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Comprehensive Geriatric Assessment Flashcards

1
Q

How many people in the history of the world who have ever lived to age 65 are alive TODAY

A

2/3

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2
Q

By 2050 people age 65 and older will equal ??? percent of the population?

A

20%

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3
Q

What is estimated need for geriatricians?

A

20,000 +

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4
Q

What is the actual amount of geriatricians?

A

7, 600 -

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5
Q

What is a geriatrician?

A

a physician that is well grounded in internal medicine, and be experienced in neurology, psychiatry, and rehabilitation medicine. And possible additional role as organizer and coordinator of health services for old people

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6
Q

What does a geriatric syndrome consist of ?

A

multiple etiological factors
Interacting physiologic pathways
Unified manifestation

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7
Q

What is homeostenosis?

A

The ability to maintain homeostenosis in our body begins to go down.

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8
Q

When disease severity begin to increase, what happens to compensatory mechanisms?

A

Decreases

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9
Q

What is the goal of comprehensive geriatric assessment?

A

develop coordinated and integrated plan for long term care and follow up

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10
Q

What should be done for a “ too well to benefit” patient?

A

promote health
maintain functional independence
Emphasize self care practices
Identify early dysfunction in the home environment

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11
Q

What should be done for a “appropriate geriatric pt”

A

recovery of health and education
Prevention of disability
Maintain home environment
monitor environment functional status to asses effectiveness of intervention

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12
Q

What should be done for “too sick to benefit”

A

supportive care during a time of dependence and decline
Respect dignity during a period of expected decline
Monitoring of function, caregiver support, and the home environment

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13
Q

What are the 5Ms of geriatrics?

A 
Matters Most
Mind
Mobility
Medications
Multi- complexity
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14
Q

Maintaining the ability to walk/and or maintain balance

A

Mobility

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15
Q

The single best predictor of institutionalization?

A

impaired functional staus

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16
Q

Self- reported function is an accurate predictor of ??

A

health risks and costs

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17
Q

Pre admission ADLs are the highest in?

A

eating

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18
Q

Discharge ADLs lost are the highest in?

A

eating

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19
Q

What are 5 reasons for IADL losses?

A 
Cognitive impairment
Physical impairment
Psychological factors
Inadequate caregiver/ social support
Unfriendly environment
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20
Q

What is the goal of targeting medications?

A

reducing polypharmacy
de-prescribing
prescribing txt exactly for an older person needs
helping build awareness of harmful medication effects

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21
Q

What 4 things makes medication use so challenging in older adults?

A

low representation in research
Health system factor that compound complexity
Polypharmacy
Physiologic changes (PK.PD)

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22
Q

How the body reacts to a medication?

A

Pharmacokinetics

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23
Q

How the medication reacts to the body?

A

Pharmacodynamics

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24
Q

In the elderly effects of drugs at similar concentrations are ??

A

more pronounced

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25
Q

How many meds are considered polypharmacy?

A

> 5

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26
Q

What are 5 problems of polypharmacy?

A 
disability 
frailty
drug-drug interactions
impaired cognition
slowed gait speed
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27
Q

The elderly account for ?? percent of drug costs in the US?

A

33%

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28
Q

The average elderly person is on ?? of prescription drugs and ?? OTC drugs at any given time

A
  1. 5 prescription drugs

3. 5 OTC

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29
Q

What is deprescribing?

A

Planned or supervised process of DOSE REDUCTION or STOPPING MEDICATION(S) that may be causing HARM or NO LONGER PROVIDING BENEFIT

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30
Q

What are the 5 steps to deprescribing protocol?

A
  1. Reconcile all medications
  2. Consider risks/ benefits of use
  3. Assess eligibility
  4. Prioritize
  5. Implement and monitor deprescribing
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31
Q

What are 4 medication assessment tools?

A

American Geriatrics Society Beers Criteria
Medication Appropriateness Index
Anticholinergic Risk scale
STOPP and START

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32
Q

What are things you should consider in priority?

A 
benefit vs harm
easiest to discontinue
patient "buy-in"
complex regimens
cost
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33
Q

What are some anticipated barriers?

