2. Differential Diagnoses of Common Presentations Flashcards
1
Q
Describe: Frailty (1)
A
clinically-recognizable state of decreased reserve in older adults with increased vulnerability to acute stressors resulting from functional decline across multiple physiologic systems
2
Q
Describe: Functional decline
A
progressive limitation in the ability to carry out basic functional activities
3
Q
The Clinical Frailty Scale is shown to predict what?
A
to predict death and need for institution
4
Q
Describe: Clinical Frailty Scale (9)
A
5
Q
Describe: Dementia Frailty Scale (3)
A
Degree of frailty corresponds to degree of dementia.
-
Mild Dementia
- Common symptoms include forgetting details of recent event, though still remembering the event itself. Repeating the same question/story and social withdrawal.
-
Moderate Dementia
- Recent memory is very impaired, although can remember past life events well. Can do personal care with prompting.
- Severe Dementia: Cannot do personal care without help.
6
Q
Describe: Physical Frailty (PF) Phenotype (Fried et al.) (5)
A
Frail = 3 or more criteria; at-risk or pre-frail = 1 or 2 criteria
- Shrinking: unintentional weight loss (baseline: >10 lbs or 5% total body weight lost in prior year)
- Weakness: grip strength in lowest 20% (by gender, BMI)
- Poor endurance: as indicated by self-report of exhaustion
- Slowness: walking time/15 feet in slowest 20% (by gender, height)
- Low activity: kcals/wk in lowest 20% (males: <383 kcals/wk, females: <270 kcals/wk)
7
Q
Describe: Cumulative Deficit Approach (Rockwood et al.) (2)
A
- balance between assets (e.g. health, attitudes, resources, caregiver) and deficits (e.g. illness, disability, dependence, caregiver burden) that determines whether a person can maintain independence in the community
- Frailty Index = number of deficits present/number of deficits possible
8
Q
A
9
Q
Describe: Screening Tool for Frailty (5)
A
FRAIL
- Fatigue: “Are you fatigued?”
- Resistance: “By yourself and without aids, do you have any difficulty walking up 10 steps without resting?”
- Ambulation: “By yourself and without aids, do you have any difficulty walking several hundred yards?”
- Illnesses: more than five
- Loss of weight: greater than five percent
Frailty: “Yes” to 3 or more questions
Pre-frailty: “Yes” to 1-2 questions
10
Q
Name: Etiologies of Frailty (5)
A
- Physiologic Changes with Aging
- Immune System
- Endocrine System
- Dysregulated Stress Dysregulation of autonomic nervous system
- Age related changes in renin-angiotensin system and mitochondria likely impact sarcopenia and inflammation
11
Q
Describe mechanism of this etiology of frailty: Physiologic Changes with Aging (4)
A
- Sarcopenia (age-related loss of skeletal muscle and strength)
- decreased mass
- increased stiffness of organs
- decreased reserve capacity of systems
12
Q
Describe mechanism of this etiology of frailty: Immune system (3)
A
- Elevated levels of circulating interleukin-6, C-reactive protein, white blood cells, and monocytes associated with skeletal muscle decline
- Elevated clotting markers (factor VIII, fibrinogen, D-dimer) upregulates clotting cascade
- Chronic inflammation
13
Q
Describe mechanism of this etiology of frailty: Endocrine system (4)
A
Decreased skeletal muscle mass via:
- Decreased growth hormone and IGF-1
- Increased cortisol levels
- Decreased DHEA-S
- Decreased 25 (OH) vitamin D
14
Q
Describe: Comprehensive Geriatric Assessment (5)
A
- includes:
- Past Medical History, Medications, Allergies, Social History, Function, Physical Exam, and Geriatric Review of Systems (cognition, mood, sleep, pain, nutrition, falls, continence, vision/ hearing, skin, and safety)
- interdisciplinary primary care
- pharmaceutical care and medication optimization
- management of geriatric syndromes (e.g. falls, cognitive impairment, incontinence)
- caregiver support
15
Q
Define: Delirium (2)
A
- acute and potentially reversible disturbance in cognition, attention, or level of consciousness
- screened using the Confusion Assessment Method: delirium likely if 1 + 2 and either 3 or 4 are present
- 1: acute onset and fluctuating course
