Approach to older adults Flashcards
Lens accommodation begins to decrease between what ages?
40-50 years old
Hearing decline begins at what age?
12 years
Bone mineral content plateaus a what age?
20 years
What does the rule of 4ths measure?
Causes of functional decline
What is the rule of 4ths?
1/4 disease, 1/4 disuse, 1/4 misuse, 1/4 physiologic
10 Geriatric Giants
Delerium Depression Dizziness Dysphagia Falls Frailty Polypharmacy Incontinence Syncope
ADL’s
DEATH Dressing Eating Ambulating (walking, up/down stairs) Toileting Hygiene
IADL’s
SHAFTTT Shopping Housework Accounting Food preparation Transport Telephoning Taking medications
Describe how to perform/measure Tinetti balance and gait evaluation
Observe patient from getting up from chair without arms, walk 10ft and turn around and return to sitting (should take < 16 seconds)
Immunizations to consider for older adults
Tdap - 1 time
Td - Q 10 years
Hep A & B - high risk groups
Influenza annually
Pneumovax 23 (1 dose > 65 and repeat dose if high risk) /13 (if high risk)
Shingrix ( > 50 years, not covered)
Varicella - no history of infection/vaccination, 2 doses 6 weeks apart
Breast cancer screening for average risk age 50-74
Mammogram Q 2 years
Breast cancer screening for average risk >/= 75 years
Discuss benefits/limitations, eligible Q2-3 years
Breast cancer screening age 40-74 with first degree relative with breast cancer
Q 1 year mammogram
Screening mammograms are recommended ____ if you are between _____ and at least one of the following applies to you:
You are a BRCA1 or BRCA2 carrier;
You are an untested first degree relative of BRCA1 or BRCA 2 carrier;
You have a very strong family history1 of breast cancer; or,
You have had prior chest wall radiation.
Yearly, 30-74 years
All of the following are NOT eligible for mammogram EXCEPT:
a) have breast implants
b) pregnant or breastfeeding
c) have had mammogram on one breast in last 12 months
d) have had mammogram on both breasts in last 12 months
e) new breast complaints ie. lump or discharge
C
Cervical cancer screening frequency and age to start/stop
Q3 years, 25-69 years
A 70 year old comes into the clinic asking about cervical screening. They have not been screened in the last 10 years and have no history of cervical cancer or abnormalities. What is your next steps?
Complete PAP and can discontinue when there has been 3 negative screens in past 10 years
Colon cancer screening for average risk asymptomatic 50-74 years
FIT Q2 years (follow up all + FIT with colonoscopy) OR
colonoscopy Q10 years
Acute mesenteric ischemia: typical S+S (may be more vague in elderly)
Pain out of proportion to PE findings
N/V/D
may have post prandial pain
AAA - typical S+S (may be more vague in elderly)
HypoTN
Abdo or back pain
pulsatile abdominal mass
hematuria
Bowel obstructions: typical S+S (may be more vague in elderly)
abdo pain constipation vomiting sometimes overflow diarrhea
Commonly missed surgical emergency
Name this GI condition based on the below S+S
Typical presentation
- Fever, nausea
- Change in bowel regimen (constipation, diarrhea or tenesmus)
- LLQ pain, leukocytosis
- +/- lower GI bleeding
Elderly presentation
- GU S+S
- afebrile
- normal PE
- +/- lower GI bleeding
Diverticulitis
** most common cause of GI bleeding in the elderly
What percentage of elderly patients with appendicitis DO NOT present with the classic S+S:
- RLQ pain, fever, leukocytosis, anorexia
2/3rds
< 1/3 of elderly patient with appendicitis present with the classic S+S
Peptic ulcer disease
A) typical presentation
B) elderly presentation
A) Abdo pain, rigidity, melena
B) often don’t have abdo pain or rigidity
*** moral of the story, ask about poop colour
What is the most common location of acute mesenteric ischemia (hint, remember A+P for GI arterial circulation… what artery innervates the majority of the GI tract)
Superior mesenteric artery (small intestines and the ascending and transverse colon)
Acute cholecystitis is the most common sx emergency in the elderly name the typical S+S of this condition and explain how elderly pts may present differently
Typical presentation: Fever, RUQ pain, N/V, leukocytosis, abnormal LFT
Elderly may have NONE of the above S+S….
What cardiac conditions increase your risk of acute mesenteric ischemia (HINT: which cardiac conditions increase risk of thromboemobolism)
Atrial fibrillations
dilated cardiomyopathy
arrhythmias
valcular disease
What symptom is indicative of a narrowing supermesenteric artery (i.e. intestinal equivalent of stable angina/CAD)
post prandial abdod pain
intestinal angina
S+S of AAA can mimic what two common conditions
renal colic
acute back pain
Name some cuases of small bowel obstructions
Hernias
Adhesions
Neoplasms
Gall stone ileus
Name some causes of large bowel obstructions
Neoplasms
Diverticulitis
Volvulus
Name common conditions that mimic S+S of divertitculitis
UTIs
renal colic
appendicitis
Non-abdominal causes of abdo pain related to each of the below systems
A) Cardiac B) Pulmonary C) Metabolic D) GU E) Misc
A) MI, CHF, pericarditis
B) pneumonia, PE, pleural effusion, pneumothorax
C) DKA, addisonian crisis, hypercalcemia
D) cystitis, pyelonephritis, prostatitis, urinary retention
E) Herpes zoster (difficult to diagnosis pre vasicular phase)
Best imaging tests for mesenteric ischemia
Best diagnosed with angiography
CT next best if angiography not available
Imaging for AAA
Abdo US or CT
Imaging for small bowel obstructions
Xray > if not visible but still high index of suspesion > CT
True or false: CT is the best choice of imaging if you suspect cholecystitis
False - U/S preferred
True or False: CT is the best choice of imaging if you suspect pancreatitis or appendicitis in the elderly
True - no change to imaging approach with the elderly for these conditions
Tx for outpatient managment of diverticulitis in the elderly?
[Septra &
Metronidazole]
Or
[Ciprofloxacin &
Metronidazole]
Or
Amoxicillin-clavunate
** from bugs and drugs, couldn’t find anything in text or notes (5-7 days of treatment for all abx options)
