Approach to older adult Flashcards
9 geriatric giants
Delerium Depression Dysphagia Dizziness Frailty Falls Urinary incontinence Syncope Polypharmacy
ADLs
DEATH Dressing Eating Ambulation Toileting Hygiene
IADLs
SHAFTTT Shopping Housework Accounting Food prep Telephoning Transportation Taking medications
If asymptomatic patient has >____ year survival, screening is warranted
5 year surivival
Osteoporosis screening
Female, DEXA >/= 65 years
Tinetti balance and gait evaluation
getting up from chair without using arms, walking 10 feet, turning around and returning to seated. Normal if < 16 seconds
Pneumovax 23
1 dose if > 65 years, booster 5 years following if high risk (CKD, immunocompromised, liver disease, etc.)
Prevnar 13
1 dose if HIGH RISK given 8 weeks prior to pneumovax 23. If given after pneumovax, wait 1 year
Shingrix
Recommended over age 50 years, not covered, 2 doses 2-6 months apart. Wait 1 year if patient had shingles or received Zostavax.
Breast cancer screening average risk 50-74 years
Q2 years
Higher than average risk for breast cancer (first degree relative)
40-74, Q 1 years
When to screen for breast cancer between 30-40 years
if BRCA gene in 1st degree relative
All of the following are examples of what?
Pregnant/breastfeeding
Have breast implants
Previous hx of breast cancer
New breast complaints
Had mammogram on both breasts < 12 months ago
Mammogram ineligibility
Cervical cancer screening frequency and when to start
Every 3 years >/= 25 years to 69 years
If 2 negative screens in past 10 years and 69 years, can cervical cancer screening be stopped?
No, requires 3 negative screens in previous 10 years
Colon cancer screening, average risk - age and frequency
50-74, FIT Q2 years or colonoscopy Q10 years
All of the following are examples of increased risk of colon cancer. When to screen these individuals for colon cancer?
- One 1st degree relative < 60 years with colon ca
- Two 1st degree relatives at ANY age
Colonoscopy Q5 years starting at age 40 or 10 years earlier than youngest affected relative
If previous IBD involving most of colon for + 8 years of left colon for 15+ years, how often should this person be screened for colon cancer?
Colonoscopy Q1-2 years
True/False
Screening is not reccomended if > 85 years for colon cancer
True
True/false
PSA is indicated for men < 55 years or > 69 years with < 10 year life expectancy with no risk factors
False
True/False
PSA testing may be considered every 2 years if >/= 40 years with additional risk factors
True
If you intend to order PSE, what physical exam should be performed in combination?
DRE
All of the following are risk factors for what type of cancer?
- Age > 40
- Male gender
- Caucasian
- overuse of analgesic drugs
- environmental exposure ie. tobacco workers, nurses, electricians, hairdressers, etc.
bladder cancer
If + microscopic hematuria on UA, what is the next tests you would order and what component of PE is important to complete?
serum Cr
Urine ACR
Consider KUB US
BP
If > 40 and + imaging findings on KUB with presence of additional risk factors for cancer, what would be your next step?
Refer to urology for cystoscopy
Loss of 10 lbs in 6 months is concerning. True/False
True
Primary stroke prevention if 10 year risk of CAD is > 6 %
ASA
Dietary calcium intake reccomendation
1200-1500 mg day
Vitamin D reccomendation
600IU -1000 IU/day
What pharmacokinetic factor is least impacted by age?
Absorption
True/False
Increased body fat results in shorter elimination phase and lower therapeutic effect with phenytoin, valproic acid, diazepam and amiodarone (fat soluble)
False, longer elimination phase and higher therapeutic effect/toxic effect
True/False
Albumin increases with chronic illness
False, it decreases
What test/calculation is useful for determining medication excretion ability in older adults?
Creatinine clearance
Creatinine is a reliable measure of renal function in older adults. T/F?
False, decreased creatinine with decreased muscle mass
True/False
Thyroid abnormalities impact digoxin kinetics as well as CHF and renal impairment
True
> 0.125mg dose of digoxin is safe to administer in elderly for HF. T/F?
False
Yellow/green vision, haloes and photophobia are all ocular signs of what?
Dig toxicity
What screening tools for frailty should be used:
General screening (1)
Mobility (2)
Cognitive impairment (2)
General - PRISMA-7 (>/= 3 is frail)
Mobility - gait speed test (> 5 seconds over 4 m is abnormal) or TUG (>10 seconds indicates frailty)
Cognitive impairment - MOCA, MMSE
What is the therapeutic range for digoxin in older adults?
0.5-0.9 nmol/L, < 1 has reduction in morbidity and mortality
HR changes are seen in acute and chronic toxicity with digoxin. Explain what these are.
Brady in acute
Tachy in chronic
What is the target range for older adults for TSH?
0.5-7.5 instead of 0.5-5 in adults
What pharmacokinetic is more affected in the elderly?
Excretion
T/F
In older adults, decreased albumin results in higher rates of unbound drugs/free drugs that can increase risk of toxicity
True
First pass metabolism is ___ in older adults
Decreased
Decreased CYP450 metabolism starts to occur at what age
40
Digoxin - no adjustment if CrCl >/= ____
Ramipril = no adjustment if CrCl >/= ____
Bisoprolol = no adjustment if CrCl >/= ____
Digoxin = no adjustment if CrCl >/= 60 Ramipril = no adjustment if CrCl >/= 40 Bisoprolol = no adjustment if CrCl >/= 20
Adverse drug effects of HCTZ
hypotension
photosensitivity (BCC risk)
Acute angle glaucoma
Gout
Adverse drug effects of ramipril
cough
angioedema
hypotension
S&S of thyrotoxicosis
“SWEATING”
sweating weight loss emotional lability appetite increased Tremor/tachycardia Intolerance to heat/ irregular menses Nervousness Goitre/GI disturbance
Dig ADE
N/V
Visual changes
Hypotension, dysrhythmias (v. fib), palpitations
BB ADE
fatigue insomnia/vivid dreams sexual dysfunction depression bronchospasm heart block
T/F
High calcium and low magnesium can increase dig toxicity?
True
Tight control of TSH can decrease bone density in older adults. T/F?
True
TSH is lower at night and higher during the day. T/F?
False.
TSH is higher at night and lower during the day
How to take synthroid. Instructions for patients.
Empty stomach. 30-60 minutes before breakfast. 4 hour sbefore or after iron, calcium or antacids
Bisoprolol is often tolerated better if taken in the morning. T/F?
False, can make tired during the day. Take at night.
Define sarcopenia
muscle wasting
Iatrogenic disease: define and 3 most common in elderly.
illness caused by medical interventions
ADE, AKI, adverse surgical outcomes
HTN initial diagnostic workup
UA electrolytes FBG A1C Lipid profile ECG
What 5 symptoms constitute frailty? “FRAIL”
Fatigue Resistance - weak grip Ambulation (slow walking speed, low physical acitivity) Illnesses Loss weight
Hearing screening frequency in older adults
Q2 years > 60 years
Eye screening frequency for DM
1-2 years
Screening for falls risk, frequency
Annual
