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CCFP > Elderly > Flashcards

Elderly Flashcards

1
Q

Psychosocial things to discuss w/ elderly

A

Safety
Driving Ability
Power of Attorney/Wills
End of Life Care
Caregiver Support
Family Education
Living Arrangements
Financial Responsibility

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2
Q

Beers criteria

A

List of meds not appropriate for elderlyHypotension: BP meds, alpha-adrenergic blockers
Over sedation: opioids, benzos, antihistamines
Impaired postural reflexes: anti-convulsants
Parkinsonism: CCB, antiemetics, APs, SSRIs
Complicating: PPI (increased # risk), antithrombotics, diuretics, laxatives

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3
Q

RF for falls

A

Previous fall
Advanced age
Meds (psychotropics, sedatives, antidepressants)
Functional decline
Risk taking behaviours, impulsivity, inappropriate footwear, dehydration
Environment: stairs, home hazards, poor lighting, lack of handrails, obstacles
Medical: weakness, gait difficulties, visual impairment, incontinence, stiffness, pain, depression
Cardio: arrhythmia, postural hypotension, AS, HF, PAD
Neuro: delirium, dementia, MS, Parkinson’s, vertigo
Sensory: hearing or visual impairment
MSK: cervical spondylosis, gout, lumbar stenosis, muscle atrophy, OP, arthritis
Metabolic: DM, thyroid, obesity, low B12, hepatic encephalopathy
MH: MDD, SUD
Sleep: OSA

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4
Q

What to do on physical exam for elderly

A

Postural vitals
Cardiac exam
Eye exam
Neuro
MSK
Gait
Cognition/ mood

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5
Q

Ix for elderly

A

CBC, lytes, B12, BG, TSH, Cr, BUN
BMD

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6
Q

Management of elderly pts in hospital

A

Vit D 700 IU/ day
Bowel protocol
Compression stockings
OT, PT, RD, optometry, podiatry

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7
Q

Screening for falls

A

Have you fallen? How many times? Were you injured?
Do you ever feel unsteady?
Do you worry about falling?

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8
Q

Risk assessment areas for falls

A

Medications
Medical conditions
Mobility
Home environment
OP review

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9
Q

Description of gait disturbances: arthralgic, peripheral sensory, vestibular, spastic, cerebellar, parkisonism, frontal, subcortical

A

Arthralgia = antalgic
Peripheral sensory = high step gait
Vestibular = drunken
Spastic/ hemiplegic = scissor
Cerebellar ataxia = uncoordinated
Parkinsonism = shuffling
Frontal = lower half parkinsonism, upper half normal
Subcortical = cautious gait

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10
Q

Management of elderly in office

A

Avoid polypharmacy
Periodically review meds - monitor for interactions + SE
Enquire about OTC meds
Screen for modifiable RF e.g. visual changes, impaired hearing
Assess functional status + ensure good social support

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11
Q

Types of incontinence

A

Stress Incontinence
Urge Incontinence
Mixed Incontinence
Overflow Incontinence
Functional Incontinence
Total Incontinence

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12
Q

RF for incontinence

A

Advanced Age
Multiple Pregnancies
Obesity
Smoking
Post Menopausal
Pelvic Surgery
Genital Prolapse
Cognitive Impairment
Chronic Coughing (COPD)
Neurological Conditions (MS, Stroke etc.)
Constipation
Vaginal Deliveries

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13
Q

Ix for incontinence

A

Urinalysis
Urine Culture & Sensitivity
Creatinine
Pelvic Ultrasound (+/- Post Void Residuals)
Urodynamic Studies

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14
Q

Rx for urge vs stress incontinence, and lifestyle measures for both

A

Lifestyle:
- lose weight
- stop smoking
- reduce caffeine + alcohol

Stress:
- pessaries
- duloxetine (SNRI)
- surgery (mid urethral sling)
- botox injections

Urge:
- bladder training
- mirabegron (beta 3 adrenergic agonist)
- oxybutynin (antimuscarinic)

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15
Q

Causes of incontinence

A

Delirium
Infection
Atrophic Vaginitis
Pharmaceuticals
Psychological
Excessive Urinary Output
Reduced Mobility
Stool Impaction

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16
Q

Geriatric giants - who to ask about?

A

frailty, sarcopenia, anorexia of aging, cognitive impairment, falls, hip fractures, depression, dementia, delirium, immobility, instability, incontinence

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17
Q

Risks in elderly?

A

RISKS - roaming, imminent danger (fire, falls), self neglect/ suicide, kinship (abuse, supports), safe driving, substance use

18
Q

CFP frail elderly checklist

A

cognition, mobility, ulcers, pain, med review, rx monitoring

19
Q

ADLs

A

DEATH - dressing, eating, ambulating, toilet, hygiene

20
Q

iADLs

A

SHAFT - shopping, housework, accounting, food + meds, telephone/ transportation

21
Q

5 ways to improve function in eldrely

A

hearing aid, dentures, glasses, walker/ wheelchair, refer to SW/ OT

22
Q

What to look at in a med review?

A

SE, are they appropriate, interacting w/ each other

23
Q

What meds to deprescribe in elderly?

A

Benzos for insomnia, APs for insomnia or dementia (taper if >3mos or ineffective)

24
Q

Guidelines for alcohol in elderly

A

age >65, women 1 SD/d, no more than 5/wk. Men 1-2 SD/d, no more than 7/wk

25
Q

Advice for alcohol in elderly

A

non-drinking day every wk, chronic heavy drinkers - give thiamine 50mg daily, pre-op taper

26
Q

How to manage neglect in elderly

A

optimize community assistance, identify alternative caregivers, consider respite/ day home

27
Q

How to manage verbal abuse in elderly

A

SW, assess MH + SU, address caregiver burden

28
Q

How to manage financial abuse in elderly

A

stop loss ASAP, consider power of attorney, alert banks, police, SW

29
Q

How to manage sexual or physical abuse in elderly

A

evaluate, treat, document, refer to police, consider shelter, emphasize safety plan

30
Q

Definition of wt loss in elderly

A

reduction >5% body wt over 1 month or >10% in 6mo

31
Q

Modifiable causes of wt loss in elderly

A

STOP WEIGHT LOSS =
Side effects of meds
treatment effects (chemo)
other med dx (CHF)
pain

wandering (dementia)
emotional problems (depression)
impaired function (can’t feed self)
GI dz (malabsorption d/t celiac)
hyperthyroidism
texture of food

loss of appetite
oral health
swallowing disorder
social issues (poverty)

32
Q

What CK level is diagnostic for rhabdo?

A

> 5000

33
Q

Rx for rhabdo

A

fluids, rest x72 hrs, exercise restriction

34
Q

Approach to altered MS

A

DIMS - drugs, infection/ inflammation, metabolic + endocrine, environmental, retention, structural

35
Q

Pneumonia vaccines

A

PCV 13 + PPSV23 + PPSV23 booster 5 yrs later - PPSV23 for people w/ comorbidities

36
Q

Pts at risk of PNA that need vax

A

asthma, alcoholism, chronic liver dz, chronic lung dz, neuromuscular disorders, RA, Crohns, lupus, smokers

37
Q

Pts at HIGH risk of PNA that need vax

A

CKD, cochlear implant, congenital immunodeficiency, dz of WBC, functional asplenia, HIV, immunosuppressant drugs

38
Q

RF for hearing loss

A

male, age, light skin, noise exposure

39
Q

Gold standard for hearing test

A

pure tone audiogram

40
Q

Reasons to refer hearing loss

A

asymmetric, sudden, otitis media, vertigo

CCFP (67 decks)

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