming to rest inadvertently on the ground or floor or other lower level.
Techniques such as exercise and balance training, community-based evidence-based programming, and home modification education.
An individual's risk of falling identified by a myriad of factors that include falls history, medical conditions, medications, gait, strength and balance, and postural hypotension.
A standardized tool to assess fall risk.
Also known as bowel incontinence; the inability to control bowel movements, causing stool (feces) to leak unexpectedly from the rectum; Ranges from an occasional leakage of stool while passing gas to a complete loss of bowel control.
An age-related syndrome of physiological decline, characterized by marked vulnerability to adverse health outcomes.
(Also see: Sarcopenia)
The physiological ability of people to move independently and safely in a variety of environments in order to accomplish functional activities or tasks and to participate in activities of daily living, at home, work, and in the community.
(Also see: Activities of Daily Living)
A person’s pattern of walking.
The healthcare specialty dedicated to supporting health, safety, and independence as individuals age.
Multifactorial conditions that are prevalent in older adults, and develop when an individual experiences accumulated impairments in multiple systems that compromise their compensatory abilities. Common geriatric syndromes include falls, depression, polypharmacy, cognitive changes, and delirium.
Primary care physicians who have additional specialized training in treating older patients.
Multidisciplinary study of all aspects of aging, including health, biological, sociological, economic, behavioral, and environmental factors.
One who studies aging and older adults. Researchers in this field are diverse and are trained in areas such as physiology, social science, psychology, public health, and policy.
Gradual Dose Reduction (GDR)
The stepwise tapering of a medication dose to determine if symptoms, conditions, or risks can be managed by a lower dose or if the dose or medication can be discontinued.
A normal response to a traumatic event. Grief can happen in response to loss of a loved one, changes to daily routines, and ways of life that usually bring comfort and a feeling of stability.
An individual who has been granted the legal authority to make decisions for another person.
A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.
Health Promotion/ Wellness
The process of enabling people to increase control over their health and make improvements.
Health-related quality of life (HRQOL) is an individual’s or a group’s perceived physical and mental health over time.
(Also see: Quality of Life)
Types of person-centered care delivered in the home and community. HCBS programs address the needs of people with functional limitations who need assistance with everyday activities and are designed to enable people to stay in their homes, rather than moving to a facility for care.
Care that allows a person with special needs (e.g.; having a chronic illness, recovering from surgery, living with a disability) to stay in their home and age in place. Home care services include: personal care, household chores, cooking meals, money management, and health care. Home care should be differentiated from home health care, which focuses on skilled medical and rehabilitation services.
(Also see: Home and Community-Based Services (HCBS))
Home Health Care
Skilled medical care provided intermittently in the patient’s home to treat a chronic health condition or help in recovery from illness, injury, or surgery. Includes skilled nursing care, physical therapy, occupational therapy, speech therapy, social services, and assistance with activities of daily living.
The state of dynamic equilibrium of the internal environment of the body that is maintained by the constant processes of feedback and regulation in response to external or internal changes.
A program that gives special care to people who are near the end of life and have stopped treatment to cure or control their disease. Hospice offers physical, emotional, social, and spiritual support for patients and their families. The main goal of hospice care is to control pain and other symptoms of illness so patients can be as comfortable and alert as possible. It is usually given at home, but may also be given in a hospice center, hospital, or nursing home.
Inability to control the flow of urine from the bladder (urinary incontinence) or the escape of stool from the rectum (fecal incontinence).
A community which offers specific services and amenities for older adults that promote active, healthy lifestyles.
Activities that allow an individual to live independently in the community. The major domains of IADLs include cooking, cleaning, transportation, laundry, medication management and managing finances.
(Also see: Activities of Daily Living)
Healthcare providers from different fields working together in a coordinated fashion toward common goals for the patient and with patients, families, informal caregivers, and communities to deliver the highest quality of care across settings.
An initiative of the IMPACT Act of 2014, which mandates an evaluation of the medication regimen similar to a MRR, but is performed more frequently. An iMRR should occur if a resident has experienced a change of status and is designed to determine if the resident's change in status is medication-related.
The number of years that an average person of a given age may be expected to live.
A written, legal document that states the wishes of an individual regarding life-saving devices and procedures in the event of a terminal illness or injury when they are no longer competent and able to make decisions on their own.
Long-Term Care Facility
An umbrella term that includes residential/custodial care facilities.
Deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients. The term covers two broad conditions- undernutrition and overnutrition (this includes overweight, obesity and diet-related noncommunicable disease (such as heart disease, stroke, diabetes and cancer).
(Also see: Undernutrition)
A joint federal and state public assistance program for financing health care for people with low incomes. It is the largest public payer of long-term care services.
Medicaid Waiver Programs
States can develop home- and community-based services waivers (HCBS Waivers) to meet the needs of people who prefer to get long-term care services and supports in their home or community, rather than in an institutional setting.
Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease. Different parts of Medicare cover different services. The parts of Medicare are:
Medicare Supplement Insurance (Medigap)
Private health insurance policies that provide additional coverage of health care costs above those covered by Medicare.
A drug used to diagnose, cure, treat, or prevent disease. One of the four M’s of the age-friendly health system.
4Ms framework: Medication: If medication is necessary, use Age-Friendly medication that does not interfere with What Matters to the Older Adult, Mobility, or Mentation across settings of care.
The delivery of a drug to a patient via routes including oral, rectal, topical, and parenteral.
Medication Administration Record (MAR)
Record to provide uniform guidelines for documenting medications and treatments utilizing the pharmacy-generated medication and treatment record or approved flowsheet. MAR formats and information vary by institution but at a minimum must include the patient’s name, and each medication’s name, dose, frequency, and route as well as directions for treatments.
The extent to which a patient’s behavior in taking or using medications coincides with medical advice.
An instrumental ADL skill that refers to a person’s ability to safely manage their own medications.
The process of identifying the most accurate list of all medications that the patient is taking including name, dosage, frequency, and route.
A thorough evaluation of the medication regimen by a pharmacist, with the goal of promoting positive outcomes and minimizing adverse consequences associated with medication. The review includes preventing, identifying, reporting, and resolving medication-related problems, medication errors, or other irregularities in collaboration with other members of the interdisciplinary team. Each facility resident should receive a MRR once a month. An MRR should also be performed for residents anticipated to stay less than 30 days.
Medication Therapy Management
For an individual patient, an assessment of medication use for appropriateness, effectiveness, safety, and adherence with consideration for accessibility and cost.
The mental registration, retention, and recollection of past experiences, sensations, or thoughts.
Global mental functions, such as consciousness, orientation function, motivation, and impulse control; and specific mental functions such as attention, memory, emotion, and perception.
4Ms framework: Mentation: Prevent, identify, treat and manage depression, dementia and delirium across settings of care.
Emotional, psychological and social well-being. It is influenced by biological, environmental, and cultural factors and is highly variable in definition depending on time and place.
Mild Cognitive Impairment (MCI)
A cognitive decline greater than expected for an individual's age and education level but that does not interfere notably with activities of daily life. Examples include difficulties with word finding, naming, or complex skill execution.
Moving by changing body positions or locations; by transferring from one place to another; by carrying, moving, or manipulating objects; by walking, running, or climbing, and by using various forms of transportation. This includes ambulation and wheeled mobility. Also includes mobility at a structural/tissue level (e.g. joint, nerve, soft tissue)
4Ms framework: Mobility: Ensuring that older adults move safely every day to maintain function and to do what matters to them.
Money Follows the Person (MFP)
A Medicaid program that helps older adults and persons with disabilities to return from institutional care to their homes and communities.
National Council on Aging (NCOA)
An advisory council established under provisions of the federal Older American’s Act (OAA), the NCOA is a nonprofit advocacy and service organization that focuses on joining the efforts of government, businesses, and nonprofit organizations to improve the lives of our older adults.
A facility that provides health and personal care services that include nursing care, 24-hour supervision, 3 meals a day, and assistance with everyday activities. Also known as a skilled nursing facility (SNF). Rehabilitation services such as physical, occupational, and speech therapy are also available.
An individual aged 65 years of age or older. The age of 65 is an arbitrary age linked to the time of Medicare eligibility.
Federal legislation that specifically addresses the needs of older adults in the United States and provides some funding for aging services. The OAA creates the structure of federal, state, and local agencies that oversee aging services programs.
(Also see: Area Agencies on Aging)
An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.
Health problems that hinder a person’s ability to engage in life activities such as working, social/leisure activities, and obtaining healthcare.
Health care customized to the needs of the individual seeking care.
(Also see: Home and Community-Based Services)
A team approach to care with the intent to improve the quality of life of patients and their families who are facing problems associated with life-threatening illness. Its aim is to reduce suffering whether physical, psychosocial or spiritual.
