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D120 > Geriatrics > Flashcards

Geriatrics Flashcards

1
Q

AGING GAMES memonic

A

Audiovisual
Gait / mobility
Insomnia
GI

GU
Assistance and ADLS, Adv. Directive
Mood and Memory
Environment and Everyday
Sexuality

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2
Q

Six categories of Basic Daily Living

A

Bathing
Toileting
Transferring
Dressing
Continence
Feeding

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3
Q

Geriatric Syndromes

A

multifactorial conditions that involve the interaction between age related risk factors, chronic disease, and functional stressors

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4
Q

Frequency of assessing physical function in older adults

A

Every visit whether it is a initial visit, annual visit, or episodic (illness) visit

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5
Q

Katz Independence in Activities of Daily Living Scale

A

most commonly used tool for assessing basic function in the home / clinical environment. Six item score list, four or less is moderate impairment, two or less is severe impairment

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6
Q

Three questions about falls to ask every time

A

Have you fallen in the past month, months, or year?
Do you feel unsteady when standing or walking?
Do you worry about falling?

A yes to any = increased fall risk

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7
Q

TUG Test

A

Timed Up and Go
Stand from seated position, walk 10 feet, turn, walk back, sit back down.
More than 12 seconds = need to further evaluate

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8
Q

Additional Balance Tests

A

30 second Chair Stand Test - Cross arms and stand up, sit down, repeat
4 Stage Balance Test
Reach Test

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9
Q

Falls in Elderly

A

Leading cause of injury related death in 65+

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10
Q

Comprehensive geriatric assessment domains

A

Functional
Physical health
Cognition
Medications
Socioeconomic
Other (Adv directives, driving)

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11
Q

Common Screening Tools for Geriatric Patients

A

Hearing
Vision
Physical Function (BADLS.Katz, IADLs)
Gait / Balance
Cognition
Depression
Nutrition
Driving

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12
Q

Sarcopenia

A

loss of muscle mass and strength. Significant geriatric disorder and can mean loss of ADLs

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13
Q

When to screen for cognitive impairment specifically

A

If patient has a concern, family or caregivers report concerns, or if concerns are found during routine physical / exam

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14
Q

Depression in elderly

A

Often mistaken as normal grief
Many elderly do not seek help

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15
Q

Best means to detect cognitive impairment

A

Specialized screening tools

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16
Q

Embarrassing topics for elderly to disclose

A

Falling, incontinence, vision / hearing loss, cognitive impairments, depression / anxiety

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17
Q

How to elicit more truthful responses for difficult topics

A

Use standardized scoring tools, elicit information from family, structured assessment of all systems, frank and honest discussion with patients and allay thier concerns

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18
Q

Skin changes in aging

A

subcutaneous fat layer diminishes, resulting in less protection from injury

greater skin fragility, skin tears, bruises, senile purpura, blood vessels more vulnerable

Wrinkling, loss of elasticity, and environmental stresses over lifetime can result in dryness, liver spots, cancer, decreased skin strength

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19
Q

Skin disorders common in eldery

A

herpes zoster, PVD, cellulitis, atopic / contact dermatitis, psoriasis, skin cancer, infections, TENS

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20
Q

Nail changes in aging

A

normal aging nails can be thickened, yellowed, and have horizontal ridging

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21
Q

Nail warning signs

A

Brittle nails = hypothyroid

misshapen nails with clubbing (COPD), pitting (ppsoriasis), cuticle invasion (lichen planus), spoon-like appearance (anemia), splinter hemorrhage (endocarditis), or longitudinal ridge lines (melanoma)

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22
Q

Hearing changes in aging

A

Sensorineural loss is an expected aging change (presbycusis). Many patients do not use hearing aids even if they should.

Try having patient in quiet environment and read back

Bone Conduction > Air conduction = sensorineural loss (localizes to good ear on Weber)

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23
Q

Vision changes in aging

A

Presbyopia - decrease in lens elasticity causes less ability to accomodate for near objects.

Dry eyes are common in elderly

aging results in fewer nerve cells and rods so more light is needed to see

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24
Q

Macular Degeneration

A

Wet - leaky blood vessels grow under retina

Dry - Center of retina deteriorates

Loss of sharp ahead vision or dark spot / loss in center of visual field

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25
Q

Increase in ‘floaters’

A

increased floaters or cobweb-like visual sensation is concern for vitreous detachment

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26
Q

Glaucoma

A

Enlarging disc cuping with visual field loss or patchy blind spots (periphjeral then central)

Open Angle - slower onset

Closed Angle - rapid onset with significant IOP, eye pain, blurry vision, halos

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27
Q

Cataracts

A

cloudy area in lens of the eye. sensitivity to light, clouded or blurry vision, poor vision at night, halos, faded colors

28
Q

smell changes in aging

A

May be medication related or infection. There is some olfactory neuron loss with aging.

