Approach to Geriatric Patient

Question 1

Differences in clinical presentation of falls and weight loss of geriatric patients

Answer 1

Falls

• Usually more than one cuase
• Vision, meds, arthritis

Weight loss

• Psychosocial, meds, oral/GI changes, etc
• Usually NOT cancer (only 15% of weight loss due to cancer)

Question 2

Presentation of acute illness in geriatrics

Answer 2

• Weakness/dizziness/syncope (Wadao)
• Falls
• Confusion
• Acute MI without CP #1 symptom in old old is dyspnea
• Infection/sepsis often without fever or leukocytes

May be substantial lag between dx/tx –> improve

Question 3

Wadao

Answer 3

weak and dizzy all over

Question 4

What is the #1 symptom of old old ppl with MI?

Answer 4

Dyspnea - can’t catch breath

Question 5

How does a febrile illness presentation differ?

Answer 5

• Fever may be absent in 20-30% of elderly with serious infection
• Fever may be absent in 30-50% of FRAIL elderly with serious infection
• Adjust diagnostic criteria for elderly

Question 6

Adjusted febrile criteria for old old

Answer 6

Single temp > 100 degF
Repeated temp >99 degF
or rise in temp > 20 degF

Question 7

Every day spent in bed takes __ days to get back to wehre you started

Answer 7

2-3 days for every day in bed

Question 8

Clinical consequences of immobility

Answer 8

• Orthostatic intolerance
• Loss of muscle mass within 24 hours supine position
• After adjusting for illness severity and comorbidity
• low mobility in hosp –> functional decline
• low mobility in hosp –> new NH placement

Question 9

Approaches to improving immobility

Answer 9

• Don’t constrain them with unnecessary lines (catheters, IV lines)
• Order PT early and confirm pt participation
• Ambulate in hallway
• “Road test” your patient prior to d/c

Question 10

Majority of adults have __ or more conditions

Answer 10

3 or more

Question 11

Polypharmacy

Answer 11

> 5 drugs

Question 12

What we ask about age vs what we should be asking

Answer 12

Chronological age vs. Physiological age

Question 13

Functional assessment

Answer 13

Change in functional status is an important presenting symptom

Function can help prioritize individual problems

Function is important in deciding treatment efficacy

Knowing baseline function helps in managing acute illness

Question 14

Components of geriatric assessment

Answer 14

• Functional
• Physical
• Mental
• Social

Question 15

Can you go home if you can’t do IADLs?

Answer 15

Yes, but you may need some kind of assistance like assisted living

Question 16

Can you leave the hospital if you cannot do ADLs?

Answer 16

Nope.

Question 17

What is the first and last thing to go for ADLs?

Answer 17

First to go is bathing, last to go is feeding

Question 18

What to do with medication review for geriatrics

Answer 18

• Try never to add more pills

- If you add a pill, try to remove one too.

Question 19

“Get up and go test”

Answer 19

• Rise from hard chair w/o using arms, walk 10 ft, turn, return and sit back down

If takes >10 sec to walk 10 ft and back, 2x risk of fall
If takes >20 sec to do it, really big risk - get therapy

Question 20

Depression screen

Answer 20

2 question screen, has a geriatric depression scale

Question 21

Cognitive impairment screen

Answer 21

• MMSE: 30 pt screen

- Mini-cog = 3 item recall + clock test

Question 22

Which test on the cognitive screen is more sensitive?

Answer 22

The clock test

Question 23

Screening to enhance function - things you can really help on

Answer 23

Osteoporosis - screen all women age 65+, age 60 if risk factors

Risk factors:

• low body wt
• fragility fractures

Hearing, Vision