A

rebound s/s
withdrawal s/s
patient attachment
patient/provider relationship

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34
Q

Stopping a medication should be done with the ….

A

same considerations as starting one

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35
Q

Maintaining mental activity, helping treat and prevent delirium

A

Mind

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36
Q

T/F Dementia is normal aging?

A

FALSE

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37
Q

What is the life expectancy after symptoms of dementia begin?

A

8-10yrs

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38
Q

How is dementia diagnosed?

A

Decline in at least 2 areas + a decline in functional status PLUS evidence of both (family complaint, neuropsych testing)

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39
Q

What is the most common type of dementia?

A

Alzheimers disease

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40
Q

What are the 3 stages of dementia?

A

preclinical, mild cognitive impairment, dementia

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41
Q

What are 3 ways to screen for cognitive impairment?

A

Mini Cog (repeat 3 words, clock draw, recall 3 words)

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42
Q

What patients should be screened for dementia?

A

When there are concerns from patient, family, caregivers

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43
Q

What should be ruled out in evaluation for dementia?

A

“reversible contributors”

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44
Q

What things make up the evaluation of dementia?

A 
History
Function
Cognition
Mood
Labs and imaging
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45
Q

What assessment can be used to r/o cognition?

A

Mini mental state exam

Montreal Cognitive Assessment (MoCA)

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46
Q

What assessment can be used to r/o mood?

A

Geriatric Depression Scale

Zarit Burden interview for caregivers

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47
Q

Brain imaging should be considered in ?

A

onset occurs at age <65 years
Neurologic signs are asymmetric or focal
Clinical picture suggests normal pressure hydrocephalus
Patient has had recent fall or other head trauma

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48
Q

What are 3 types of imaging to consider in brain imaging?

A

CT non-contrast (go to)
MRI
PET

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49
Q

What are 2 medications for dementia?

A

Acetylcholinesterase inhibitors

NMDA antagonists

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50
Q

What med should be started in the early/mild dementia?

A

AChl

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51
Q

What med should be started in middle/moderate dementia?

A

Start AChI + NMDA antagonist

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52
Q

MMSE: 26-21, MoCA 16-9

A

Early/mild dementia

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53
Q

MMSE: 20-10, MoCA 14-4

A

Middle/ moderate

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54
Q

MMSE: 9-0, MoCA 0-3

A

Late/severe

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55
Q

What med should be started in late/severe dementia?

A

Start AChI + NMDA antagonist

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56
Q

What are the side effects of AChI?

A

GI upset, nausea, vomiting, diarrhea
Bradycardia
Insomnia

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57
Q

What are the side effects of NMDA antagonist

A

GI upset
Dizziness
Confusion

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58
Q

Disturbance in mental abilities that results in decreased awareness of environment and confused thinking

A

Delirium

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59
Q

What are 3 differences in dementia vs delirium?

A

sudden onset
fluctuating course
can improve

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60
Q

What are 3 types of delirium?

A

hyperactive- least common were
hypoactive
mixed

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61
Q

What is the mortality rate for delirium?

A

VERY HIGH! 1 month 14%

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62
Q

What criteria is used to access for delirium?

A

Confusion Assessment Method (CAM)

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63
Q

What criteria is used to access for depression?

A

Geriatric depression scale

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64
Q

Helping older adults manage a variety of health conditions?

A

Multi-complexity

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65
Q

Recommendations for colonoscopy in 76-85yrs old?

A

should be an individual one, taking into account the patients overall health and prior screening history

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66
Q

Coordinating advanced care planning, helping manage goals of care?

A

Matters Most

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67
Q

What is lagtime to benefit?

A

time between the preventative intervention to when improved health outcomes are seen

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68
Q

What is a good resource for cancer screening?

A

ePrognosis

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69
Q

What 4 things do CAM test for?

A

Acute Onset and Fluctuating Course
Inattention
Disorganized Thinking
Altered Level of Consciousness

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70
Q

Diagnosing Delirium requires what 2 things?

A

Acute Onset and fluctuating Course AND

Inattention

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71
Q

What are 6 physiologic changes associated with normal aging?