- 2: inattention
- 3: disorganized thinking
- 4: altered level of consciousness
16
Q
Name Differential Diagnosis of Delirum (3)
A
3Ds (dementia, delirium, depression) can present with overlapping cognitive changes
17
Q
Describe work-up of delirium (4)
A
work-up is not universal, and depends on possible causes based on history and physical exam:
- Drugs: medication review
- Infection, Infarction, Inflammation: CBC, urinalysis, urine culture, blood culture, chest x-ray, ECG/ troponin
- Metabolic: basic and extended electrolytes, Vit B12, TSH, LFT, toxicology screen
- Structural: neurologic exam, CT head
18
Q
Describe: Delirium Prevention in Elderly (6)
A
- ensure optimal vision and hearing to support orientation (e.g. appropriate eyewear and hearing aids)
- provide adequate nutrition and hydration (up in chair to eat and drink whenever feasible)
- encourage regular mobilization to build and maintain strength, balance, and endurance
- avoid unnecessary medications and monitor for drug interactions
- avoid bladder catheterization
- ensure adequate sleep at night and wakefulness during the day
19
Q
Describe use of antipsychotics for treatment of delirium (1)
A
There is no evidence that antipsychotics shorten the course of delirium, reduce mortality risks, or improve quality of life in hospitalized patients
20
Q
Describe: Dementia
- Onset
- Duration
- Natural History
- Level of Consciousness
- Attention
- Orientation
- Behaviour
- Psychomotor
- Sleep-Wake Cycle
- Mood and Affect
- Cognition
- Memory Loss
A
- Onset: Gradual or step-wise decline
- Duration: Months to years
- Natural History: Progressive, usually irreversible
- Level of Consciousness: Normal
- Attention: Intact initially
- Orientation: Intact initially
- Behaviour: Disinhibition, loss of ADL/ IADLs, personality change
- Psychomotor: Normal
- Sleep-Wake Cycle:
- Mood and Affect: Fragmented sleep at night
- Cognition: Labile but not usually anxious
- Memory Loss: Decreased executive function, paucity of thought
21
Q
Describe: Delirum
- Onset
- Duration
- Natural History
- Level of Consciousness
- Attention
- Orientation
- Behaviour
- Psychomotor
- Sleep-Wake Cycle
- Mood and Affect
- Cognition
- Memory Loss
A
- Onset: Acute (hours to days)
- Duration: Days to weeks
- Natural History:
- Fluctuating, reversible
- High mobidity/mortality in very old
- Level of Consciousness: Fluctuating
- Attention: Impaired, difficulty concentrating
- Orientation: Impaired, fluctuates
- Behaviour: Severe agitation/retardation
- Psychomotor: Fluctuates between extremes
- Sleep-Wake Cycle: Reversed sleep-wake cycle
- Mood and Affect: Anxious, irritable, fluctuating
- Cognition: Fluctuation preceded by mood changes
- Memory Loss: Marked short-term
22
Q
Describe: Depression
- Onset
- Duration
- Natural History
- Level of Consciousness
- Attention
- Orientation
- Behaviour
- Psychomotor
- Sleep-Wake Cycle
- Mood and Affect
- Cognition
- Memory Loss
A
- Onset: Subacute (weeks to months)
- Duration: Variable
- Natural History: Recurrent, usually reversible
- Level of Consciousness: Normal
- Attention: -
- Orientation: Intact
- Behaviour: Importuning, self-harm/ suicide
- Psychomotor: Slowing
- Sleep-Wake Cycle: Early morning awakening
- Mood and Affect: Depressed, stable
- Cognition: Concentration impaired
- Memory Loss: Short-term
23
Q
Define: Falls (2)
A
- an event resulting in a person coming to rest inadvertently on a lower level
- other than as a consequence of sudden paralysis, epileptic seizure, or overwhelming external force
24
Q
Describe epidemiology: Falls (5)
A
- 30-40% of people >65 yr old and ~50% of people >80 yr old fall each year
- equally common between men and women, but more likely to result in injury in women and death in men
- falls are the leading cause of death from injury in persons ≥65 yr
- 25% associated with serious injuries (e.g. hip fracture, head injury, bruises, laceration)
- between 25-75% do not recover to previous level of ADL function after injurious falls
25
Name etiologies of falls (3)
* intrinsic factors
* extrinsic factors
* situational factors
26
