Complex Geriatrics Flashcards
six complex geriatric conditions
hypertension, falls/gait disturbance, osteoporosis, incontinence, polypharmacy, infections
___% of people ages 65 or older experience at least one fall each year
33%
falls are responsible for ___% of nursing home admissions
40%
intrinsic factors for falling (6)
age-related changes and dz lower extremity weakness poor grip strength balance disorders functional and/or cognitive impairment visual deficit
extrinsic factors for falling (2)
polypharmacy (> or = to 4 meds)
environmental factors
some causes of falling (7)
mental health weakness and frailty vision defects musculoskeletal neuro epilepsy stroke heart problems environment
two most frequent causes of gait impairment
myelopathy and multiple cerebral infarcts
which assessment tool measures risk of falling? what five things does it measure?
stratify risk assessment tool: previous falls, agitation, impaired vision, frequent toileting, Barthel score of 3 or 4
what does the Barthel index assess? what seven actions do you look at to make this score?
transfer and mobility: chair transfer, bathing, ambulation, dressing, toileting, grooming, feeding
what are three environmental modifications for falling?
wheelchair, bed alarm, hip protectors,
what environmental modification does not reduce fall?
physical restraints
what do you counsel your falling pt on? (4)
reviewing meds associated with falls, discuss exercise, importance of improving or maintain good gait/balance, treating the foot problems
what type of exercise increases strength/endurance? exercise that improves balance and mobility?
weight bearing; tai chi
what are two measures of balance assessment?
functional reach test and get-up and GO
how does the functional reach test work?
Assesses how far the individual can reach beyond arm’s length while maintaining a fixed base of support while standing. The patient should be able to move the fist a distance of 15 cm; risk for falling is evident if the individual moves the fist <15 cm
what does the get-up and go test assess?
An older adult who moves less than 3 feet/second is at risk of falling; the higher the score, the greater the risk of falling
what are the two types of primary osteoporosis? define them
type 1 postmenopausal: when women’s estrogen decreases (increase in resorption)
type 2 senile: thinning of trabecular and cortical bone (leads to hip and vertebral fractures)
what are two main conditions that can lead to secondary osteoporosis? by what process do these conditions affect bone density?
hyperthyroidism or leukemia; their meds cause bone breakdown
supplement treatment options for osteoporosis?
calcium- decreases bone turnover reducing bone loss
vitamin D- increases calcium absorption from GI tract
what is urinary incontinence? is it part of aging?
unintentional leakage of urine at inappropriate times; not a normal change of aging
what are the two most prevalent subgroups of incontinence?
nursing home residents and homebound elderly persons (about 50% for both)
what are seven things that can cause acute incontinence?
DRRIIPP drugs/delirium retention of urine restricted mobility impaction infection polyuria prostatism
what are three types of chronic incontinence?
urge, stress, and overflow
what is urge incontinence?
results from bladder contractions that overwhelm the ability of the cerebral centers to inhibit them
what is stress incontinence?
malfunction of the urethral sphincter that causes urine to leak from the bladder when intra-abdominal pressure increases
what is overflow incontinence?
urine retention with bladder distention: urine accumulates until max bladder capacity is reached, then urine leaks through urethra and causes dribbling
treatment options for osteoporosis? (5)
behavior treatments, kegel exercises, medication, pessary, surgery
what is polypharmacy?
concurrent use of 5 or more drugs
__% of people over 75 years old take four or more meds
36%
long term care team patients are on an average of ____ meds
seven
what is the beer’s criteria
this is a list of meds that should be avoided in older adults
NSAIDS cause what disease? which leads to what meds in elderly?
NSAIDS - HTN - BP meds
decongestants leads to what condition? which leads to what?
decongestant - urinary retention - more meds
CCB used for BP management can lead to what?
constipation, which can cause a pt to need a laxative
HCTZ used for BP management can lead to what?
gout, which can lead to more treatment
what can the drug metoclopramide lead to?
parkinsonism
what are some negative outcomes of polypharmacy? (7)
non adherence, ADRs, DDI, increased risk of hospitalization, medication errors, cost, potentially inappropriate medications
three main infections in geriatric patients?
pneumonia, UTI, C diff
most common signs of UTI in elderly?
burning when peeing or abdominal pain (before mental status changes)
people who are on what drug for a long period of time are more prone to getting C dif?
PPIs
what are two first line meds for C dif?
vancomycin or flagyl
