Approach to Geriatrics

Question 1

What age range is considered:
Elderly: __-__ y/o
Old: __-__ y/o
Very Old: __-__ y/o

Answer 1

Elderly: 65-75 y/o
Old: 76-90 y/o
Very Old: >90 (80 according to mike lamb) y/o

Question 2

What is the average lifespan for a person who is 65 y/o?

How does this differ for women? Men?

Answer 2

18.8 years

Women: 20 yrs
Men: 17.3 yrs

Question 3

What are the components of the biology of aging?

Answer 3

Free Radicals
Errors and Somatic Mutations
Wear and Tear
Pacemaker
Immunologic

Question 4

What is the “rule of 1/4” attributed to decline and aging?

Answer 4

1/4 - Dz
1/4 - Disuse
1/4 - Misuse
1/4 - Actual physiologic aging

Question 5

What lifestyle factors are involved in successful aging?

Answer 5

Exercise
Diet
Intellectual stimulation
Stop smoking

Question 6

What should you establish upon entering a room to evaluate an elderly pt?

Answer 6

Can they…
See?
Hear?
Cognition?

Question 7

Geriatrics commonly present (Typically/Atypically) w/ illnesses

Fevers are (Common/Uncommon) in geriatrics

Answer 7

Atypically

UNCOMMON
***Use their temp + 1 to evaluate if they have a fever

Question 8

Generally community/outpatient settings and hospital inpatient w/ specialized units reduce pt ____, ____ , Delayed development of _____, and increased ____

Whereas a hospital inpatient w/ consultation teams has ____ results

Answer 8

Reduce mortality, permanent SNF use,
Delayed development of disability
Increased function

Mixed results

Question 9

With evaluative H/P and Dx work-up, what do you need to consider in the geriatric population?

Answer 9

Prognosis
Values and preferences
Ability to fxn independently

Question 10

What are special tests that should be used to assess function in a geriatric pt? (x4)

Answer 10

Cognition
Depression
Mobility
Senses

Question 11

What determines the need/utilization of preventative screening in a geriatric pt?

Answer 11

Life expectancy

<10 years life expectancy: focus on QOL and harm vs benefit

Question 12

What lifestyle topics should you address w/ a geriatric pt?

Answer 12

Smoking, alcohol, drug use
Sex
Exercise
Nutrition

Question 13

What are the 4 questionnaires that can be used to evaluate spiritual hx?

Answer 13

HOPE
FICA
SPIRIT
FACT

Question 14

What does SPIRIT stand for?

Answer 14

S: Spiritual belief system
P: Personal spirituality
I: Integration w/ a spiritual community
R: Ritualized practices and restrictions
I: Implications for medical care
T: Terminal events planning

Question 15

When obtaining a functional assessment, input from (a single source/multiple sources) is helpful

Answer 15

multiple sources

Question 16

What does IADL stand for? ADL?

What is the difference between the two?

Answer 16

IADL: Instrumental Activities of Daily Living
ADL: Activities of Daily Living

IADLs are more complex activities than ADLs (basic care tasks)
IALDs - used to assess if they can live in the community independently
ADLs - used to assess if they can live at home/alone

Question 17

T/F: Bacteria in the urine must be tx in geriatric women and men

Answer 17

False: if a women in asymptomatic, they do not need tx

Men ALWAYS need tx

Question 18

What is included in the Mini Cognitive Test?

Answer 18

1. Tell them 3 words (apple, table, penny)
2. Have them do the clock drawing
3. Ask them to repeat the 3 words

Question 19

How are the points dispersed in the mini cognitive test?

What is a (+) result for dementia
What is a (-) result for dementia

Answer 19

1 point: All numbers are depicted once each, in correct sequence and positioned appropriately on clock face

1 point: The hands reasonably displayed the requested time

1 point: Per word recalled

(+) 0-2
(-) 3-5

Question 20

What is a normal animal naming test?

Answer 20

Name x14 four-legged animals in 1 minute

Question 21

What are the parts of a MOCHA test (Montreal Cognitive Assessment)
** Probably don’t need to know all of this……

Answer 21

Visual spatial/ Executive
Naming
Memory
Attention
Language
Abstraction 
Delayed recall 
Orientation

Question 22

What are common S/s that an elderly pt is suffering from depression?

Answer 22

Vague sx and somatic complaints

**check meds and conditions that can mimic depression

Question 23

What are the screening tools for depression?

Answer 23

PHQ-9 (or PHQ-2)

Geriatric depression scale

Question 24

How should you assess balance?

Answer 24

Seated
Transition
Walking

Question 25

How is the timed “Get up and Go” test performed?

Answer 25

1. Begin timing
2. Rise from standing arm chair
3. Walk in line on floor, ~10 ft away from chair (3 meters)
4. Return to chair
5. Sit in chair again
6. End timing

Question 26

How is the timed “Get up and Go” test scored?

Answer 26

< 10 seconds good - education
< 20 seconds fair – needs intervention
≥ 20 seconds – needs workup if no known condition

Question 27

What factors place an older adult at risk for nutritional deficiencies? (x9)

Answer 27

Chronic dz  
Drugs
Dental issues
Depression
Decreased taste and smell
Food fads
Isolation 
Low SES
Physical weakness

Question 28

What is the WILDA assessment guide used for?

Answer 28

Pain assessment tool

it is basically OLDCARTS

Question 29

What are the 4 screenings that should be performed w/ an elderly pt at each visit?

Answer 29

PEE
POOP
SLEEP
FOOD

**old people are basically larger babies

Question 30

What is involved in end of life care?

Answer 30

Living wills
DNR/MOST forms (medical orders for scope of tx)
POA/HCPOA

Question 31

What is the difference between a DNR and a MOST form?

Answer 31

DNR: intended for pts not originating from a hospital or nursing home, not intended for use in facilities and only applies to pts in full cardio or pulmonary arrest

MOST form: for pts to document their end-of-life care preferences and to assure that those preferences are made known to health care providers across the health care delivery system