5 M's of Geriatric Care

Question 1

what are the the 5 Ms

Answer 1

evidence based appraoch to care for the geriatric population

Mobility
- impaired gait and balance
- preventing falls!!
Mind
- depression, delirum, dementia
Medication
- deprescribing, polypharm, ADRs
Multicomplexity
- multiple comorbities
- bio-psycho-social situation
Matters Most (pt. centerd care!!)
- pt preferences!!!

Question 2

Mobility
Evaulation of Falls and Fall Risk

Answer 2

• ability to get around their home (stairs, steps, rugs, etc.)
• ability to walk, move around
• use of assist devices,etc.
• PREVENTING FALLS!

Stats & why
- longer hopsital stay = increase fallrisk
- fall = decrease ADL
- reasons to be put in a home
- Trauma and falls is a leading cause of death in these patients

Evaluation of Falls
- Screening!! you HAVE To ask!!!!
- 2+ falls in 6 months = evalute for a treatable cause
- ask a good history: its almost never a mechaniacl issue: theres an underlying delirum, neuropathy, ADR, etc.

Risk Assessment
- perform assessment with a fall risk tool
- perform a physical exam!!! : balance/gait testing & ADL/iADl testing

Evaluation of the Home for Mobility
- Flors: rugs, excess things
- Stairs
- Bathroom: grab bars
- Bedroom: easy to reach lights, etc.
- Kitchen: easy to reach items low

Question 3

Mind
three Ds
Goals of assessment
Causes of Delirum& outcomes

Answer 3

Dementia
Delirum
Depression

Goals
- want to maintain metnal activit = increase independence!
- manage memory loss & dementia
- PREVENT DELIRUM: risk for mental recline is higher when delirum dx.
- assess and amange mood disorders

Delirum
- aute onset with underlying caues
- D: drugs dementia
- E: eyes, ears, (sensory deficts)
- L: low O2 conditions
- I: infection
- R: retention (urine and stool)
- I: ictal post seizure
- U: underhydration
- M: metabolic derangement
- S: sudural, sleep issues

OUtcomes of Delirum
- increase mortality - 6month risk 2x higher
- longer time they are symptomatic = increase risk of death
- increased risk of future impairment
- and predictve drop in MMSE

Question 4

Mind
Depression
outcomes
Management

Answer 4

Depression
- actually not that common in the older population & not a normal consequence of aging: they shouldnt be depressed!!!
- atypical presentations, misdiagnosed and pt. reluctant to tell you how they feel

Outcomes
- amplifies other disabilities
- increase suicude risk and if attempted: more succesiful
- increase dementia risk

Management
- antidepressants are still first line : SSRI
- ECT and theray highly successful
- WATCH POLYPHARM

Question 5

Mind
Demenita

Answer 5

Dementia: umbrella term
- AD
- vascualr
- LB
- frontotemporal

not normal aging!!

Evaluation
- Mini-cog
- evalute : history, functioing, congition, mood and labs/imaging
- manage with medications (Acetlycholinesterase inhibitors early on then NMDA agonist later)
- always explcitly share the diangosis of demenia with pt. and edcuate

Question 6

Medications
Treatment & medication Problems
deprescribing Tools

Answer 6

Problems with Medication in Elderly
- Falls
- fractures
- bleeding
- accidents
- polypharm.
- DD interactions
- ADRs
- quality of life “dont snow them”

Deprescribing!!!
- always check what condition teh medicationt they’re on is for– no condition? take them off
- focus on pt. center care: not helping them? take it off
- be PROACTIVE not reactive to adverse reaction

TOOLs : help to assess what meds to use and avoid
- BEERS guidlines
- appropiration index
- STOPP an STARTT
- anticholenergic risk scale

Question 7

MultiComplexity
frality
geratric syndromes

Answer 7

manage multi comorbid conditions, fragility and prognostigate

Geratric Syndromes
- no clear definition but, these are thing that happen (diagnosis or just things) more commonly in teh elderly & are associted with increased adverse outcomes and morbity
- term to capture clinical conditions that don’t fit in a category by themselves
- these are accumualted impairments in multiple body systems that are devleoped in compensation for another compromised condition

Dementia
Delirum
Falls
Urinary Incontinence
Pressure Ulcers

these syndromes are markers of frality

Frality: aging-related syndrome of physiological delcine, characterized by vulnerabilit to adverse health outcomes
- can use multiple score assessments to see how “frail” pt. is
- use ones that encompass physical and psychological changes

Question 8

Frality
Assessment tools

Answer 8

Frality Tools can help to predict survival in some elderly pt.

take in account the legnth of hospital stay, discharge and survival for a pt.
help to contextualized converastions with family and pt. themselves

Fried Frailty Tool: more physical sx.
- weight loss : > 5% of BW in 1 year
- exhustion : postive
- weakness : grip strength
- Slow speed walking: > 7 seconds for 15 feet
- decreased physical activity

Balducci Method: physical and psychological

Medical Comorbities
Fit (0 comorbiities)
Vulnerable (1-2)
Frail (3+)

Functional Status
Fit (independet ADL/iADLs)
Vulnerable (independet ADLs)
Frail (dependent ADLs)

Presecene of geratic syndromes or age > 85

Question 9

Prognostication of life with Frail tools

eprognosis
life tables

Answer 9

Foreseeing = formulation of prognosis
Foretelling = communication of the prognosis

these both make up prognostication for probility of outcomes related to illness

consider…
- emotional barries (hard convo!)
- concern you arent the expert: youll get it wrong anyway its ok
- ballpark without good data about life estiamtes

Eprognosis: incorporates functional data into calculators to determine outcomes

Life Tables
- frailty indices to indicatedlife expectancy

Approach
- identify pt. preferences
- estimate prognosis
- idetify whats feasible with pt.
- communiate a plan
- always center care around what pt. wants and values

add life to years!!! not just years to ife