Dental caries, poorly fitted dentures, medication side effect, infection should be ruled out first then investigate further as loss of smell = safety issues

29
Q

taste changes in aging

A

Taste buds decrease with aging. May be medication related, endocrine, other GI / metabolic issues. Always investigate further and may be related to olfactory loss.

30
Q

throat changes in aging

A

Swallowing issues can emerge from poor dentition, dry mouth, diminished muscle mass, loss of elasticity

Men’s voice becomes higher pitched in again while women’s become lower pitched. Less ability to project voice or talk for long periods of time.

31
Q

cardiac changes in aging

A

Arteriosclerosis / atherosclerosis means the aorta and arteries become more rigid and less pliable. Result in increases in afterload and decreased left ventricle volume and resultant hypertrophy.

Elderly are also less responsive to beta adrenergic or parasympathetic stimulation (prone to decompensate)

32
Q

GI changes in aging

A

Dry mouth can lead to inadequate salvia for amylase and swallowing

esophageal strictures or motility disorders can affect GI tract movements

Gastric atrophy is common which results in less hydrochloric acid and malabsorption

Live P450 affects some medication clearance

33
Q

Constipation

A

Poor water intake, lack of exercise, poor fiber intake, and some medical illnesses can lead to constipation.

Overuse of laxatives is a common issue

34
Q

Renal changes in aging

A

Many diseases can affect renal function over time, but aging itself does involve decreased functional nephrons.

Higher doses of vitamin D are needed as well as some elderly may have glucose in the urine due to decreased glucose reabsorption in the renal

35
Q

GU changes in aging

A

urinary incontinence include urge incontinence, stress incontinence, functional incontinence, overflow incontinence, and mixed (a combination of stress and urge) incontinence

Women’s urethra shortens with age making UTI more common, esp. asymptomatic

Nocturia is a common complaint

36
Q

UTIs in the elderly

A

In women the change in perineal flora along with shortened urethra may be contributor

Many elderly do not have the typical UTI symptoms, always suspect UTI in elderly with a cognitive/functional change, change in oral intake, or fever along with or without the classic symptoms

37
Q

Musculoskeletal changes in aging

A

loss of muscle mass, stiffness in joints, decreased range of motion. Osteoarthritis can occur (especially weight bearing joints)

38
Q

OA v RA

A

Osteoarthritis - Bouchard and Herbden Nodes, often assymetrical

Rheumatoid - symmetrical, fever, fatigue

39
Q

aging and anxiety

A

Elderly may be anxious about health, finances, family, death . dying. Most elders with anxiety have general anxiety disorder. There is a high rate of self-medication with alcohol or drugs. The GAD-7 is useful tool.

Older adults are more vulnerable to serotonergic effects - use lowest dose and escalate slowly.

Buspirone may be helpful

40
Q

aging and depression

A

High rate of depression (50%, 75% in assisted living).

Consequences of depression is cognitive decline, functional decline, increased morbidity

Somatic complaints about constipation or urinary issues are more often reported than direct complains of depression like moods

41
Q

mild cognitive impairment

A

Prodromal dementia. Often reported by family.

Amnestic MCI - memory issues, strong association with alzheimer progression

Nonamnestic MCI - issues with planning, judgements

42
Q

dementia

A

Intellectual dysfunction and behavioral changes

Cognitive loss in one domain, and often more than one and it progresses over time.

43
Q

delirium

A

Acute behavioral change assocaited with alcohol, anesthesia, illness, medication, metabolic issue. Often mistaken for dementia or worsening of dementia.

Acute and transient, often different than any underlying dementia.

Use a screening tool like the CAM

44
Q

sleep disorders

A

NREM decreases resulting in more awakenings at night

Avoid medications for sleep due to the side effects

45
Q

delirium v. dementia

A

Delirium is acute and transient. The behavior changes will be different than the ones of an underlying dementia

Dementia is chronic.