Name etiologies of falls: Intrinsic factors (3)
* age-related changes and diseases associated with aging:
* musculoskeletal (arthritis, muscle weakness)
* sensory (visual, proprioceptive, vestibular)
* cognitive (depression, dementia, delirium, anxiety)
* cardiovascular (CAD, arrhythmia, MI, low BP)
* neurologic (stroke, decreased LOC, gait disturbances/ataxia)
* metabolic (glucose, electrolytes)
* orthostatic/syncopal
* acute illness, exacerbation of chronic illness
27
Name etiologies of falls: Extrinsic factors (2)
* environmental (e.g. home layout, slippery surfaces, overcrowding, new environments)
* side effects of medications, polypharmacy (\>4 medications), and substance abuse (e.g. alcohol)
28
Name etiologies of falls: Situational factors (2)
* activities (e.g. rushing to the toilet, walking while distracted)
29
Describe history: Falls (7)
* previous falls and/or gait instability
* inquire about intrinsic, extrinsic and situational factors
* associated symptoms
* loss of consciousness
* medication and alcohol use
* change in medications
* have a witness present if possible for interview
30
Describe physical exam: Falls (8)
* orthostatic blood pressure
* cardiac
* visual acuity
* examination of feet and footwear
* Performance-Oriented Assessment of Mobility
* Timed Up-and-Go Test
* musculoskeletal
* neurologic
31
Describe investigations: Falls (3)
* comprehensive geriatric assessment to identify all potential causes
* CBC, electrolytes, BUN, creatinine, glucose, Ca2+, TSH, B12, urinalysis, cardiac enzymes, ECG, CT head (as directed by history and physical), coagulation profile
* bone densitometry (DEXA) for osteoporosis screening in all women and men \>65 yr old
32
Describe interventions: Falls (8)
* multidisciplinary, multifactorial, health, and environmental risk factor assessment and intervention programs in the community
* muscle strengthening, balance retraining (e.g. Tai Chi), and group exercise programs
* home hazard assessment and modification (e.g. remove loose rugs and tripping hazards, add shower bars and stair railing, improve lighting)
* prescription of vitamin D 1000 IU daily if vitamin D stores are low
* tapering or gradual discontinuation of psychotropic medication
* postural hypotension, heart rate, and rhythm abnormalities management
* eyesight (cataract surgery) and footwear optimization
* compression socks if venous stasis edema
33
Name: Key Clinical History Findings in Falls Evaluation (6)
**SPLATT**
* **S**ymptoms
* **P**revious falls
* **L**ocation of falls
* **A**ctivity at the time of fall
* **T**ime of fall
* **T**rauma
34
Describe: Impact of Medication Classes on Falls Risk in Geriatrics (Odds Ratios) ()
* Antidepressants (1.68)
* Neuroleptics/Antipsychotics (1.59)
* Benzodiazepines (1.57)
* Sedatives/ Hypnotics (1.47)
* Antihypertensive agents (1.24)
* NSAIDs (1.21)
* Diuretics (1.07)
* Φ1-blockers (1.01)
35
Define: Malnutrition (3)
* no uniformly accepted definition of malnutrition in older adults. Some commonly used definitions include the following:
* involuntary weight loss (community: ≥2% over 1 mo, \>10 lbs over 6 mo, or ≥4% over 1 yr; nursing home: ≥5% over 1 mo, ≥10% over 180 d)
* hypoalbuminemia (community: ≤38 g/L; hospital: ≤35 g/L), hypocholesterolemia (\<4.1 mmol/L)
* other features include: insufficient energy intake, loss of muscle mass, fluid accumulation (e.g. edema), loss of subcutaneous fat, decreased hand-grip function
36
Describe etiology: Malnutrition (6)
nutritional
* decreased assimilation: impaired transit, maldigestion, malabsorption
* decreased intake: financial, psychiatric (depression), cognitive deficits, anorexia associated with chronic disease, functional deficits (e.g. difficulty shopping, preparing meals or feeding oneself due to functional impairment)
* stress: acute or chronic illness/infection, chronic inflammation, abdominal pain
* mechanical: dental problems, dysphagia
* age-related changes: appetite dysregulation, decreased thirst
* mixed: increased energy demands (e.g. hyperthyroidism), abnormal metabolism, protein-losing enteropathy
37
Describe history: Malnutrition (7)
