approach to geriatric patients

Question 1

presentatoin of acute illness in elderly

Answer 1

often nonspecific- weakness, dizziness, falls, confusion, dyspnea (acute MI)

Question 2

Infections in elderly

Answer 2

Fever may be absent in 20%-30% elderly w/serious infxn. Fever may be absent in 30-50% frail elderly w/serious infxn. A single temp >100F, or repeated over 99F, or a rise >2F over baseline is indicative in elderly of infection

Question 3

clinical consequences of immobility while in hospital

Answer 3

Orthostatic intolerance , Loss of muscle mass within 24hrs supine position, functional decline

Question 4

components of geriatric assessment

Answer 4

function: Activities of daily life and instrumental activities of daily life, mobility/ falls, continence. Physical: meds, nutrition, alcohol, vision and hearing. Mental: depression, cognition, competence. Social: support systems, advanced directives

Question 5

list acitivties of daily life and which is usually the first need for help

Answer 5

bathing (first needed), dressing, transferring, toileting, grooming, feeding

Question 6

List instrumental activities of daily life

Answer 6

telephone, shopping, food prep, housekeeping, doing laundry, transportation, medicating, handling finances

Question 7

screening for falls

Answer 7

Get up and go test- rise from chair w/out arms, walk 10ft, return and sit back down. If time >10 seconds, increased fall risk. If time >20 s consider therapy referral

Question 8

screen for depression

Answer 8

2 question screen, geriatric depression scale

Question 9

cognitive impairment screen

Answer 9

mini mental status exam (30 pts), mini-cog (3 item recall plus clock test)

Question 10

when to screen for osteoporosis

Answer 10

All women 65 yrs and older. Start at 60yrs if low body weight (best predictor of low bone mineral density) or fragility.

Question 11

hearing screening

Answer 11

inquire about difficulties

Question 12

vision screening

Answer 12

annual snellen and gluacoma screen every 2 years starting at 60yrs (as early as 40 yrs if African American)