A residence that provides individuals with support of instrumental activities of daily living and/or activities of daily living.
The study of the relationship between the concentration of a drug and the response obtained in a patient.
The study of the impact of genetic polymorphisms on drug response in a patient.
The study of the absorption, distribution, metabolism, and elimination of drugs in patients requiring drug therapy.
Also known as homeostatic reserve, the capability of an organ to carry out its activity under stress. A gradual decline in physiologic reserve occurs with aging.
The prescription, administration, and/or use of more medications than are clinically indicated in a given patient. While often referenced as the use of five or more medications, polypharmacy is when more medications are used than needed, despite the number.
Gives one or more persons the power to act on a person’s behalf as their agent in legal/financial matters. Durable POA for healthcare covers healthcare decisions.
Post-Acute Care (PAC)
Care that follows acute care and includes rehabilitation or palliative services. These services can be provided outpatient, at home or in facilities including long-term care hospitals, inpatient rehabilitation facilities, skilled nursing facilities, and by home health agencies.
A largely preventable medication-related problem that begins when an adverse drug reaction is misinterpreted as a new medical condition. A new medication is initiated based on this interpretation, putting the patient at risk of developing additional adverse effects relating to this potentially unnecessary treatment. To prevent the prescribing cascade, prescribers should always consider any new signs and symptoms as a possible consequence of current drug treatment.
Injuries to skin and underlying tissue resulting from prolonged pressure on the skin. Also known as bedsores, decubitus ulcers, or pressure ulcers.
The gradual and inevitable process of body deterioration that takes place throughout life.
Program for All Inclusive Care for the Elderly (PACE)
Provides comprehensive medical and social services to certain frail, elderly people still living in the community. Most of the participants who are in PACE are dually eligible for both Medicare and Medicaid.
A person appointed by a patient and granted the authority to make medical decisions in the event the patient is unable to express personal preferences about medical treatment.
The discipline concerned with measures that affect the health of communities.
Quality of Care
A measure of the degree to which delivered health services meet established professional standards and judgements of value to the customer.
The objective conditions, consequences, or subjective value or satisfaction experienced in life. The concept holds varying meanings for different people and may evolve over time.
(Also see: Health-Related Quality of Life)
Provides short-term relief for primary caregivers. It can be arranged for a portion of a day, several days or weeks. Care can be provided at home, in a healthcare facility, or at an adult day center.
Use of pharmacologic or physical means to prevent patients from harming themselves or others.
A progressive and generalized skeletal muscle disorder that is associated with increased likelihood of adverse outcomes including falls, fractures, physical disability and mortality.
(Also see: Frailty)
Screening tools are tests or measures to evaluate for diseases and health conditions before symptoms appear. Screenings allow for earlier management and referral to appropriate providers. An age-friendly provider conducts screenings for conditions that are prevalent in older adults.
Aging resulting from disease, lack of physical activity, and unhealthy activities (smoking or drinking), poor nutrition, and exposure to hazardous materials; may be delayed by leading a moderate lifestyle with minimal bad habits.
A general term used to describe a vulnerable adult living in a way that puts his or her health, safety, or well-being at risk.
(Also see: Abuse (Elder))
Skilled Nursing Facilities (SNF)
Licensed healthcare residences for individuals who require a higher level of medical care than can be provided in an assisted living facility. Skilled nursing staff are available to provide 24-hour medical attention. Skilled nursing facilities are commonly used for short-term rehabilitative stays, which are at least partially covered by Medicare for up to 100 days in many instances.
Changes in the sleep-wake cycle and sleep architecture commonly referred to as insomnia. Specific sleep disturbances may be reported as difficulty falling asleep, difficulty staying asleep, a nonrestorative sleep, and/or awakening early in the morning with an inability to return to sleep.
A national insurance program that provides income to people when they retire or are disabled.
Stopping Elderly Accidents, Deaths and Injuries (STEADI)
A CDC initiative that is designed to offer a coordinated approach to implementing the American and British Geriatrics Societies clinical practice guideline for fall prevention.
Transient, usually sudden loss of consciousness, due to drop in blood flow to the brain and is commonly accompanied by an inability to maintain an upright position.
The act of practicing healthy habits on a regular basis to attain better physical and mental health outcomes.
4Ms Framework: What Matters: Know and align care with each older adult’s specific health outcome goals and care preferences including, but not limited to, end-of-life care, and across settings of care.