Geriatrics Flashcards
What is frailty?
Age related syndrome of physiological decline characterized by marked vulnerability to adverse health outcomes
5 indicates of frailty
- weight loss 4-5kg
- Exhaustion and fatigue
- Low activity
- Weakness or low grip strength
- Slowness or slowed gait speed
Fragility index score
70 clinical deficit questions. Presence of 25 or more —> .025 (10 present/40 considered).
What is the comprehensive geriatric assessment tool
Multidimensional and multidisplinary diagnostic and therapeutic process conducted to determine the medical, mental, and functional problems of older adults with frailty
1. Develop a coordinated plan to maximize overall health with aging
Major components of geriatric assessments
- Functional capacity
- Fall risk
- Cognition
- Mood
- Poly pharmacy
- Social support
- Financial concerns
- Goals of care
- Financial planning.
Wat gender and ethnicity to live linger
Women änd white
Definition of aging
progressive decline and deterioration of functional properties at the cellular, tissue, and organ level that lead to a loss of homeostasis, decreased ability to adapt to internal or external stimuli, and increased vulnerability to disease and mortality.
Metric for aging for clinical decision making?
Physiological age, and not chronological age
Genetic Variations linked with Alzheimer’s disease
APOE, the most common Alzheimer disease risk gene.
(Apolipoprotein)
& protocadherin 11 X-linked (PCDH11X)
Cardiovascular changes with aging.
Increased:
left ventricular wall thickness
lipofuscin and fat deposits
ventricular stiffness
Decreased:
maximum heart rate
heart rate variability
responsiveness to receptor-mediated agents
Decreased:
cardiac output and vascular compensation in orthostasis, sepsis, etc
Digestive changes with aging
Increased:
dysphagia
achlorhydria
lipofuscin and fat deposition in pancreas
mucosal cell atrophy
Altered intestinal absorption
Decreased:
iron, B12 and calcium absorption
Age changes with ears
Increased:
conductive deafness (low-frequency sounds)
sensorineural hearing loss (high-frequency sounds)
Decreased:
detection of gravity, changes in speed, and rotation
Age changes with eyes
Decreased:
transparency of the cornea
accommodation and dark adaptation
Difficulty in focusing on near objects
Endocrine changes with age
atrophy of certain glands (eg, pituitary, thyroid, thymus)
parathyroid hormone, atrial natriuretic peptide, norepinephrine, baseline cortisol, erythropoietin
Decreased:
growth hormone, dehydroepiandrosterone, testosterone, estrogen
Changes in target organ response, organ system homeostasis, response to stress, functional capacity
Age changes with immune system
Increased:
autoimmune syndromes
monoclonal gammopathies
reactivation of latent infections
systemic chronic inflammation
Decreased:
vaccine responses
fever response to infection
response to new pathogens
T lymphocytes, natural killer cells, cytokines needed for growth and maturation of B cells
Age changes with muscle
Decreased:
muscle mass
tone and contractility
strength
Biomarker: grip strength
age changes with nervous system
Decreased:
muscle innervation
fine motor contro
Age changes with skin
Decrease elasticity - delayed skin tugor
Age changes in renal system
Decreased:
concentrating ability of kidney
renal clearance of drugs, toxins
ability to resorb glucose
The brain commonly shows volume loss, microvascular changes in white matter, reduced cerebral blood flow, increased permeability of the blood-brain barrier, reduced glucose uptake and utilization, and accumulation of amyloid plaques.
What is most common causes of mobility, functional decline in older adults
Sarcopenia, the geriatric syndrome of reduced skeletal muscle mass and strength, is one of the most important causes of mobility decline, functional decline, and loss of independence in older adults.
Bone mass (or density) is lost with aging, especially in women after menopause, and bones become more brittle.
What is presbycusis
Significant age-associated hearing loss is termed presbycusis
Selection, Optimization, and Compensation model (SOC)?
As individuals age, and realize that their resources, including both cognitive and physical energy, may be limited, they adapt by selecting what is important, optimizing function, and compensating as needed so that desired activities can still be enjoyed.
Example:: enjoy gardening, but have difficulty kneeling or standing outside for long periods of time, can compensate by taking more breaks or working in shorter blocks of time, by reducing the size of the garden, or by moving some gardening indoor
Four guiding ethical principles of American medical practice
respect for autonomy, nonmaleficence, beneficence, and justice.
What is beneficence
Doing good to someone
What is nonmalfience
Doing no harm
How to determine medical capacity
What is your main medical problem right now?
What treatment has been recommended?
If you receive this treatment, what will happen?
If you don’t receive this treatment, what will happen?
Why have you decided to/not to receive this treatment?
Doctrine of double effect
Under this doctrine, if a procedure has both potentially good and bad effects, it can be justified if the action itself is good, if the intent is for the good effect, and if the good effect is not achieved through the bad effect.
The double effect would ethically justify prescribing large doses of opioids if the clinician’s primary intent was for patient comfort and if suppressing respiration was not essential to provide comfort.
substituted judgment standard versus best interest standard,
- Knows patient wishes and fulfills them
- Doesn’t know wish and makes best decision in interest of patient
Medicare Part A
inpatient hospital, subacute skilled-nursing home, home health, and hospice services.
Medicare Part B
covers physicians, nurse practitioners, social workers, psychologists, therapists, laboratory tests, home health services, and durable medical equipment.
Medicare Part D
covers some of the cost of prescription medications.
Medicaid
is a joint federal and state program that provides health insurance to people of all ages who have low incomes and limited savings. Medicaid will pay for long-term custodial care in nursing homes for patients who reach a “spend down” threshold.
Veterans eligible for care from the Veterans Administration health system receive comprehensive care benefits that cover inpatient, outpatient, and pharmacy needs. Receipt of veteran care benefits does not preclude veterans from receiving Medicare or Medicaid benefits if otherwise eligible.
Medicare c
Part A and B services delivered through private managed care plans
Additional services (eg, vision, dental, wellness) may be included
Prescription drug coverage may be included
MA plans (eg, HMOs [most common], PPOs, POS, PFFS, PSO, SNP, MSA)
What is Medicare
is a federal insurance program run by CMS, which pays health professionals and organizations to provide health care for Americans who are ≥65 years old, disabled, or have end-stage renal disease. A
Who is eligible for Medicare A & B
Older Americans (and their spouses) who have had Medicare taxes deducted from their paychecks for at least 10 years are entitled to coverage through Part A without paying premiums. Others may be able to purchase Part A coverage, for up to $458 per month in 2020 depending on how long Medicare taxes were deducted from their paychecks.
Medicare Part B uses other regional insurance companies (“carriers”) to pay physicians, nurse practitioners, social workers, psychologists, rehabilitation therapists, home-care agencies, ambulances, outpatient facilities, laboratory and imaging facilities, and suppliers of durable medical equipment for the Medicare-covered goods and services they provide.
At age 65, older adults become eligible for Part B coverage if they are entitled to Part A coverage and if they are citizens or permanent residents of the US. To obtain this coverage, eligible older adults must enroll in Part B and pay premiums, usually by agreeing to have these amounts deducted from their monthly Social Security checks.