* weight loss in 6 mo prior to examination
* recent or chronic illness
* constitutional symptoms (e.g. recent weight loss)
* dietary intake in relation to usual pattern
* depression, GI symptoms (anorexia, nausea, vomiting, diarrhea)
* functional disability: impaired ADLs and IADLs
* social factors: economic barriers, dental problems, and living situation (e.g. living alone)
38
Describe physical exam: Malnutrition (5)
* BMI \<23.5 in males, \<22 in females should raise concern
* muscle wasting, temporal wasting, presence of triceps skin fold
* loss of subcutaneous fat
* ankle or sacral edema, ascites
* assess cognition
39
Describe investigations: Malnutrition (2)
* CBC, electrolytes, Ca2+/albumin, Mg2+, PO43–, creatinine, LFTs (INR, bilirubin), B12, folate, TSH, lipid profile
* if indicated by assessment, can consider urinalysis, ESR, CXR
40
Describe tx: Malnutrition (3)
* direct treatment at underlying causes
* dietary modification: high calorie foods, oral nutritional supplementation: patient specific meal replacement products (e.g. Ensure™, Glucerna™, Nepro™), vitamins/minerals (e.g. B12, calcium, vitamin D)
* referral: speech language pathologist, nutritionist
41
Name: Etiology of Malnutrition in the Elderly (13)
**MEALS ON WHEELS**
* **M**edications
* **E**motional problems
* **A**norexia
* **L**ate-life paranoia
* **S**wallowing disorders
* **O**ral problems
* **N**osocomial infections
* **W**andering/dementia related activity
* **H**yperthyroid/Hypercalcemia/ Hypoadrenalism
* **E**nteric disorders
* **E**ating problems
* **L**ow-salt/Low-fat diet
* **S**tones
42
Define: Constipation (5)
Rome IV Diagnostic Criteria:
* straining
* hard stools
* sensation of incomplete evacuation
* use of digital maneuvers, and/or sensation of anorectal obstruction/blockage with 25% of bowel movements and \<3 bowel movements per wk.
* The criteria must be fulfilled for the last 3 mo with symptom onset ≥ 6 mo prior to diagnosis
43
Describe epidemiology: Constipation (2)
* chronic constipation increases with age (up to 1/3 of patients \>65 yr experience constipation and 1/2 of patients \>80 yr)
* in the elderly, chronic constipation may present as fecal impaction
44
Describe pathophysiology: Constipation (2)
* impaired rectal sensation (increased rectal distention required to stimulate the urge to defecate)
* colorectal dysmotility
45
Describe tx: Constipation (5)
* non-pharmacological
* increase fibre intake (note: bulking agents, e.g. psyllium, Metamucil, may worsen constipation)
* ensure adequate fluid intake
* increase physical activity
* pharmacological
* discourage chronic laxative use
* review medication regime, reduce dosages or substitute
46
Name: Common Causes of Constipation in the Geriatric Population include (6)
* Primary impaired colonic and anorectal function
* Drugs
* Diet (dehydration, low fibre “tea and toast” diet)
* Colo-anorectal disorders (cancer, masses, stenosis, strictures)
* Neurologic (stroke, dementia, Parkinson’s, autonomic neuropathy)
* Psychiatric (depression, anxiety)
47
Name: Drugs Associated with Constipation (7)
* OTC (antihistamines, NSAIDs)
* Opioids
* Psychotropic (antipsychotics, TCAs)
* Anticholinergics
* Calcium channel blockers
* Diuretics
* Supplements (iron or calcium)
48
Describe: Treatment algorithm for the management of chronic constipation in the elderly (Figure)
49
Define: Fecal incontinence (3)
* involuntary or inappropriate passing of feces that impacts social functioning or hygiene
* severity can range from unintentional flatus to the complete evacuation of bowel contents
* there are three subtypes:
1. passive incontinence: involuntary discharge of stool or gas without awareness
2. urge incontinence: discharge of fecal matter in spite of active attempts to retain bowel contents
3. fecal seepage: leakage of stool following otherwise normal evacuation
50
Describe epidemiology: Fecal incontinence (3)
the incidence of fecal incontinence differs by setting:
* community (17-36%)
* hospital (16%)
* nursing home (33-65%)
51
Name risk factors: Fecal incontinence (7)
* constipation
* age \>80 yr
* female sex
* urinary incontinence