A 
Less water
More fat
Less muscle mass
Slowed hepatic metabolism
Decreased renal excretion
Decreased responsiveness and sensitivity of baroreceptor reflex
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72
Q

What is NOT affected by the normal aging process?

A

Absorption

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73
Q

What can alter drug absorption?

A

Antacids

Iron

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74
Q

What diseases can effect absorption?

A

lack of intrinsic factor (B12 absorption)

Delayed gastric emptying

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75
Q

Less water = decrease volume of distribution =

A

higher concentration of water soluble drugs

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76
Q

More fat = increase volume of distribution =

A

prolonged action of fat soluble drugs (increase half life)

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77
Q

Lower serum proteins =

A

increases the concentration of unbound/ active drugs

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78
Q

Phase I metabolism is ??

A

slowed

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79
Q

Two drugs effected by Phase I metabolism?

A

Warfarin and phenytoin

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80
Q

What occurs in phase I reaction?

A

Oxidation, reduction, dealkylation

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81
Q

What occurs in phase II reaction

A

Conjugation, acetylation, methylation

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82
Q

Which phase is unchanged?

83
Q

What may NOT be an accurate reflection of renal clearance in elderly patients

A

Serum creatinine

84
Q

What makes it difficult to predict drug metabolism or drug effects in older adults?

A

clinical trials exclusion

85
Q

What are 6 medications that commonly account for ADEs in older adults?

A 
Cardio
Psychotropic
Antibx
Anticoag
Non-opioid analgesics (NSAIDS)
Anti-seizure
86
Q

What are the 7 risk factor for ADEs?

A 
> 6 chronic disease
> 12 doses/day
> 9 MEDICATIONS
Low BMI (< 22Kg)
Age > 85
Creatinine clearance < 50kml/min
History of prior ADE
87
Q

a-adrenergic activity causes?

A

urine retention and raises blood pressure

88
Q

a-adrenergic antagonist causes?

A

decrease in urinary retention and lowers bp

89
Q

Associated with significant morbidity and mortality in older adults?

A

Falls and hip fractures

90
Q

What should be done rather than treating an ADE with another medication?

A

Consider discontinuing or dose reducing

91
Q

What is Beers Criteria?

A

A list of potentially` inappropriate mediations

92
Q

What does Beers not account for?

A

Complexity of the entire medication regimen

93
Q

Dry mouth, urinary retention, constipation, confusion, deliurium?

A

anticholinergic meds

94
Q

How to prescribe meds to the elderly?

A

start one medication at a time

Start low dose and increase gradually

95
Q

What are the 4 principles to prescribing?

A

Less is more!
Think drugs!
Start low and go Slow
Assess adherence

96
Q

Belief that each of us has the right to die pain free and with dignity, and that our loved ones will receive the necessary support allow us to do so

97
Q

What are the 8 domains of palliative care?

A 
interdisciplinary team
physical
psychological and psychiatric
social
spiritual, religious, existential
cultural
imminently dying
legal ethical
98
Q

Who needs palliative care?

A

Patients of all ages suffering from a Serious, life-limiting illness

99
Q

Hospice focuses on ?? not ??

A

caring not curing

100
Q

What are the 4 domains of hospice care?

A

physical, social, spiritual, psychological

101
Q

Who is eligible for hospice services?

A

Patients of any age, religion, race or illness, regardless of health insurane

102
Q

Where is hospice care largely delivered?

A

At home (98%)

103
Q

What does Medicare cover in hospice benefits?

A

routine home care
general inpatient care
continuous home care
inpatient respite care

104
Q

What are the 4 general referral criteria for hospice?

A

Prognosis < 6mo
End stage illness
Life threatening illness
Terminal cancer willing to forgo further palliative txt

105
Q

When is palliative care most beneficial?

A

when started at diagnosis

106
Q

Those who received PC at time of diagnosis experienced?

A

better symptom control
improved quality of life
less aggressive interventions
LIVED LONGER

107
Q

When does palliative care stop?

A

DOESN’T continues through disease until death

108
Q

Who provides palliative care?

A

All HEALTH CARE PROFESSIONALS

109
Q

What is prognostication?

A

provides information to set patient goals, priorities, and expectations of care

110
Q

What 4 things make up total pain?

