Complex Geriatrics

Question 1

six complex geriatric conditions

Answer 1

hypertension, falls/gait disturbance, osteoporosis, incontinence, polypharmacy, infections

Question 2

___% of people ages 65 or older experience at least one fall each year

Answer 2

33%

Question 3

falls are responsible for ___% of nursing home admissions

Answer 3

40%

Question 4

intrinsic factors for falling (6)

Answer 4

age-related changes and dz
lower extremity weakness
poor grip strength
balance disorders
functional and/or cognitive impairment
visual deficit

Question 5

extrinsic factors for falling (2)

Answer 5

polypharmacy (> or = to 4 meds)

environmental factors

Question 6

some causes of falling (7)

Answer 6

mental health
weakness and frailty
vision defects
musculoskeletal
neuro epilepsy stroke
heart problems
environment

Question 7

two most frequent causes of gait impairment

Answer 7

myelopathy and multiple cerebral infarcts

Question 8

which assessment tool measures risk of falling? what five things does it measure?

Answer 8

stratify risk assessment tool: previous falls, agitation, impaired vision, frequent toileting, Barthel score of 3 or 4

Question 9

what does the Barthel index assess? what seven actions do you look at to make this score?

Answer 9

transfer and mobility: chair transfer, bathing, ambulation, dressing, toileting, grooming, feeding

Question 10

what are three environmental modifications for falling?

Answer 10

wheelchair, bed alarm, hip protectors,

Question 11

what environmental modification does not reduce fall?

Answer 11

physical restraints

Question 12

what do you counsel your falling pt on? (4)

Answer 12

reviewing meds associated with falls, discuss exercise, importance of improving or maintain good gait/balance, treating the foot problems

Question 13

what type of exercise increases strength/endurance? exercise that improves balance and mobility?

Answer 13

weight bearing; tai chi

Question 14

what are two measures of balance assessment?

Answer 14

functional reach test and get-up and GO

Question 15

how does the functional reach test work?

Answer 15

Assesses how far the individual can reach beyond arm’s length while maintaining a fixed base of support while standing. The patient should be able to move the fist a distance of 15 cm; risk for falling is evident if the individual moves the fist <15 cm

Question 16

what does the get-up and go test assess?

Answer 16

An older adult who moves less than 3 feet/second is at risk of falling; the higher the score, the greater the risk of falling

Question 17

what are the two types of primary osteoporosis? define them

Answer 17

type 1 postmenopausal: when women’s estrogen decreases (increase in resorption)
type 2 senile: thinning of trabecular and cortical bone (leads to hip and vertebral fractures)

Question 18

what are two main conditions that can lead to secondary osteoporosis? by what process do these conditions affect bone density?

Answer 18

hyperthyroidism or leukemia; their meds cause bone breakdown

Question 19

supplement treatment options for osteoporosis?

Answer 19

calcium- decreases bone turnover reducing bone loss

vitamin D- increases calcium absorption from GI tract

Question 20

what is urinary incontinence? is it part of aging?

Answer 20

unintentional leakage of urine at inappropriate times; not a normal change of aging

Question 21

what are the two most prevalent subgroups of incontinence?

Answer 21

nursing home residents and homebound elderly persons (about 50% for both)

Question 22

what are seven things that can cause acute incontinence?

Answer 22

DRRIIPP
drugs/delirium
retention of urine
restricted mobility
impaction
infection
polyuria
prostatism

Question 23

what are three types of chronic incontinence?

Answer 23

urge, stress, and overflow

Question 24

what is urge incontinence?

Answer 24

results from bladder contractions that overwhelm the ability of the cerebral centers to inhibit them

Question 25

what is stress incontinence?

Answer 25

malfunction of the urethral sphincter that causes urine to leak from the bladder when intra-abdominal pressure increases

Question 26

what is overflow incontinence?

Answer 26

urine retention with bladder distention: urine accumulates until max bladder capacity is reached, then urine leaks through urethra and causes dribbling

Question 27

treatment options for osteoporosis? (5)

Answer 27

behavior treatments, kegel exercises, medication, pessary, surgery

Question 28

what is polypharmacy?

Answer 28

concurrent use of 5 or more drugs

Question 29

__% of people over 75 years old take four or more meds

Answer 29

36%

Question 30

long term care team patients are on an average of ____ meds

Answer 30

seven

Question 31

what is the beer’s criteria

Answer 31

this is a list of meds that should be avoided in older adults

Question 32

NSAIDS cause what disease? which leads to what meds in elderly?

Answer 32

NSAIDS - HTN - BP meds

Question 33

decongestants leads to what condition? which leads to what?

Answer 33

decongestant - urinary retention - more meds

Question 34

CCB used for BP management can lead to what?

Answer 34

constipation, which can cause a pt to need a laxative

Question 35

HCTZ used for BP management can lead to what?

Answer 35

gout, which can lead to more treatment

Question 36

what can the drug metoclopramide lead to?

Answer 36

parkinsonism

Question 37

what are some negative outcomes of polypharmacy? (7)

Answer 37

non adherence, ADRs, DDI, increased risk of hospitalization, medication errors, cost, potentially inappropriate medications

Question 38

three main infections in geriatric patients?

Answer 38

pneumonia, UTI, C diff

Question 39

most common signs of UTI in elderly?

Answer 39

burning when peeing or abdominal pain (before mental status changes)

Question 40

people who are on what drug for a long period of time are more prone to getting C dif?

Answer 40

PPIs

Question 41

what are two first line meds for C dif?

Answer 41

vancomycin or flagyl