* impaired mobility
* dementia
* neurologic disease
52
Name etiologies: Fecal incontinence (8)
* physiological changes with age \>80 yr (e.g. decreased external sphincter strength, decreased resting tone of internal sphincter, weakened anal squeeze, increased rectal compliance, and impaired anal sensation)
* trauma (e.g. vaginal delivery, pudendal nerve damage, cauda equina)
* iatrogenic
* surgical (e.g. anorectal surgery, lateral internal sphincterotomy, hemorrhoidectomy, colorectal resection)
* radiation (e.g. pelvic radiation)
* neurogenic (e.g. neuropathy, stroke, MS, diabetic neuropathy)
* anorectal/colorectal diseases (e.g. rectal prolapse, hemorrhoids, IBD, rectocele, cancer)
* medication (e.g. laxative, anticholinergics, antidepressants, caffeine, muscle relaxants)
* cognitive (e.g. dementia, willful soiling with psychosis)
* constipation/fecal impaction
53
Describe investigations (if cause not apparent from history and physical): Fecal incontinence (5)
* differentiate true incontinence from frequency and urgency (e.g. IBS, IBD)
* stool studies
* endorectal ultrasound
* colonoscopy, sigmoidoscopy, anoscopy
* anorectal manometry/functional testing
54
55
Describe management of fecal incontinence: physiological changes with age (6)
* medication management (anti-motility agents (e.g. loperamide)
* diet/ bulking agents for loose stool)
* increase fluid intake
* biofeedback
* retraining of pelvic floor muscles
* surgery
56
Describe management of fecal incontinence: trauma (1)
* direct surgical repair or augmentation of the sphincters
57
Describe management of fecal incontinence: iatrogenic (2)
* surgical repair
* artificial sphincters
58
Describe management of fecal incontinence: neurogenic (5)
* medication management
* abdominal massage
* digital stimulation for dysfunction
* biofeedback and behavioural training
* prevent autonomic dysreflexia in spinal injury
59
Describe management of fecal incontinence: anorectal/colorectal diseases (2)
* treat underlying cause (optimize IBD medications)
* surgical (e.g. mass removal, prolapse repair, hemorrhoid removal, colostomy)
60
Describe management of fecal incontinence: medication-related causes (2)
* stop laxatives, lower dose or discontinue any other offending agents
* cognitive: regular defecation program in patients with dementia, psychiatric consult (optimize medications and cognitive function)
61
Describe management of fecal incontinence: constipation/fecal impaction (4)
* disimpaction
* prevent impaction
* enema
* or rectal irrigation
62
Name Transient Causes of Fecal Incontinence (6)
**DIAPERS**
* **D**elirium
* **I**nfection
* **A**trophic urethritis/vaginitis
* **P**harmaceuticals
* **E**xcessive urine output
* **R**estricted mobility
* **S**tool impaction
63
Define: Urinary incontinence (2)
* complaint of any involuntary loss of urine
* there are 4 subtypes:
* stress incontinence
* urge incontinence
* overflow incontinence
* functional incontinence
64
Define: Stress incontinence (1)
leakage associated with physical strain
65
Define: Urge incontinence (1)
leakage associated with strong urge to urinate
66
Define: overflow incontinence (1)
leakage associated with poor bladder emptying
67
Define: functional incontinence (1)
leakage due to illness or disability not related to the urinary tract
##
68
Describe epidemiology: Urinary incontinence (3)
* 15-30% prevalence dwelling in community and at least 50% of institutionalized seniors
* morbidity: cellulitis, pressure ulcers, urinary tract infections, falls with fractures, sleep deprivation, social withdrawal, depression, sexual dysfunction
* not associated with increased mortality
69
Name risk factors: Urinary incontinence (8)
* impaired mobility
* falls
* medications
* depression
* TIA/stroke
* dementia
* CHF
* obesity
70
Name etiologies: Urinary incontinence (8)
* physiologic changes with age: decreased bladder capacity
* genitourinary diseases (e.g. cystitis, urethritis, benign prostatic hyperplasia)
* neurogenic (e.g. cauda equina syndrome, stroke, MS)
* iatrogenic: prostate surgery
* trauma: pelvic trauma, traumatic spinal cord injury