A

physical
spiritual
psychological
social

111
Q

What is FICA used for?

A

spiritual assessment tool

112
Q

F in (FICA)?

A

Faith, Belief, Meaning

113
Q

I in (FICA)

A

Importance and influence

114
Q

C in (FICA)

115
Q

A in (FICA)

A

Address/ Action in Care

116
Q

What are palliative care physicians primary task?

A

helping patients choose the best interventions to meet their needs in specific situations and then providing pts with the best possible care

117
Q

What does prognostication conversation help improve?

A

QOL
Decreases aggressive medical care at death
earlier hospice referral
improved bereavement for family

118
Q

What are two components of prognostication?

A

Forseeing- formulating the prediction

Fortelling- communicating the prediction

119
Q

Assess a patient’s understanding of information?

A

Ask-tell-Ask

120
Q

What does SPIKES stand for?

A 
S- Setting
P- Perception
I- Invitation
K- Knowledge
E- Emotions
S- Strategy/Summary
121
Q

What does NURSE stand for?

A 
N- Name the emotion
U- Understand
R- Respect
S- Support
E- Explore
122
Q

What 4 phrases to avoid?

A

There is nothing more we can do for you
Would you like us to do everything possible
Withdrawal of care
It is futile

123
Q

The movement of a patient from one setting of care to another

A

Transitions of care

124
Q

Changes in the level, location, or providers of care as patients move within the healthcare system

A

Transitions of care

125
Q

What is the key problem in TOC?

A

Information is often not available to those who need it when they need it

126
Q

Who is at a risk for complicated care transition?

A

Older adults

127
Q

8 P’s

A 
Problems w/ meds
Psychological 
Principal diagnosis
Physical limitations
Poor health literacy
Patient support
Prior hospitalization
Palliative care
128
Q

What 3 P’s are not included?

A

Lack of Primary care
Public support used by pt
Poor mobility status

129
Q

Best for older adults who require only intermittent skilled services?

A

home health care

130
Q

Medicare requires that older adults who receive home health care be ??

131
Q

Medicare covers up to how many days of skilled nursing care?

A

100 days after a hospital stay

132
Q

What does a safe transition include?

A

communication and coordination of care

133
Q

What is the requirement for acute rehabilitation?

A

must be able to participate in 3 hrs per day of intense therapy

134
Q

What is the most common type of nursing homes?

A

For profit (68%)

135
Q

Provide only personal assistance that can be performed by someone with little or no medical training?

A

Assisted Living Facilites

136
Q

Custodial Care?

A

assisted living or nursing home

137
Q

What is the least common type of nursing home?

A

Government nursing home

138
Q

What is considered a lower quality nursing home?

A

For profit, large population funded by Medicaid

139
Q

Most common condition in nursing homes?

A

Dementia (46%)

140
Q

More than 60% of nursing home residents are on?

A

psychoactive meds

141
Q

What does skilled nursing facility include?

A

full staff, skilled needs, short period, wound care

142
Q

No governed by the government, no onsite RN?

A

Assisted living facilites

143
Q

If nursing home is mostly funded by Medicaid its probably?

A

lower quality

144
Q

Who makes up 80% of nursing home population?

A

Long-stay residents (>90days)

145
Q

What is more important than a diagnosis?

A

What CAN the patient do!

146
Q

What are icebergs?

A

unreported symptoms that people contribute to old age

147
Q

Why are generalist important in geriatric care?

A

because they are the “jack of all trades”

148
Q

What are the 4 domains in a assessment?

A

Mental, physical, functional, and social economic

149
Q

Why is it always important to take time with the geriatric patient?

A

to form bonds

150
Q

What are 3 barriers to care?

A

Sensory deficits
Cognitive Impairment
Passive patients

151
Q

What is the highest chronic condition in medicare beneficiaries?

A

High blood pressure

152
Q

Presence of 3 of more of what makes up frailty?

A 
Weight loss
Exhaustion
Slow walking speed
Low physical activity
Weak grip strength
153
Q

What 3 things do some experts suggest adding to the frailty list?

A

cognition
depressed mood
pain

154
Q

T/F Frailty is not synonymous with age or disease?

