Geriatrics Flashcards

Question

Four guiding ethical principles of American medical practice

Answer 1

respect for autonomy, nonmaleficence, beneficence, and justice.

Answer 2

Doing good to someone

Answer 3

Doing no harm

Answer 4

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?

Answer 5

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.

Answer 6

1. Knows patient wishes and fulfills them 2. Doesn’t know wish and makes best decision in interest of patient

Answer 7

inpatient hospital, subacute skilled-nursing home, home health, and hospice services.

Answer 8

covers physicians, nurse practitioners, social workers, psychologists, therapists, laboratory tests, home health services, and durable medical equipment.

Answer 9

covers some of the cost of prescription medications.

Answer 10

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.

Answer 11

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)

Answer 12

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

Answer 13

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.

Answer 14

Fill some of the holes in the insurance coverage provided by Medicare Parts A and B. Private insurance companies offer Medigap plans Within 6 months of their initial enrollment in Medicare Part B, beneficiaries are entitled to purchase any Medigap policy on the market at advertised prices. This is referred to as the Medigap open enrollment period and is the only open enrollment available for this coverage. After this period, Medigap insurers can refuse to insure individual beneficiaries or can charge them higher premiums because of their past or present health problems.

Answer 15

the ability to adapt to change and adversity and to recover from stressors—is a key concept in healthy aging and can be conceptualized across physical, psychological, and social domains.

Answer 16

Develop personal attributes, eg, vigor, optimism, physical robustness Improve socialization Strengthen self-efficacy, self-esteem, and motivation

Answer 17

oxidative stress, inflammation, and glucose and lipid dysregulation diabetes, midlife hypertension and obesity, depression, physical and cognitive inactivity, and smoki

Answer 18

Physical activity is the best studied intervention to prevent or slow functional decline, and engaging in regular physical activity is the most effective strategy we have to prevent loss of physical function in aging

Answer 19

Age & sedentary lifestyle

Answer 20

promoting health, preventing injury, and managing chronic conditions; 2) optimizing cognitive health; 3) optimizing physical health; 4) optimizing mental health; and 5) facilitating social engagement

Answer 21

1. Primary - Maintain healthful balanced nutrition, Avoid tobacco, Avoid recreational drugs or excess alcohol, Maintain sleep hygiene, Maintain ideal body weight.Practice oral hygiene, Manage stress, Engage in lifelong intellectual pursuits, Participate in enriching social activities 2. Secondary - Diabetes treatment, Ischemic heart disease treatment, Early detection of sensory impairment, Caregiver education Fall prevention programs, Osteoporosis screening and management, Dental examinations, Osteoarthritis management 3. Tertiary - Rehabilitation services, Use of adaptive equipment, Palliative care, Environmental modification, Elder abuse screening, Accessible family and social supports, Senior safety services

Answer 22

Multidimensional, multidisciplinary diagnostic and therapeutic process conducted to determine the medical, mental, and functional problems of older adults with frailty

Answer 23

brief performance-based screen can be accomplished by asking an older adult to read (using corrective lenses, if applicable) a short passage from a newspaper or magazine (SOE=C). Significant visual impairment can be confirmed through use of a Snellen chart or Jaeger card; visual acuity worse than 20/40 is the standard criteria for visual impairment. Referral to opthomology

Answer 24

Older adults who acknowledge hearing loss (in the absence of cerumen impaction) should be referred directly for formal audiometric testing. For those who deny hearing loss, further screening with the whisper-voice test is indicated (SOE=B). Inability to perceive a letter/number combination whispered at a distance of 2 feet is considered abnormal and warrants a discussion about referral for formal audiometric testing.

Answer 25

Unintentional weight loss of ≥5% in 6 months or a low BMI (<20 kg/m2) suggests poor nutrition and requires further evaluation (SOE=A).

Answer 26

a brief cognitive screen should be included in the assessment of all older adults, especially those ≥75 years old (SOE=C).

Answer 27

short-term memory loss is typically the first sign of dementia

Answer 28

single screening question is recall of 3 words after 1 minute. Or Mini-Cog: recall = 0 or recall <3 and abnormal clock drawing test

Answer 29

1. Montreal Cognitive Assessment (MoCA) or Saint Louis University Mental Status Examination (SLUMS). The MoCA, which also assesses concentration, language, and orientation, takes about 10 minutes to complete. The total possible score is 30 points; a score ≥26 is considered normal. The SLUMS takes about 7 minutes to complete. The total possible score is 30 points; a score ≥27 is considered normal. Regardless of the instrument used, the results of cognitive testing should be interpreted in the context of the patient’s educational attainment and literacy.

