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Clinical Disciplines II > Comprehensive Geriatric Assessment > Flashcards

Comprehensive Geriatric Assessment Flashcards

1
Q

Goal of comprehensive geriatric assessment?

A

maximize overall health w/aging

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2
Q

Who should receive a comprehensive geriatric assessment?

A

elderly pt’s w/ heart failure or CA, psychosocial disorders, isolation, dementia, falls, prior/predicted high health care utilization, change in living situation

exclude: pt’s too well or too sick to benefit

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3
Q

What are 2 things that are NOT inevitable consequences of aging?

A

decline in fx and loss of independence

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4
Q

Similarities and differences from standard medical eval?

A

Incorporates all facets of a conventional medical history

Includes non-medical domains

Emphasis on functional capacity and quality of life

multidisciplinary team

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5
Q

What is included in a structured multidimensional approach?

A
  1. functional capacity
  2. physical health (pharmacy)
  3. cognition/mental health
  4. socio-environmental
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6
Q

What is functional capacity?

A

person’s ability to perform tasks that are required for living.

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7
Q

What can signal the need for more in-depth eval’s of the pt’s socio-environmental circumstances and need for adtn’l assistance

A

Deficits in Basic Activities of daily living (ADL)
and
Instrumental activities of daily living (IADL )

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8
Q

Examples of Basic ADL’s

A

self-care activities that a person performs daily

Eating, dressing, bathing, grooming, transferring to bed/chairs, using toilet, controlling bladder and bowel fx’s

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9
Q

What tool can you use to assess ADL’s?

A

Katz Index of independence

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10
Q

Examples of IADL’s:

A

activities needed to live independently

housework, meal prep, taking meds properly, managing finances, telephone use

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11
Q

What tool can you use to assess IADL’s?

A

Lawton instrumental activities questionnaire

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12
Q

what are 5 specific topics related to physical health?

A
  1. Nutrition
  2. Vision/hearing
  3. Fecal and urinary continence
  4. Balance and fall prevention, osteoporosis
  5. Polypharmacy
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13
Q

What are some concerning vital signs?

A

BP - HTN or orthostatic hypotension
HR - brady or afib
RR - >25
temp - hyper/hypothermia

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14
Q

what signs are you looking for on a cardiac exam?

A

S4
systolic ejection
regurgitant murmurs

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15
Q

what signs are you looking for on a pulmonary exam/breast exam?

A

barrel chest, SOB, masses

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16
Q

what signs are you looking for on abdomen, GI, genital/rectal exam?

A

pulsatile mass, atropy of vaginal mucosa, constipation, fecal incontinence, prostate enlargement/nodules, rectal mass, occult blood, urinary incontinence

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17
Q

what signs are you looking for on extremity exam?

A

abnormalities of the feet, diminished or absent lower extremity pulses, heberden nodes

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18
Q

what signs are you looking for on muscular/skeletal exam?

A

diminished ROM, pain, dorsal kyphosis, vertebral TTP, back pain, gait disturbances, leg pain, muscle wasting, proximal muscle pain or weakness

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19
Q

what signs are you looking for on skin exam?

A

erythema, ulceration over pressure points, unexplained bruises, premalignant lesions

20
Q

Which vitamins are often deficient in elderly?

A

vitamins A, C, D, and B12 calcium
iron
zinc

21
Q

4 components specific to geriatric nutrition assessment?

A
  1. nutritional health checklist for nutrition hx
  2. 24hr dietary recall
  3. PE for s/s assoc. w/inadequate nutrition or overconsumption
  4. select lab tests
22
Q

Low vision is assoc. w/

A

increased risk of falls, decline in cognition, and increased rates of depression

23
Q

what are some common causes of vision impairment?

A

presbyopia, glaucoma, diabetic retinopathy, cataracts, and ARMD (age-related macular degeneration)

24
Q

Who should vision assessments be performed on?

A

adults with recent cognitive decline, functional impairment, or falls

25
Q

hearing loss is assoc. w/…

A

depression, social isolation, poor self-esteem, increased hospitalization rates, cognitive decline, and functional disability

26
Q

who should you screen for hearing loss and how?

A

adults over 65

asses w/ surveys, whisper voice test and audiometry

27
Q

What questionnaire can you use to assess hearing loss?

A

hearing handicap inventory for the elderly

28
Q

what is one potential cause of hearing loss?

A

ototoxic drugs

29
Q

who should you refer to if having hearing loss?

A

Otolaryngologist

30
Q

TOC for hearing loss?

A

hearing aids

31
Q

urinary incontinence complications?

A

decubitus ulcers, sepsis, renal failure, urinary tract infections, and increased mortality

32
Q

what major decision do you have to consider if elderly pt is having urinary incontinence?

A

nursing home placement

33
Q

what should you look for on PE for incontinence?

A

evaluate fluid overload
neurologic function
mobility

34
Q

what diagnostic tool can you use to assess balance and fall prevention?

A

tinetti balance and gait evaluation: get up from chair, walk 10 ft, turn around and come back

35
Q

how can older persons decr their fall risk?

A

exercise, PT, home hazard assessment, withdrawal of psychotropic meds

36
Q

osteoporosis may result in…

A

low impact or spontaneous fx’s

37
Q

how does the USPSTF recommend screening of women 65+ y/o for osteoporosis?

A

DEXA of the femoral neck

38
Q

which tool can helps with medication assessment to reduce adverse effects?

A

Beers criteria (list of meds inapprop. for elderly)

39
Q

what are some atypical sxs that older pt’s w/depression present w/?

A

somatic complaints, cognitive, functional problems, sleep problems, fatigue

40
Q

What 2 Q’s should you use to eval depression in elderly?

A
  1. during past mo. have you been bothered by feeling down, depressed, or hopeless?
  2. during past mo. have you been bothered by little interest or pleasure in doing things?
41
Q

what is the next step if positive screen for depression w/2 Q’s screener?

A

7 additional questions to complete PHQ-9

42
Q

What does an eval of dementia include?

A 
thorough history
brief cognition screens
detailed mental status exam neuropsychologic testing
labs (Vitamin B12, TSH)
depression assessment
radiographic imaging
43
Q

what is the most widely used cognitive test for dementia?

A

MMSE (mini mental status exam)

44
Q

how do you perform mini-cognitive assessment?

A

step 1 –> repeat 3 unrelated words

step 2 –> pt draw clock set to 11:10

step 3 –> recall 3 words from step 1

45
Q

what does a brief screen of socioenvironmental circumstances include?

A

social support - who would be available to elder if they become ill

Clinical Disciplines II (4 decks)

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