* drugs (e.g. alcohol, loop diuretics, sedative hypnotics, GABAergic agents)
* cognitive (e.g. dementia, depression)
* functional impairment (e.g. arthritis, poor vision)
71
Describe investigations: Urinary incontinence (1)
* urinalysis and culture
72
Describe management: Urinary incontinence (6)
* **lifestyle modification**: avoid excessive fluid intake and alcohol
* **pharmacologic**: **β**-adrenergic agonists to reduce involuntary bladder contractions
* **physiologic changes with age**:
* pelvic muscle exercises
* bladder training
* biofeedback
* **genitourinary diseases**: treat underlying cause (empiric antimicrobial treatment for cystitis, **α** blockers/5-**α** reductase inhibitors for benign prostatic hyperplasia)
* **functional impairment**: incontinence pads, environmental modification, personal assistance
* **cognitive**: referral to incontinence program if needed
73
Name complications of immobility (7)
* cardiovascular: orthostatic hypotension, venous thrombosis, embolism
* respiratory: decreased ventilation, atelectasis, pneumonia
* gastrointestinal: anorexia, constipation, incontinence, dehydration, malnutrition
* genitourinary: infection, urinary retention, bladder calculi, incontinence
* musculoskeletal: atrophy, contractures, bone loss
* skin: pressure ulcers
* psychological: sensory deprivation, delirium, depression
74
Define: Pressure Ulcers (1)
* any lesion caused by unrelieved pressure resulting in damage of underlying tissue; usually develops over bony prominences
75
Name risk factors: Pressure Ulcers (12)
* extrinsic:
* friction
* pressure
* shear force
* intrinsic:
* immobility
* malnutrition
* moisture
* sensory loss
* geriatric:
* age-related skin changes
* bed-bound
* cognitive impairment
* chronic illness
* use of anti-hypertensive medications
76
Describe pressure Ulcers: Stage 1 (2)
* Changes include skin temperature, tissue consistency or sensation
* An area of persistent erythema in lightly pigmented, intact skin; in darker skin, it may appear red, blue or purple
77
Describe pressure Ulcers: Stage 2 (2)
* Partial thickness skin loss involving the epidermis, dermis or both
* The ulcer is superficial and presents as an abrasion, blister or shallow crater
78
Describe pressure Ulcers: Stage 3 (2)
* Full thickness skin loss involving damage or necrosis of subcutaneous tissue which may extend down to, but not through, underlying fascia
* Presents as a deep crater with or without undermining of adjacent tissue
79
Describe pressure Ulcers: Stage 4 (2)
* Full thickness skin loss with extensive destruction, tissue necrosis or damage to muscle, bone or supporting structures
* May have associated undermining and/or sinus tracts
80
Describe prevention: Pressure Ulcers (3)
* pressure reduction
* frequent repositioning
* pressure-reducing devices (static, dynamic)
* maintaining nutrition, encouraging mobility and managing incontinence
* use validated pressure injury risk assessment tools on admission for those identified to be at risk for skin breakdown (Canadian Association of Wound Care, 2018)
81
Describe tx: Pressure Ulcers (11)
* optimize nutritional status
* minimize pressure on wound
* analgesia
* all ulcers with necrosis warrant debridement (mechanical, enzymatic and autolytic are non-urgent forms of debridement, whereas sharp debridement is performed urgently due to risk for sepsis or cellulitis)
* dressing application (exudate absorbing, barrier products to reduce friction)
* maintain moist wound environment to enable re-epithelialization
* treatment of wound infections (topical gentamicin, silver sulfadiazine, mupirocin)
* diabetic foot ulcers: offloading with removable cast walker (e.g. aircast boot), orthopedic shoes and orthotics
* swab wounds not demonstrating clinical improvement for C&S; biopsy chronic wounds to rule out malignancy
* referral to Wound Care
* consider other treatment options
* negative pressure wound therapy/vacuum-assisted closure
* biological agents: application of fibroblast growth factor, platelet-derived growth factor to wound
* non-contact normothermic wound therapy
* electrotherapy
82
