Approach to Geriatric Patient Flashcards
Differences in clinical presentation of falls and weight loss of geriatric patients
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)
Presentation of acute illness in geriatrics
- 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
Wadao
weak and dizzy all over
What is the #1 symptom of old old ppl with MI?
Dyspnea - can’t catch breath
How does a febrile illness presentation differ?
- 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
Adjusted febrile criteria for old old
Single temp > 100 degF
Repeated temp >99 degF
or rise in temp > 20 degF
Every day spent in bed takes __ days to get back to wehre you started
2-3 days for every day in bed
Clinical consequences of immobility
- 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
Approaches to improving immobility
- 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
Majority of adults have __ or more conditions
3 or more
Polypharmacy
> 5 drugs
What we ask about age vs what we should be asking
Chronological age vs. Physiological age
Functional assessment
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
Components of geriatric assessment
- Functional
- Physical
- Mental
- Social
Can you go home if you can’t do IADLs?
Yes, but you may need some kind of assistance like assisted living
Can you leave the hospital if you cannot do ADLs?
Nope.
What is the first and last thing to go for ADLs?
First to go is bathing, last to go is feeding
What to do with medication review for geriatrics
- Try never to add more pills
- If you add a pill, try to remove one too.
“Get up and go test”
- 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
Depression screen
2 question screen, has a geriatric depression scale
Cognitive impairment screen
- MMSE: 30 pt screen
- Mini-cog = 3 item recall + clock test
Which test on the cognitive screen is more sensitive?
The clock test
Screening to enhance function - things you can really help on
Osteoporosis - screen all women age 65+, age 60 if risk factors
Risk factors:
- low body wt
- fragility fractures
Hearing, Vision