Answer 30

Screen with PHQ-2 Answers “Yes” to either of the following (PHQ-2): In the past month, have you often been bothered by: feeling down, depressed, or hopeless? having little interest or pleasure in doing things? Administer a validated depression scale, eg, 15-item Geriatric Depression Scale or 9-item Patient Health Questionnaire.

Answer 31

To identify patients with “preclinical” disability, ie, those who do not yet require personal assistance but who are at risk of becoming disabled, clinicians should ask about perceived difficulty with tasks and whether the individual has changed the way he or she completes a task because of a health-related problem or condition (SOE=A).

Answer 32

Basic ADLs (self-care) Bathing Dressing Transferring from bed to chair Toileting Grooming Feeding oneself

Answer 33

Using the telephone Preparing meals Managing household finances Taking medications Doing laundry Doing housework Shopping Managing transportation

Answer 34

usually precipitated by illness or injury. Most such new disability episodes lead to hospitalization - Most older adults who become newly disabled recover independent function within 6 months. And higher risk of disability

Answer 35

Annual screening for falls and fall risk is recommended because older adults may not spontaneously mention falls

Answer 36

he clinician should first ask the patient to stand from a seated position in a hard-backed chair while keeping his or her arms folded. Inability to complete this task suggests leg (quadriceps) weakness and is highly predictive of future disability (SOE=A). Once the person is standing, he or she should be observed walking back and forth over a short distance, ideally with the usual walking aid. Abnormalities of gait include path deviation; diminished step height or length, or both; trips, slips, or near falls; and difficulty with turning. The “Timed Up and Go” (TUG) test comprises the actions of rising from the chair, walking 10 feet (3 meters), turning around and returning to the chair, turning again, and then sitting back down in the chair. In individuals who take >12 sec, the risk of falls is increased, and further evaluation is required (SOE=B).

Answer 37

A gait speed of 0.8 meters/sec allows for independent ambulation in the community; a speed of 0.6 meters/sec allows for community activity without use of a wheelchair. These norms indicate that older adults who can walk 50 feet in an office hallway in ≤20 sec should be able to walk independently in normal activities.

Answer 38

Balance can be tested progressively by asking the older adult to stand first with his or her feet side by side, then in semi-tandem position, and finally in tandem position. Difficulty with balance in these positions predicts an increased risk of falling (SOE=A

Answer 39

the number of crashes per mile driven and the likelihood of serious injury or death are higher than for any age group other than those 16–24 years old (SOE=A).

Answer 40

poor visual acuity (worse than 20/40) and contrast sensitivity; dementia, particularly deficits in visual-spatial skills and visual attention; impaired neck and trunk rotation; and poor motor coordination and speed of movement

Answer 41

recommendations to stop driving should not be proffered lightly because driving cessation can lead to a decreased activity level and increased depressive symptoms

Answer 42

considering patient preferences, interpreting the evidence, formulating a prognosis, determining clinical feasibility, and optimizing therapies and care pl

Answer 43

Increased rate of smoking - twice as likely to report being heavy smokers & higher BMI’s. 3 times higher risk of CVD in women with BMI > 29 kg/m2.

Answer 44

After age 65 to any transgender older adult, while those who have completed gonadectomy without hormone replacement may need screening sooner

Answer 45

Gay, bisexual, and other MSM remain the group at greatest risk of acquiring HIV infection, with MSM >50 years old accounting for over half of all new HIV infections. Older adults who are of racial or ethnic minorities appear to be at greater risk of death from HIV infection/AIDS (SOE=A). According to CDC guidelines, sexually active MSM who engage in high-risk sexual behavior should be routinely assessed for gonorrhea, chlamydia, syphilis, herpes simplex virus, and human papillomavirus.

Answer 46

Gait speed, which reflects walking activity, was shown in an analysis of 9 cohort studies to predict survival as well as a number of other clinical factors, including age and chronic disease (SOE=A).

Answer 47

cardiorespiratory and muscular fitness It reduces the risk of many diseases, including coronary heart disease, stroke, hypertension, some lipid disorders, type 2 diabetes, colon cancer, breast cancer, osteoporosis, and depression, risk of unhealthy weight gain and assists in weight loss

Answer 48

Moderate intensity aerobic physical activity for 150 minutes a week. (5-6 point scale out of 10). Should be able to talk but not sing or feel breathe less. vigorous-intensity activity for at least 75 minutes each week (7-8) Engaging in a combination of moderate- and vigorous-intensity activity is also acceptable. Every 2 minutes of moderate-intensity activity counts the same as 1 minute of vigorous-intensity activity well as muscle-strengthening activities involving major muscle groups twice per week Balance therapy (tia chia)

Answer 49

Appropriate pre-participation screening and gradual progression of strength training exercises are the most important recommendations for avoiding activity-related injuries. The risk of injury is directly related to the size of the gap between a person’s usual level of activity and his or her new level of activity.

