Geriatrics

Question 1

What group of pts is more likely to be reported to APS for self-neglect?

Answer 1

Older adults with higher levels of psychological distress and lower levels of social relations

Question 2

What pt pop is at inc risk of self neglect?

Answer 2

75 years of age, African Americans, lower socioeconomic status

cognitive impairment and physical disability

Question 3

Epi RF for unbefriended elders

Answer 3

Older male
lower income
lives alone
CVA
hip fx
Cog impaitment
Depression
MMSE <10

Question 4

Signs of neglect

Answer 4

invol wt loss
BMI <22
Hypoalbumenia <3.8
Hypocholesterolemia
Vit or micronut deficiencies
sarcopenia

Question 5

Loss of homeostenosis

Answer 5

the eventual breakdown of the organism’s ability to maintain cells, tissues, and organ system

Question 6

Effect of loss of homeostenosis

Answer 6

progressive changes that lead to cell death

Question 7

Poss dz outcome of ↑ vascular intimal thickening

Answer 7

Early stages of atherosclerosis

Question 8

Poss dz outcome of ↑ vascular stiffness

Answer 8

Systolic HTN
Stroke
Atherosclerosis

Question 9

Poss dz outcome of ↑ LV wall thickness

Answer 9

↓ early diastolic cardiac filling

↑ cardiac filling pressure

Lower threshold for dyspnea

↑ risk for atrial fibrillation

Question 10

Poss dz outcome of ↑ Left Atrial size

Answer 10

Atrial Fibrillation

Question 11

Poss dz outcome of ↓ Sinus node function and conduction velocity

Answer 11

Atrioventricular Block

Sick Sinus Syndrome (tachy-brady)

Question 12

Poss dz outcome of ↓ baroreceptor responsiveness

Answer 12

↑ risk of orthostatic hypotension

Question 13

Poss dz outcome of Altered regulation of vascular tone (Stiffening)

Answer 13

HTN

Question 14

Poss dz outcome of Decreased cardiovascular reserve

Answer 14

Lower threshold for and increased severity of heart failure

Question 15

Poss dz outcome of ↓ Exercise Response (↓ max HR, CO, VO2 max, coronary blood flow, peripheral vasodilation)

Answer 15

↓ exercise capacity and

↑ cardiac complications (Ischemia, heart failure, shock, arrythmias, death) with illness

Question 16

Poss dz outcome of Changes in connective tissue (↓ size of airways, shallow alveolar sacks- ↓ surface area)

Answer 16

Pulmonary fibrosis / Interstitial lung disease

COPD / Asthma physiology

Question 17

Poss dz outcome of Loss of cilia and increased mucous glands à Loss of mucociliary clearance

Answer 17

Bronchiectasis, chronic or recurrent lung infections, Rhinosinusitis

Question 18

Poss dz outcome of Kyphoscoliosis, calcification, and arthritis of costovertebral jointsà
↓ chest wall compliance

Answer 18

Restrictive lung physiology Obstructive sleep apnea

Question 19

Poss dz outcome of Loss of diaphragmatic strength (by 25%) and intercostal muscle atrophy due to sarcopenia à ↓ FVC and FEV1 by 25-30mL/yr in nonsmokers (approx 60mL/yr in smokers)

Answer 19

Restrictive lung physiology

Question 20

Poss dz outcome of Decreased laryngeal nerve endings à ↑ aspiration risk

Answer 20

Aspiration pneumonia, chronic cough

Question 21

Sx of cardiac dysfn w/ aging

Answer 21

Dizziness, Shortness of breath, Angina, Lower extremity edema, Syncope (and pre-syncope), Decreased exercise tolerance, Fatigue, Impotence, Falls, Cognitive Impairment

Question 22

Sx of respiratory dysfn w/ aging

Answer 22

Shortness of breath, cough, wheeze, decreased exercise tolerance, apnea, nasal discharge, fatigue

Question 23

Potential dz states of resp dysfn w/ aging

Answer 23

Emphysema, Obstructive Sleep Apnea, Asthma, Pneumonia, Rhinosinusitis, Pulmonary Fibrosis / Interstitial Lung Disease, Aspiration

Question 24

Sc of GI dysfn w/ aging

Answer 24

Dry mouth, dysphagia, early satiety, nausea, constipation, dysgeusia, fecal incontinence, hypo or hyperglycemic symptoms, fragility fractures

Question 25

Physiologic changes of vision w/ aging

Answer 25

Pupil shrinks from 5 - 6 mm diameter to 2 mm diameter by age 60 Lens becomes thicker and more opaque, only 1/3 of light reaches retina by age 70 Presbyopia, caused by increased lens rigidity and thickness, is universal

Question 26

Sx of visual dysfn w/ aging

Answer 26

Glare recovery declines Speed of dark adaptation declines Peripheral vision declines Loss of lid tone often leads to entropion, ectropion, and tear overflow Decreased tears leads to dry eye syndrome

Question 27

Physiologic changes of hearing w/ aging

Answer 27

Tympanicmembrane flexibility decreases with age Ossiclearticulation becomes more rigid Cerumen becomes drier and more tenacious

Question 28

Sx of hearing dysfn w/ aging

Answer 28

Highfrequencysound perception declines much faster than low frequency sound perception Presbycusis= SNHL of aging Impacted cerumen

Question 29

What does screening tool FRAIL stand for?