Name different hazards of hospitalization (12)
* Malnutrition
* Urinary Incontinence
* Depression
* Adverse Drug Event
* Confusion/Delirium
* Pressure Ulcers
* Infection
* Falls
* Hypotension/Dehydration
* Diminished Aerobic Capacity/ Loss of Muscle Strength/ Contractures
* Decreased Respiratory Function
* Functional Decline
83
Describe recommendations for this hazard of hospitalization: Malnutrition (4)
* No dietary restrictions (except diabetes)
* assistance
* dentures if necessary
* sitting in a chair to eat
84
Describe recommendations for this hazard of hospitalization: Urinary Incontinence (3)
* Medication review
* remove environmental barriers
* discontinue use of catheter
85
Describe recommendations for this hazard of hospitalization: Depression (1)
Routine screening
86
Describe recommendations for this hazard of hospitalization: Adverse Drug Event (1)
Medication review
87
Describe recommendations for this hazard of hospitalization: Confusion/Delirium (7)
* Orientation
* visual and hearing aids
* volume repletion
* noise reduction
* early mobilization
* medication review
* remove restraints
88
Describe recommendations for this hazard of hospitalization: Pressure Ulcers (3)
* Low-resistance mattress
* daily inspection
* repositioning every 2 h
89
Describe recommendations for this hazard of hospitalization: Infection (4)
* Early mobilization
* remove unnecessary IV lines
* catheters
* NG tubes
90
Describe recommendations for this hazard of hospitalization: Falls (5)
* Appropriate footwear
* assistive devices
* early mobilization
* remove restraints
* medication review
91
Describe recommendations for this hazard of hospitalization: Hypotension/Dehydration (1)
Early recognition and repletion (ideally oral rehydration, if possible)
92
Describe recommendations for this hazard of hospitalization: Diminished Aerobic Capacity/ Loss of Muscle Strength/ Contractures (1)
Early mobilization
93
Describe recommendations for this hazard of hospitalization: Decreased Respiratory Function (1)
Incentive spirometry, physiotherapy
94
Describe recommendations for this hazard of hospitalization: Functional Decline (3)
* Structured exercise
* progressive resistance training
* walking programs
95
Define: Elder Abuse (2)
* includes physical abuse, sexual abuse, emotional/psychological abuse, financial exploitation and neglect
* elder abuse is a criminal offence under the Criminal Code of Canada and in most U.S. states
96
Describe Epidemiology: Elder Abuse (3)
* in Canada in 2013, almost 3000 seniors were victims of family violence. The perpetrators of family violence against seniors were identified to be their grown child (43% of cases) and their spouses (28% of the cases)
* in older adults aged ≥60 yr, elder abuse is estimated to occur in 10% of patients
* insufficient evidence to include/exclude screening in the Periodic Health Exam
97
Name risk factors: Elder Abuse (7)
* Situational Factors: Social
* Victim Characteristics
* Physical or emotional dependence on caregiver
* Lack of close family ties
* History of family violence
* Dementia or recent deterioration in health
* Perpetrator Characteristics
* Related to victim
* Dependency on older adult (e.g. financial dependency)
98
Name the most common cause of sensorineural hearing loss
Presbycusis
99
Define: Presbycusis (1)
sensorineural hearing loss associated with aging (starting in 5th and 6th decades)
100
Name etiologies: Presbycusis (4)
* hair cell degeneration
* age-related degeneration of basilar membrane, possibly genetic etiology
* cochlear neuron damage
* ischemia of inner ear
101
Describe clinical features: Presbycusis (4)
* progressive, bilateral hearing loss initially at high frequencies, then middle frequencies
* loss of discrimination of speech, especially with back ground noise present–patients describe people as mumbling
* recruitment phenomenon: inability to tolerate loud sounds
* tinnitus
102
Describe tx: Presbycusis (2)
* hearing aid if patient has difficulty functioning, hearing loss \> 30-35 dB, and good speech discrimination
* ± lip reading, auditory training, auditory aids (door bell and phone lights)
