2. Differential Diagnoses of Common Presentations Flashcards
Describe: Frailty (1)
clinically-recognizable state of decreased reserve in older adults with increased vulnerability to acute stressors resulting from functional decline across multiple physiologic systems
Describe: Functional decline
progressive limitation in the ability to carry out basic functional activities
The Clinical Frailty Scale is shown to predict what?
to predict death and need for institution
Describe: Clinical Frailty Scale (9)
Describe: Dementia Frailty Scale (3)
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.
Describe: Physical Frailty (PF) Phenotype (Fried et al.) (5)
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)
Describe: Cumulative Deficit Approach (Rockwood et al.) (2)
- 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
Describe: Screening Tool for Frailty (5)
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
Name: Etiologies of Frailty (5)
- 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
Describe mechanism of this etiology of frailty: Physiologic Changes with Aging (4)
- Sarcopenia (age-related loss of skeletal muscle and strength)
- decreased mass
- increased stiffness of organs
- decreased reserve capacity of systems
Describe mechanism of this etiology of frailty: Immune system (3)
- 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
Describe mechanism of this etiology of frailty: Endocrine system (4)
Decreased skeletal muscle mass via:
- Decreased growth hormone and IGF-1
- Increased cortisol levels
- Decreased DHEA-S
- Decreased 25 (OH) vitamin D
Describe: Comprehensive Geriatric Assessment (5)
- 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
Define: Delirium (2)
- 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
Name Differential Diagnosis of Delirum (3)
3Ds (dementia, delirium, depression) can present with overlapping cognitive changes
Describe work-up of delirium (4)
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
Describe: Delirium Prevention in Elderly (6)
- 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
Describe use of antipsychotics for treatment of delirium (1)
There is no evidence that antipsychotics shorten the course of delirium, reduce mortality risks, or improve quality of life in hospitalized patients
Describe: Dementia
- Onset
- Duration
- Natural History
- Level of Consciousness
- Attention
- Orientation
- Behaviour
- Psychomotor
- Sleep-Wake Cycle
- Mood and Affect
- Cognition
- Memory Loss
- 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
Describe: Delirum
- Onset
- Duration
- Natural History
- Level of Consciousness
- Attention
- Orientation
- Behaviour
- Psychomotor
- Sleep-Wake Cycle
- Mood and Affect
- Cognition
- Memory Loss
- 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
Describe: Depression
- Onset
- Duration
- Natural History
- Level of Consciousness
- Attention
- Orientation
- Behaviour
- Psychomotor
- Sleep-Wake Cycle
- Mood and Affect
- Cognition
- Memory Loss
- 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
Define: Falls (2)
- 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
Describe epidemiology: Falls (5)
- 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
Name etiologies of falls (3)
- intrinsic factors
- extrinsic factors
- situational factors
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
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)
Name etiologies of falls: Situational factors (2)
- activities (e.g. rushing to the toilet, walking while distracted)
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
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
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
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
Name: Key Clinical History Findings in Falls Evaluation (6)
SPLATT
- Symptoms
- Previous falls
- Location of falls
- Activity at the time of fall
- Time of fall
- Trauma
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)
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
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
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)
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
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
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
Name: Etiology of Malnutrition in the Elderly (13)
MEALS ON WHEELS
- Medications
- Emotional problems
- Anorexia
- Late-life paranoia
- Swallowing disorders
- Oral problems
- Nosocomial infections
- Wandering/dementia related activity
- Hyperthyroid/Hypercalcemia/ Hypoadrenalism
- Enteric disorders
- Eating problems
- Low-salt/Low-fat diet
- Stones
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
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
Describe pathophysiology: Constipation (2)
- impaired rectal sensation (increased rectal distention required to stimulate the urge to defecate)
- colorectal dysmotility
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
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)
Name: Drugs Associated with Constipation (7)
- OTC (antihistamines, NSAIDs)
- Opioids
- Psychotropic (antipsychotics, TCAs)
- Anticholinergics
- Calcium channel blockers
- Diuretics
- Supplements (iron or calcium)
Describe: Treatment algorithm for the management of chronic constipation in the elderly (Figure)
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:
- passive incontinence: involuntary discharge of stool or gas without awareness
- urge incontinence: discharge of fecal matter in spite of active attempts to retain bowel contents
- fecal seepage: leakage of stool following otherwise normal evacuation
Describe epidemiology: Fecal incontinence (3)
the incidence of fecal incontinence differs by setting:
- community (17-36%)
- hospital (16%)
- nursing home (33-65%)
Name risk factors: Fecal incontinence (7)
- constipation
- age >80 yr
- female sex
- urinary incontinence
- impaired mobility
- dementia
- neurologic disease
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
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
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
Describe management of fecal incontinence: trauma (1)
- direct surgical repair or augmentation of the sphincters
Describe management of fecal incontinence: iatrogenic (2)
- surgical repair
- artificial sphincters
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
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)
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)
Describe management of fecal incontinence: constipation/fecal impaction (4)
- disimpaction
- prevent impaction
- enema
- or rectal irrigation
Name Transient Causes of Fecal Incontinence (6)
DIAPERS
- Delirium
- Infection
- Atrophic urethritis/vaginitis
- Pharmaceuticals
- Excessive urine output
- Restricted mobility
- Stool impaction
Define: Urinary incontinence (2)
- complaint of any involuntary loss of urine
- there are 4 subtypes:
- stress incontinence
- urge incontinence
- overflow incontinence
- functional incontinence
Define: Stress incontinence (1)
leakage associated with physical strain
Define: Urge incontinence (1)
leakage associated with strong urge to urinate
Define: overflow incontinence (1)
leakage associated with poor bladder emptying
Define: functional incontinence (1)
leakage due to illness or disability not related to the urinary tract
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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
Name risk factors: Urinary incontinence (8)
- impaired mobility
- falls
- medications
- depression
- TIA/stroke
- dementia
- CHF
- obesity
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)
Describe investigations: Urinary incontinence (1)
- urinalysis and culture
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
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
Define: Pressure Ulcers (1)
- any lesion caused by unrelieved pressure resulting in damage of underlying tissue; usually develops over bony prominences
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
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
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
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
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
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)
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
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
Describe recommendations for this hazard of hospitalization: Malnutrition (4)
- No dietary restrictions (except diabetes)
- assistance
- dentures if necessary
- sitting in a chair to eat
Describe recommendations for this hazard of hospitalization: Urinary Incontinence (3)
- Medication review
- remove environmental barriers
- discontinue use of catheter
Describe recommendations for this hazard of hospitalization: Depression (1)
Routine screening
Describe recommendations for this hazard of hospitalization: Adverse Drug Event (1)
Medication review
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
Describe recommendations for this hazard of hospitalization: Pressure Ulcers (3)
- Low-resistance mattress
- daily inspection
- repositioning every 2 h
Describe recommendations for this hazard of hospitalization: Infection (4)
- Early mobilization
- remove unnecessary IV lines
- catheters
- NG tubes
Describe recommendations for this hazard of hospitalization: Falls (5)
- Appropriate footwear
- assistive devices
- early mobilization
- remove restraints
- medication review
Describe recommendations for this hazard of hospitalization: Hypotension/Dehydration (1)
Early recognition and repletion (ideally oral rehydration, if possible)
Describe recommendations for this hazard of hospitalization: Diminished Aerobic Capacity/ Loss of Muscle Strength/ Contractures (1)
Early mobilization
Describe recommendations for this hazard of hospitalization: Decreased Respiratory Function (1)
Incentive spirometry, physiotherapy
Describe recommendations for this hazard of hospitalization: Functional Decline (3)
- Structured exercise
- progressive resistance training
- walking programs
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
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
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)
Name the most common cause of sensorineural hearing loss
Presbycusis
Define: Presbycusis (1)
sensorineural hearing loss associated with aging (starting in 5th and 6th decades)
Name etiologies: Presbycusis (4)
- hair cell degeneration
- age-related degeneration of basilar membrane, possibly genetic etiology
- cochlear neuron damage
- ischemia of inner ear
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
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)