Answer 50

aerobic and resistance exercise using water or other low-impact options.

Answer 51

If the lag time to benefit from a preventive health intervention (ie, the amount of time between undergoing an intervention until benefit) is greater than the individual’s remaining expected life span, then the preventive health measure is not indicated.

Answer 52

Mammography -Every 2 years if <75 years old; consider stopping if ≥75 years old Pap smear - Stop at @ 65 PSA antigen - Consider discussing pros/cons if remaining life expectancy >10 years; stop at age 70 Colon cancer - Fecal occult blood test or fecal immunochemical test & Colonscopy (every 10 years)- Yearly up to age 75, stop at age 86, shared decision-making ages 76–85 - if 5-10year life expectancy Lung CA screening - Consider annually in those at riskd, stop at age 80 or adult has not smoked for >15 years; 5-10 YR expectancy - Consider in those at riskd, stop at age 80 or adult has not smoked for >15 years` DEXA screening for osteoporosis - At least once after age 65 in women, or age 60 if high risk; consider if 5-10 year life expetancy if not already done None of above recommended in mod dementia or end of life or 5-10 year life expectancy except lung CA screening

Answer 53

40–70 years old who are overweight or obese every 3 years with fasting plasma glucose, hemoglobin A1c (HbA1c), or oral glucose tolerance test and implementing lifestyle changes (healthy diet, physical activities) in those with abnormal blood glucose (SOE=B). - stop after age 70 Consider in all age/patient population Once for men 65−75 years old who ever smoked; consider in men who never smoked Screen to allow for risk assessment and shared decision-making High risk individuals

Answer 54

Annually - in everyone Once after age 65 Booster every 10 years - not recommended in end of life Once after age 50

Answer 55

Not recommended in adults ≥70 years old. Consider in those 50–59 years old with >10% risk of cardiovascular disease; shared decision-making for men 60–69 years old No recommended in 5-10 life expectancy, mod dementia or end of life

Answer 56

Consider vitamin D at 1,000 IU with calcium at 500–1,200 mg/d in adults ≥65 years old

Answer 57

The USPSTF found insufficient evidence to recommend for or against clinical breast examinations (CBEs) and recommends against teaching breast self examination (BSE), because BSE may lead to unnecessary biopsies and is not associated with a survival benefit

Answer 58

Subclinical hypothyroidism - asymptomatic condition which serum TSH is upper threshold but normal T4. However, TSH levels rise with age, fluctuate, and are sensitive to acute illness and certain medications. Based on expert opinion, a TSH level >10 mIU/L (on two separate occasions 6–12 months apart) is generally considered the threshold for initiating treatment.

Answer 59

Other society guidelines continue to recommend a target BP of 150/90 mmHg in adults ≥ 60 years old.

Answer 60

high-intensity statin therapy is generally recommended for adults with LDL-C ≥190 mg/dL. In addition, the ACC/AHA 2019 guidelines recommend a high-intensity statin for adults with >20% risk 10-year risk. These guidelines consider adults with ≥7.5%–20% risk as being at intermediate risk and recommend consideration of moderate-intensity statins after a risk discussion

Answer 61

For all new residents and employees of long-term care facilities, the CDC recommends screening with the two-step Mantoux test unless these individuals have documentation of a previous positive reaction. The CDC also recommends a chest radiograph of all persons with a reaction >10 mm to identify current or past disease.

Answer 62

functional status, mobility, gait speed, cognition, mood and emotional status, nutritional status, comorbidities and polypharmacy, geriatric syndromes (fall risk, delirium, incontinence, dentition, vision/hearing impairment), social and financial status, goals of care, and advanced care planning.

Answer 63

Annually The USPSTF recommends exercise interventions for community-dwelling adults ≥65 years old who are at increased risk of falls, with high risk defined by history of falls and/or problems in physical functioning and limited mobility (SOE=A). The USPSTF recommends individualized decision-making in offering these other interventions and recommends against vitamin D supplementation for fall prevention in older adults without osteoporosis or vitamin D deficiency.

Answer 64

Therefore, the ACC/AHA now state that aspirin should not be used in the routine primary prevention of CVD. USPSTF recommends aspirin in adults 50–59 years old with ≥10% 10-year CVD risk, and individualized decisions in adults 60–69 years old with ≥10% 10-year CVD risk

Geriatrics Flashcards

(95 cards)