GERI-Assess Flashcards
(54 cards)
What are the goals in geriatrics?
- measure, preserve and nurture their functional status
- maintaining quality of life
- recognize decline-cognition, mobility
What are some key points to make sure we don’t miss in the geriatric assessment?
- KEY; observation, ROS , medications
- problem lists are invaluable
- caregivers & situation: do they live alone, do they live with family, etc.
What are some unique barriers to the care of the elderly?
- beliefs about “normal” symptoms of aging –> what we think is normal and what someone else thinks might be different
- access to care- harder in the elderly
- denial, fear, past experience
- cultural barriers
- western medicine doesn’t “let people be”
- it takes a long time for both
- multiple medical diagnoses, issues
What are some reasons why the elderly may present differently?
Altered central processing:
- cellular aging
- pre-existing brain dz (dementia)
- current illness affecting brain function Neuronal degeneration
- reduced muscle strength, balance
- reduced peripheral sensitivity
What are some very significant symptoms you should not miss in an elderly person?
- confusion
- fatigue
- loss of appetite
How else might an elderly pt present differently than we would expect?
they present with vague, non-specific symptoms: -“i’m worn out”, “i feel weak, dizzy”,
- sx’s may be delayed or absent,
- sx appear abruptly or rapidly over a few days, physical, psychological, behavioral
What is something that is ALWAYS significant in an elderly pt, especially when told to you by a family member that has close contact with them?
they’re “not acting right”
How might an elderly pt with infection present differently than expected?
- delirium, altered mental status
- fever, leukocytosis may be absent
What should you think of first when your elderly pt present with some kind of infection?
urinary tract infection! *both men and women
How might an elderly pt with acute/surgical abdomen present differently than expected?
- minimal abdominal complaints
- change in mental status
- stops eating/drinking
How might an elderly pt with acute MI present differently than expected?
-MC ***SOB
-fatigue, weak, dizzy,
epigastric pain
How might an elderly pt with depression present differently than expected?
-confusion, isolation, weight loss
What are some disease states that are common in elderly pts that might mimic depression?
EtOH abuse,
vitamin deficiency,
anemia
How might an elderly pt experiencing abuse present differently than expected?
- delayed presentation, often cannot transport self to office/hospital, MC- fear care would change, may have to go to SNF
- neglect, wounds, fractures
What are the important assessment components for an elderly pt?
ADL's, IADL's physical ability/mobility cognition, memory falls vision, hearing incontinence nutrition depression, emotional state alone vs social/familial resources safety, transportation preferences, values advanced directives safety exercise sexual activity/issues tobacco/EtOH/drugs
How can pre-appointment questionnaires help you with an assessment of an elderly pt?
-save time!!! -can address function, nutrition, cognition, depression, advance care planning
What are important things to not forget in PMH during assessment of an elderly pt?
- get old medical records if you can
- specialists, recent labs, hospitalizations
- BE FAMILIAR with someone’s PMH!!! Look at their problem list, address
What are some important things to gather about medications during assessment of an elderly pt?
-have them bring all their meds to their appointment
-drug and dosage errors/interactions
-goal = minimum possible
organize, label, discard old bottles
-verifying pts understanding of how to take, what to avoid
What are some important things to keep in mind when conducting your interview with an elderly pt?
-adequate time; review old records, questionnaires,
-may undress after history,
-pace of questions, volume of your voice, manners, face the pt, get hx from pt and caregiver.
Balance listening, effecity, time. HOLD PLACE
What are some important ROS topics to not miss in your elderly pt?
- sleep, weight, appetite
- skin, sores
- vision, hearing, teeth, swallowing
- SOB, chest pain, palpitations
- abd pain, digestion, changes in stool -urinary sx’s and bladder function
- syncope, weakness -depression, mood changes
What are the basic activities of daily living (ADLs?)
bathing dressing toileting transferring (in-out of bed/chair) continence (bladder, bowel) eating
What are the instrumental activities of daily living (IADLs)?
use the telephone
public transportation do grocery shopping prepare meals handle own medications
handle finances
do housekeeping, laundry
Who should you ask about falls?
EVERYONE!, S: symptoms - before/after P: previous falls L: location A: activity T: time of day T: trauma
What is something you should have your pts try before prescribing them a pill?
behavior changes!
