36. Elderly Flashcards
In the elderly patient taking multiple medications, avoid polypharmacy by doing what ? (3)
- monitoring side effects.
- periodically reviewing medication (e.g., is the medication still indicated, is the dosage appropriate).
- monitoring for interactions.
Describe : Comprehensive Geriatric Assessment (5)
- Medical
- Psychological
- Function
- Polypharmacy - Meds
- Social and Environmental
Name elements in MEDICAL geriatric assessment (7)
- Immunizations (influenza, tetanus/diphteheria, pneumococal, herpes zoster)
- Habits (smoking, alcohol, substance, sexual)
- Nutrition (diet, appetite, weight loss, dentition,m swallowing)
- Bowel and Bladder (incontinence, constipation, diarrhea)
- Communication (vision, hearing)
- Pain
- Cancer screening
Name elements in PSYCHOSOCIAL geriatric assessment (3)
- Cognition: MCI vs dementia vs. Delirium– MMSE / MOCA
- Mood – Depression (MSIGECAPS) – PHQ-9 or geriatric depression scale
- Elder mistreatment/abuse (ELDER ABUSE SUSPICION INDEX © (EASI))
Describe SMART approach for Behavioural and Psychological Symptoms of Dementia
- Safety – remove patient to safe environment
- Medical – perform an organic workup to treat reversible causes; reduce medication load
- Assess competency – decisions regarding personal care, finances, driving; protect assets
- Rest, nutrition, hydration ensured; address problems with pain, ambulation, vision, hearing, constipation
- Trial of medication – cholinesterase inhibitor/antipsychotic/antidepressant/ mood stabilizer
Name elements in FUNCTION geriatric assessment (5)
- AVD-AVQ
- Fall risk (postural hypotension, vertigo), Vision, Hearing
- Physical activity
- Mobility
- Driving
What to consider in meds in geriatric (4)
- Non-prescription medication (herbal, OTC, vitamins)
- Consider efficacy/side effect profiles : Convenient dosing/route, Dispill / Blister pack
- Avoid treating side effect with another medication (medication cascade)
- Beer’s Criteria, STOPP/START criteria
Name elements in SOCIAL AND ENVIRONMENTAL geriatric assessment (5)
- Social activities, hobbies, interests
- Care support, POA
- Local resources
- Managing at home (financial, legal). Anticipate need for increased services
- Advance care planning (resuscitation)
Name MEDICAL Modifiable Risk Factors in the Elderly (9)
- Visual/hearing impairment
- Polypharmacy
- Dizziness or orthostasis
- Incontinence
- Diabetes
- Depression
- Cognitive impairment/Dementia
- Vaccines
- Cancer, AAA screening
- Osteoporosis (Calcium, vitamin D, BMD)
Name MOBILITY Modifiable Risk Factors in the Elderly (5)
- Balance/gait impairment
- Muscle weakness
- Exercise level
- Environmental lighting
- Footwear
Name HABITS Modifiable Risk Factors in the Elderly (2)
- Smoking
- ROH
Name atypical presentations in geriatric population
- Lack of symptoms (eg. fever), or may present with confusion/delirium
- Commonly missed diagnoses are cancer, pulmonary embolus, coronary disease, aneurysms, appendicitis
- Depression can present with somatic complaints (cognition, functional, sleep, energy)