155
Q

What improves clinical outcomes and alleviates or slows frailty progression?

A

early identification and focused interventions

156
Q

What is loss of resiliency?

A

systems no longer can compensate for one another

157
Q

What is impaired energy pathway?

A

more energy is needed to maintain homeostasis

158
Q

What does models of frailty mean?

A

goal is to predict poor clinical outcome

159
Q

What does FRAIL stand for?

A 
Fatigue
Resistance
Ambulation
Illnesses (>5)
Loss weight (>5%)
160
Q

What is the perfect tool for frailty?

A

There is NONE!

161
Q

What are 3 treatment options for frailty?

A

treat the whole pt
dx frailty and knowing the patient meets criteria
Patients greatly benefit from multidisciplinary care

162
Q

What relationship has been well established with frailty?

163
Q

What plays a unique role in mistreatment?

A

primary care

164
Q

How many Americans age 65 have been a victim of elder mistreatment or neglect?

A

1-2 million

165
Q

Who are the most common perpetrators

A

Family members (adult children) (46%)

166
Q

Who are the least common perpetrators?

A

grandchildren

167
Q

What elderly category is most likely to be abused?

168
Q

What age is most at risk for elder abuse

A

advanced age (>80)

169
Q

What are 4 risk factors for elder mistreatment?

A

advanced age
dependent on ADL
Dementia
Combative behavior

170
Q

What 3 risk factors for perpetrators?

A

depression/mental illness
alcohol/drug dependence
financial dependence

171
Q

Those >85y show what percent of frailty?

172
Q

Women are 1.7x likely to have?

A

arthritis or depression

173
Q

Men are 1.3x likely to have?

A

ischemic heart disease

174
Q

Primary Frailty?

A

without disease

175
Q

Secondary Frailty?

A

with disease

176
Q

What does STEADI stand for?

A 
Stopping
Elderly
Accidents
Deaths  and 
Injuries
177
Q

Who should be asked about falls?

A

all adults OVER 70

178
Q

What are 5 modifiable risk factors for a fall?

A 
Polypharmacy
Orthostasis
Gait and balance
Vision impairment
Environmental Hazards
179
Q

What does a “long lie” predict?

A

lasting decline in functional status

180
Q

What is a predictor of long lie?

A

cognitive impairment

181
Q

T/F 90% of hip fractures are caused by falls

182
Q

What is the leading cause of accidental death in adults over 65?

183
Q

Who should be screened for falls?

A

all older adults

184
Q

What screening is done for a single fall?

A

check of balance or gait distrubance

185
Q

What screening is done for recurrent falls?

A

A complete assessment

determine fall risk

186
Q

What are 3 balance assessment tools?

A

Romberg Test
Functional Reach
Pull Test

187
Q

High steps, foot slapping, foot drop, dragging toe

A

Neuropath gait

188
Q

Hypokinetic, stooped, shuffling, en bloc turning, tremor

A

Parkinsonian gait

189
Q

Shortened stance compared to limp

190
Q

What predicts survival?

A

gait speed

191
Q

A gait of <10sec ?

A

high mobility

192
Q

A gait >30sec?

A

low mobility and high fall risk

193
Q

Get up and go test used for?

A

gait speed

194
Q

What are intrinsic risk factors for falling?

A 
>80
previous falls
visual impairment
pain
diabetes
195
Q

What is the biggest relative risk for falls?

A

muscle weakness

196
Q

What medication group causes the greatest falls?

A

Antidepressants

197
Q

What are extrinsic risk factors for falling?

A

low lightning
throw rugs
clutter

198
Q

What daily intake of Vitamin D should be part of fall prevention?

A

800 IU daily

199
Q

What 2 of 4 areas of exercise must be effective to reduce falls?

A

strength, balance, flexibility, endurance

200
Q

What shoe is recommend?

A

high box, low heal, thin sole

201
Q

T/F Nonsurgical vision correction reduces falls?

A

FALSE (may increase risk)

202
Q

Vision intervention that decreases falls?

A

expedited first cataract surgery

203
Q

What amount of time spent on the floor has poor outcomes?

204
Q

Who should perform home safety assessment?

Gerontology (1 decks)

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