Geriatric

Question 1

Intro

• May have _____ or _____ impairment
• Difficulty s_____
• May be ____ to present symptoms, afraid, avoid ____, don’t want to lose _____ or hear anything potentially ___ diagnosis or tx
• Turn ___ TV, radio, make sure they have their g____, hearing ___

Answer 1

• hearing, visual
• speaking
• embarassed, expenses, independence, bad
• off, glasses, aides

Question 2

Normal Physiological Changes

• ______ in SBP
  
  • Aorta and large arteries around the heart become ____ - increase in SBP
  • _____ pulse _____
  • Diastolic BP typically stops rising around ___
• _____/_____ hypotension
• Decline in _____ cells (start to degenerate) of the ___ node leading to dys_____/____cardia

Answer 2

• Increase
  
  • stiff
  • widened pulse pressure
  • 60
• Postural/Orthostatic
• pacemaker, SA, dysrhythmias, bradycardia

Question 3

Normal Physiological Changes

• Loss of skin _____
  
  • Presence of a_____ p____ -well _____, purple ____. Can last for several _____. Blood _____ into the dermis from weak _____.
• Nails y_____ and t_____
• Hair _____, r_____, g_____
  
  • Women may develop ____ facial hairs

Answer 3

• elasticity
  
  • actinic purpura - demarcated, macule, weeks, leaking, capillaries
• yellow, thick
• thins, recedes, gray
  
  • course

Question 4

Normal Physiological Changes

• Eyes/P______
  
  • ___ loses elasticity, eye unable to ______ and focus on ___ objects
  • Changes persist leading to (3)
• Lens loses elasticity -> impairs passage of ____ to ______ so trouble accommodating and focus on near objects
• Ophthalmoscope, fundi cannot have light ____ as well, arteries can look _____ or p___, s_____ or d_____, less _____ to them
• Less ____ leading to ___ eyes

Answer 4

• Presbyopia
  
  • lens, accomodate, near
  • cataracts, glaucoma, macular degeneration
• light, retina
• reflection, narrower, pale, straighter, duller, resonance
• secretions, dry

Question 5

Hearing

• Hearing/P______ (starge after age ___)
  
  • First loss of ____ pitched sounds, then progresses to middle and lower ranges
  • Difficulty hearing in ____ places, unable to distinguish sounds
  • Do not _____ , speak in ___ tones, slowly, and clearly
    *

Answer 5

• Presbycusis, 50
  
  • high
  • noisy
  • Shout, low

Question 6

Mouth and Lungs w Aging

• Mouth
  
  • Decrease in salivary _____, ___ mouth, diminished _____
• Lungs
  
  • Chest wall _____, respiratory muscles may _____, lungs lose some elastic _____
  • Decreased capacity to ______

Answer 6

• Mouth
  
  • secretions, dry, taste
• Lungs
  
  • stiffens, weaken, recoil
  • exercise

Question 7

Cardiovascular and PVD w Aging

• Cardiovascular
  
  • Cardiac output ____ dt blunted responsiveness to __-____ stimulation
    
    • HR ____, but stroke volume _____ to maintain CO
  • Cardiac _____: most murmurs in young ppl are ____, but older have ____ murmurs
    
    • Aging thickens the bases of the valve ____ with _____ tissue
    • _____ of valve leaflets can occur, as this progresses the valve leaflets become less _____ and can impair blood flow ex) aortic _____
• PVD
  
  • develops dt _______ plaque

Answer 7

• CV
  
  • decreases, B-adrenergic
    
    • drops, increases
  • murmur, innocent, pathologic
    
    • leaflets, fibrous
    • Calcification, mobile, stenosis
• PVD
  
  • athersclerotic

Question 8

Breast/Axilla w Aging

• ______ tissue atrophies and is replaced by ___
• Breast becomes pendulous/______
• Decrease in _____ hair

Answer 8

• Glandular, fat
• flaccid
• axillary

Question 9

Abdomen w Aging

• ___ accumulates in the ____ abdomen near the ____, even with stable weight, along with weakening of the abdominal _____
• Leading to a more s___ p_____ abdomen

Answer 9

• Fat, lower, hips, muscles
• soft, protruding

Question 10

Genitalia Men and Women w Aging

• Genitalia Men
  
  • _____ sexual interest
    
    • But ______ lvls decline -> effects libido and sexual function -> ED
  • Erectile _____
  • Enlarged _____
• Genitalia Women
  