46
Q

pathological process of psych issues in aging

A

Older adults can be vague about symptoms, and many comorbid conditions or mediation effects

Porous changes in the blood-brain barrier can result in increased drug sensitivity (e.g., benzodiazepines, opioids) and other side effects. There can also be less coordination throughout the brain potentially causing cognitive dysfunction and decreased hormones

47
Q

Polymyalgia rheumatica

A

related to giant cell arteritis

aching in neck, hips, shoulder; fever and letharghy may occur.

Related to inflammation of the vessels

48
Q

Temporal arteritis

A

New headache with tenderness in the temporal artery area. May also have jaw pain, visual symptoms. Needs referral for biopsy and immediate corticosteroids

49
Q

BEERS Guide

A

Tool to assist providers in medication safety in older adults. Details risks of medications in older adults.

These drugs should be avoided or have doses adjusted

50
Q

Top 5 health issues in older adults

A

arthritis pain, heart disease, cancer, asthma / COPD, Alzheimers

51
Q

Irrational polypharmacy

A

occurs when health care providers forget to consider the pharmacodynamic and pharmacokinetic implications for patients taking multiple medications and neglect routine assessment for the continued need of so many medications

52
Q

Safe Prescribing Principles for Geriatrics

A

Always check a GFR

Blood brain barrier and other neuro changes can increase effects of sedatives

Anticholinergics can have higher ADRs

Half-life may be longer, so “Start Low and Go Slow” is good slogan except for antibiotics

53
Q

Pharmacokinetic changes in Aging

A

Drug distribution is affected by lower serum albumin and decreased lean muscle mass, Higher body fat means some drugs can accumulate, hydrophilic drugs need higher doses because of lower body water.

The CYP450 system may be impaired, first pass effect can be reduced

Decreased renal function may affect drug elimination

54
Q

Geriatric Specific Prescribing Concerns

A

Health literacy, cost, polypharmacy, drug interactions

55
Q

Drug Safety Tips

A

A new symptom in an older adult should be suspected as a drug-drug reaction until proven otherwise

Medication reconciliation at every visit

Routine liver and renal function tests

Simplify prescriptions and consider non-drug treatment options

Avoid half pills

Consider patient’s ability pay for medication, take the medication, and understandings of the need for medication

56
Q

ADR

A

Adverse Drug Reaction can cause harm even if dose was in a safe range. Older adults are at higher risk for ADR, and bleeding, confusion, falls, hallucinations, malnutrition, renal failure are red flags

57
Q

Holistic and Mindful Approach to Geriatric Prescribing

A

Try to decrease or discontinue one nonessential medication each visit and discuss plan for deprescribing another.

58
Q

POLST Program

A

Physician Order for Life Sustaining Treatment or now a Portable Medical Order. These are medical orders EMS can follow while advance directives are legal documents to develop care plans.

For patients at risk for life-threatening clinical event due to their life-limited medical condition. Communicates a patient’s treatment preferences as they transition care or travel, specifies the type of treatments they elect or decline to receive.

59
Q

POLST vs DNR/ADV Directive

A

POLST is medical orders and can specify orders to be carried out while DNR is a legal document that applies in arrest. Advance directives or HCPA identifies a surrogate decision maker. POLST generally can only be completed by a patient with a serious life-limiting medical condition.

60
Q

Advanced Care Plan

A

Two components - living will specifies treatment plans, and the surrogate decision maker (health care proxy)

61
Q

Decision making capacity

A
  1. must understand the information presented and state a treatment choice
  2. Appreciate their situation and consequences of decisions
  3. Understand the treatment options
  4. Voice their decision
62
Q

3 types of moral dilemma

A

Moral uncertainty - Patient wishes go against clinician morals
Moral Dilemma - two or more options that are morally / ethically correct
Moral Distress - personal morals / ethics go against institutional rules

63
Q

Palliative v. Hospice

A

Major difference is that palliative care patients may still receive curative treatment and there is no 6-month or less life expectancy requirement

64
Q

Who is eligible for Hospice

A

Eligibility set by Medicare based on prognosis of 6 months or less. Must elect to enroll into hospice care for the terminal illness.

65
Q

Services included in Hospice

A

Everything related to the care for the terminal illness including a hospice doctor and on-call 24/7 RN or Doctor. May be eligible for in-home or in-facility hospice care. All medicare beneficiaries can get a hospice consultation for free, even if they choose not to proceed.

Respite care is also available to provide your usual caregiver with a temporary break.

Treatments and such for other illnesses are not included.

66
Q

When should families be involved in Advanced Care Directives?

A

As soon as possible, they should be involved in making ACP and PLOST. Ideally family should be involved during any stage of health or disease at any age.

D120 (14 decks)

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