Answer 29

``` F—Fatigue R—Resistance A—Aerobic capacity I— Illnesses L -- Weight loss ```

Question 30

Primary Frailty

Answer 30

Inflammatory vs reduced immunity vs. anemia, reduced DHEA-S vs Low levels of vitamins and Carotenoids

Question 31

Secondary Frailty

Answer 31

Result of chronic disease

Question 32

Define pressure ulcer

Answer 32

localized inj to skin or underlying tissue, usually over a bony prominence as a result of unrelieved pressure

Question 33

Intact skin with non-blanching redness

Answer 33

Stage I pressure ulcer

Question 34

Shallow, open ulcer with red-pink wound bed

Answer 34

Stage II pressure ulcer.

Question 35

Full-thickness tissue loss with visible subcutaneous fat

Answer 35

Stage III pressure ulcer

Question 36

Full-thickness tissue loss with exposed muscle and bone

Answer 36

Stage IV pressure ulcer

Question 37

How often does the Agency for Health Care Policy and Research recommend that pts who are bedridden be repositioned (even though no evidence) And what angle should the head of the bed be?

Answer 37

every 2 hrs No more than 30 deg

Question 38

MC etiology of LE ulceration

Answer 38

venous ulcer (stasis ulcer)

Question 39

poss causes of venous ulcers

Answer 39

inflammatory processes resulting in leukocyte activation, endothelial damage, platelet aggregation, and intracellular edema.

Question 40

General PE of venous ulcers?

Answer 40

irregular, shallow, and located over bony prominences Granulation tissue and fibrin are typically present in the ulcer base

Question 41

Triad of diabetic ulcers

Answer 41

peripheral sensory neuropathy, trauma, and deformity

Question 42

Assisted Living

Answer 42

Good for indiv who have difficulty with ADLS Residents at assisted living communities are free to live an independent lifestyle, but also receive regular support for a range of daily activities ranging from cleaning to meal preparation Housekeeping and maintenance services are often included in the monthly rental of an apartment, along with laundry services, utilities, transportation and meals

Question 43

Independent Living

Answer 43

ideal for indiv who can still live indep but enjoy access to assitance when needed access to dining, med care, entertainment housekeeping and laundry may also be included

Question 44

complications of MVA with elderly

Answer 44

complicates cardiopulmonary disease and has independent complications (PNA, flail chest)

Question 45

what falls have greatest mortality in elderly?

Answer 45

Falls with blunt cerebral injury or long bone fx

Question 46

FIM score factors

Answer 46

age (less improvement with inc age) GIM score at admin (less improvement with high admit FIM score) head inj (greater improvement w/ head inj)

Question 47

what is FIM score used for

Answer 47

assess phys and cog relative to burden of care ie: level of disability indicating the burden of caring for them

Question 48

what d/c destination has mortality highest?

Answer 48

skilled nursing facility d/c

Question 49

What albumin level has inc post surg comp in hip fx and why

Answer 49

<3.8 inc in infections, cardiac, pulm, hemorrhage and thromboembolic comp

Question 50

4th leading cause of death in US as of 2014

Answer 50

polypharm

Question 51

Why is LT PPI use concerning?

Answer 51

Inc risks- ``` changes in microbiome B12 and mag deficiency falls and fx penumonias C diff Kidney fx ```

Question 52

How do pts qualify for post acute care (rehab) that is covered by medicare?

Answer 52

need and would benefit from rehab req 3 day hospital stay acute rehab in hospital 3+ hrs subacute is in nursing home 2+ hrs

Question 53

How are nursing homes funded?

Answer 53

privately until poor then covered by medicaid

Question 54

How are assisted living facilities funded?

Answer 54

privately- rarely accept medicaid

Question 55

Define MCI

Answer 55

Evidence of modest cognitive decline (change from baseline) Deficits DO NOT INTERFERE with independence (ADLs)

Question 56

Benefits of cholinesterase inhibitors with alzheimers or vascular demenita

Answer 56

show a small effect to slow the decline of progression, give people a few additional months before need for nursing home placement; may have a greater effect on daily symptom burden – data is in development