  • Sexual interest ______
  • Diminished _____ function
  • Vaginal mucosa ____, it becomes pale and ___ with loss of _____, leading to _______ (painful sex)
  • Decrease in size of ___ and _____

Answer 10

• Genitalia Men
  
  • Continued
    
    • testosterone
  • Dysfunction
  • Prostate
• Genitalia Women
  
  • continued
  • ovarian
  • thins, dry, lubrication, dyspareunia
  • labia, clitoris

Question 11

MSK w Aging

• Loss of ____ dt interveterbal disk ____/shortening/even _____, also from what disease state _____
• Loss of ____ mass
  
  • First noticed on back of ____, as atrophy of interosseous muscles causes concavities or grooves
  • They ____!
  • Vertebral disks becoming thinner

Answer 11

• height, thinning, collapse, osteoporosis
• muscle
  
  • hands
  • shrink

Question 12

Nervous System w Aging

• Decrease in ____ volume and cortical brain _____
• Process and retrieves information ____
• Benign forgetfulness =
• ______ - older ppl surrounded by death
• Increased risk for d____/d____/d_____
• Benign essential tremor =
• ___ reflex diminished = risk for _______
• Diminished r_______

Answer 12

• brain, cells
• slower
• can retrace steps and eventually remember
• Depression
• depression, dementia, delirium
• hands, jaw, lip - are faster and dissappear with rest - NO rigidity compared to Parkinson’s
• Gag, aspiration
• reflexes

Question 13

Common Concerns

• Actitivities of ____ ____
• _____ ADL
• Acute and persistent _____
• N______
• F_____
• Advanced _____ and _____ care
• M____ -are they taking them correctly?
• A____/S_____

Answer 13

• Daily Living
• Instrumental
• pain
• Nutrition
• Frailty
• Directives, Palliative
• Meds
• Alcohol/Smoking

Question 14

Advanced Directives

(2)

• Before a living will can guide medical decision making - ___ physicians must certify
  
  • Patient is ____ to make medical decisions
  • Patient is in the medical condition specified in the living will law (such as “_____ illness” and “permanent ______”)
• A medical power of attorney (or healthcare proxy) =
• Who cannot honor living wills or medical powers of attorney?
• What is the MOLST document?

Answer 14

Living Will

Health Care Proxy

• 2
  
  • unable
  • “terminal”, “unconsciousness”
• allows an appointed person to make medical decisions on behalf of the patient
• EMT’s
• Unless in NYS they are provided an executed (Medical Orders for Life-Sustaining Treatment)
  
  • MOLST- physician or NP can have patient maintain their DNR/DNI status outside of hospital

Question 15

ADLs

Answer 15

• Bathing
• Dressing
• Toileting
• Transferring
• Continence
• Feeding

Question 16

IADLs

Answer 16

• Using the phone
• Shopping
• Cooking
• Housekeeping
• Laundry
• Transportation
• Taking medication
• Managing money

Question 17

Alcohol Screening CAGE

C =
A =

G =

E =

Each yes response = __ point

Score of > ___ clinically significant/need to refer to counseling

Answer 17

Have you felt you should CUT back on your drinking?

Have people ANNOYED you by criticizing your drinking?

Have you ever felt bad or GUILTY about your drinking?

Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hang-over - as an EYE OPENER?

1

2

Question 18

Frailty

• Can occur in the absence of _____
• Loss of ___ mass
• Decreased e____, _____ intolerance, physiologic ____
• Increased vulnerability to _____ - fires and emergencies
• What is the test for Frailty?

Answer 18

• disease
• muscle
• energy, exercise, reserve
• stressors
• Timed Up and Go Test

Question 19

Timed Up and Go Test

Answer 19

• Sit, walk 10 feet, come back and sit down
• if it takes > 12 seconds, risk for falls
• Used to measure correlation between balance and increased fall risk

Question 20

Fall Prevention/Screening

• Screen for high risk (___+)*
  
  • ___ fall past 12 months with abnormal ___ or balance
  • ___ or more falls in last 12 months
  • Presents with ___ fall/seeking medical ____ for fall
  • Difficulty with ___ and balance
• Institute Fall Prevention ______
• Assess cognition with the (2)
• Meds that put elderly at high risk for falls are?
• Functional assessment:
• Environmental assessment:

Answer 20

• 65+
  
  • 1, gait
  • 2
  • acute, attention
  • gait
• Evaluation
• Mini cog, Mini mental
• Anticoags -> ICH
• Timed Up and Go
• CDC Fall Kit (STEADI - Stopping Elderly Accidents, Deaths & Injuries) - toolkit for providers to use for geriatric pts - want to make sure they have proper tools, rollator, PT

Question 21

Medication Therapy and the Elderly

• ​​________ (multiple meds) brings on SE and interactions
• ________ due to financial factors (medicare cuts -pts may ____ their meds)
• Medication _____ are helpful sometimes have so many bottles of the same pill, help them organize by boxes, ziplocs
• Be aware of what other meds that are not FDA regulated, that can also have SE?

Answer 21

• polypharmacy
• noncompliance, ration
• boxes
• vitamin supplements

Question 22

Medications associated with Fall Risk

• Antia____
• Antih____
• Antihy____
• Antip____
• B____ and other sedative hypnotics
• D____
• D____
• L_____
• M _ _ _
• ____ relaxants
• N_____
• T_____ antidepressants
• V______

Answer 22

• Antiarrhythmics
• Antihistamines
• Antihiypertensives
• Antipsychotics
• Benzodiazepines
• Digoxin
• Diuretics
• Laxatives
• MAOI
• Muscle
• Narcotics
• Tricyclic
• Vasodilators

Question 23

Interventions for Fall Risk

• Minimize ______
• _____ program or _ _ - diagnosis of deconditioning
• Treat _____ issues such as cataracts
• Manage postural ______
• Manage heart ___ and ___ abdnormalities
• Supplement with Vitamin __ (bone health)
• Manage ____ and foot____ problems
• Modify the home _______
• Provide _______ information

Answer 23

• medication
• Exercise, PT
• vision
• hypotension
• rate, rhythm
• D
• foot, footwear
• environment
• educational

Question 24

Early Indicators of Acute Illness

• Change in _____ status***(Could be (2))
• F____
• D______
• Decreased ______
• Decreased ____ capacity
• Di_____
• In______

Answer 24

• mental (UTI/SEPSIS)
• Falls
• Dehydration
• appetite
• function
• Dizziness
• Incontinence

Question 25

**10 Min Geriatric Screener**

Answer 25

Question 26

**Depression** (V IMPORTANT TO SCREEN FOR) * Chronic, acute, or gradual * One of the most ____ and most \_\_\_\_\_/\_\_\_\_\_ impairment in the elderly * Ask about m\_\_\_\_ or sp\_\_\_\_\_ * _____ \_\_\_\_\_ in elderly are often successful

Answer 26

* common, undetected/untreated * mood, spirits * Suicide attempts

Question 27

**Mini-Cognitive Assessment Instrument** 1) Say: 2) Instruct pt to draw the face of a _____ with the numbers, then ask them to draw the ____ for a specific ____ *(more demented - #s will be on side/will fget numbers)* 3) Ask them to repeat the: Scoring * 1 point for: * dementia = * nondemented = * 1-2 words: classification based on clock * Abnormal = * Normal =

Answer 27

1. 3 words, repeat 2. clock, lines for a specific time 3. 3 words * each recalled word after clock drawing distractor * 0 words * 3 words * demented * nondemented

Question 28

**Mini-Mental Exam (Neurologists)** * Neurologists use this to assess \_\_\_\_\_\_\_ * Y\_\_\_\_\_, M\_\_\_\_\_, ____ are we, what ____ are we in? * 3 \_\_\_\_, have them repeat * Spell word \_\_\_\_\_, count back by \_\_ * What were the 3 objects? As the score gets lower -\> indicates more ____ impairment * 0-10 = * 25-30 =

Answer 28

* orientation * year, month, where, building * objects * backwards, 7's severe * severe * mild deficits

Question 29

**Delirium** * _____ onset * _____ course * Lasts h\_\_\_ to w\_\_\_\_ * _____ disrupted * Associated with i\_\_\_\_\_ or drug \_\_\_\_\_\_ * Disturbed level of \_\_\_\_\_\_\_ * A\_\_\_\_\_\_ or S\_\_\_\_\_\_ * Dis\_\_\_\_\_\_\_ _____ process * Disoriented mostly to \_\_\_\_\_\_

Answer 29

* Acute * Fluctuating * hours to weeks * Sleep * illness, toxicity * consciousness * Agitated, Somnolent * Disorganized thought * time * *Change in environment? New medication? Hospitalization?*

Question 30

**Dementia** * _______ onset * **\_\_\_\_\_\_\_** **progressing course** * Lasts _____ to \_\_\_\_ * _____ fragmented * Not usually associated with ______ or ____ except with Alzheimers * No change in ______ until late in disease * Normal to slow b\_\_\_\_\_ * Difficulty finding w\_\_\_\_\_ * Often flat or depressed \_\_\_\_\_

Answer 30

* Insidious * **Slowly** * months to years * Sleep * illness, drugs * consciousness * behavior * words * mood

Question 31

**Eight Warning Signs of Alzheimers** ## Footnote 1) Difficulty with _____ thinking - balancing checkbook 2) Dis\_\_\_\_\_\_\_ - forget where they are 3) Lack of ______ - become passive 4) Lack of ______ - gives large sums of money away 5) Loss of ______ - forget words and substitute 6) _____ things - watch in the sugar bowl 7) Rapid _____ changes - calm to tears to anger 8) ________ changes - suspicious, fearful * They have no recollection of what they did half an hour ago. ______ retrace their steps*

Answer 31

1) abstract 2) Disorientation 3) initiative 4) judgement 5) language 6) Misplaces 7) mood 8) personality * CANNOT*

Question 32

**Sexuality** **Myth:** * 53% of people between \_\_-\_\_ are sexually active * 25% of people between \_\_-\_\_ are sexually active * _________ system loses efficacy * Ph\_\_\_\_\_ changes/M\_\_\_\_\_ conditions * Outbreaks of ____ in skilled nursing facilities * 90+ year olds come request \_\_\_\_\_

Answer 32

* 65-75 * 75-85 * Reproductive * Physiologic/Medical * STIs * Viagra

Question 33

**Physical Exam** Focus on age specific issues such as * N\_\_\_\_\_ * V\_\_\_\_/H\_\_\_\_\_ * Fecal and urine \_\_\_\_\_\_ * ____ and ____ prevention * O\_\_\_\_\_ * \_\_\_-pharmacy

Answer 33

* Nutrition * Vision/Hearing * Incontinence * Balance, Fall * Osteoporosis * Poly-pharmacy

Question 34

**Focused Geriatric Physical Exam 1**

Answer 34

Question 35

**Focused Geriatric Physical Exam 2**

Answer 35

Question 36

**Focused Geriatric Exam 3**

Answer 36

Question 37

**Focused Geriatric Exam 4**

Answer 37

Question 38

**Immunizations** * **Influenza** **​** * **​**\_\_\_\_ adults * Adults with _____ illnesses * Adults who are immune-compromised (\_\_\_\_\_ vaccine) * **Pneumococcal PPSV 23** * **​**All adults \> \_\_\_ * \_\_-\_\_ with ____ condition * **Zoster Shingles** * **​**All aduts \>\_\_\_, _____ of exposure * Do not give with? * **Td** * **​**Every __ yrs \_\_\_\_\_ * If suffers a ____ and last Td \>\_\_ yrs * Tdap, ____ recorded Tdap or in contact with infant \< ___ months of age * Td series _____ of primary series

Answer 38

* **Influenza** * **​**All * chronic * inactivated * **PNA** * **​**\>65 * 19-64, chronic * **Zoster Shingles** * **​**\>60, regardless * Immune deficiency * **Td** * **​**10, booster * wound, 5 days * Never, 12 * unsure

Question 39

**Immunization** 1. PNA vaccine age \_\_\_+ 2. Herpes zoster shing vaccine \_\_\_+ 3. Tetanus shot booster every ___ years 4. PNA vaccine can be given in ____ with any COPD, RA, etc 5. Adults with immunodeficiency should not get ____ vaccine 6. If someone with a chronic illness gets a bad cut and its been over 5 years, they would get another \_\_\_\_ 7. \*\*Immunocompromised should get ____ Flu vaccine\*\*

Answer 39

1. 65 2. 60 3. 10 4. younger 5. zoster 6. Tdap 7. inactivated