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CLINDX Unit 2 UFCOM > E. Geriatric Assessment/Incontinence/Falls > Flashcards

E. Geriatric Assessment/Incontinence/Falls Flashcards

1
Q

Overall theme from Geriatric Assessment lecture?

A

Everything is underreported by patients & often goes unrecognized by MDs –> need specific screenings/tests/checklist/questions to assess everything otherwise you will miss a lot

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2
Q

What are ADLs? What are IADLs?

A

Activities of daily living = being able to dress themselves, go to the bathroom …

Independent activities of daily living = managing finances, shopping …

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3
Q

Approximately when should screenings for geriatric patients begin & how often should they be performed?

A

About 65 or when the patient becomes frail

About every year

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4
Q

What is the preferred test for cognition?

A

Mini-cog

Slightly higher specificity & sensitivity + easier/faster to administer

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5
Q

How is a Mini-cog performed?

A

Do 3 item memory test

If get more than 1 wrong –> clock test

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6
Q

What are the advantages of the Mini-cog?

A

Quick to administer
Not language dependent
Not education dependent

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7
Q

What are the cutoffs for the MMSE? When are these cutoffs not accurate?

A

> 24 = OK
18-23 = mild impairment
t fluent in English get false +

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8
Q

What is the MMSE used for?

A

Screening for dementia (NOT diagnosis)

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9
Q

What area of cognition is not adequately tested with MMSE?

A

Visuospatial (test is highly verbal)

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10
Q

Who should the MMSE not be used on?

A

People with less than an 8th grade education

People who are not fluent in english

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11
Q

What is the test for gait assessment?

A

Get up & Go

Stand from chair without using arms, pause, walk forward, turn around & return

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12
Q

Assessment for Driving Ability?

A

At least 20/70 vision
Adequate cognition
Adequate Motor skills

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13
Q

How does focus of preventative care change with aging?

A

As life expectancy changes switch from things like cancer screenings to frailty screening

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14
Q

What type of autonomics controls the detrusor muscle? Which inhibits detrusor contraction?

A

Parasympathetics

Sympathetics

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15
Q

What type of autonomics controls the internal urethral sphincter? External?

A

Sympathetics

Striated muscles

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16
Q

Where is the micturation center located?

A

Pons

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17
Q

What changes occur as the bladder ages?

A

Decreased bladder capacity
Decrease in ability to inhibit reflex bladder contractions
Lower urethral closure pressure
Increased residual volume

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18
Q

What is detrusor instability?

A

Urge incontinence

Strong sudden need to urinate –> loss of urine

Usually elderly men

Due to CNS problem or excitability

19
Q

What is overflow incontinence?

A

Bladder pressure can’t overcome pressure needed to open valve –> overly full bladder –> loss of urine

Due to blockage of urinary flow (BPH) or weak detrusor muscle (Diabetic nueropathy)

20
Q

What is Stress Incontinence?

A

Cough, sneeze or exercise –> loss of small amount of urine

Due to week muscles (Sphincter or pelvic floor) from estrogen excess or urology surgery

21
Q

What is Functional Incontinence?

A

Bladder is working but due to mental capacity or physical limits cannot get to bathroom fast enough

22
Q

What are the types of Urinary Incontinence?

A 
Overflow
Stress
Urge/detrusor instability 
Functional 
Mixed
23
Q

Criteria for referral to Urodynamics?

A 
Prior pelvic surgery/radiation 
Pelvic Prolapse
Prostatic obstruction 
Increased residual volume (>100mL) 
Uncertain diagnosis/doesnt respond to treatment
24
Q

What is part of Urodynamics?

A 
Post void residual volume
Urine Flow (how fast can empty)
Cystometry (measures created pressure)
Cystoscopy (endoscopy) 
Electromyography (electrical activity of the bladder)
25
Q

What drug(s) cause(s) polyuria?

A

Diuretic

26
Q

What drug(s) cause(s) urinary retention?

A

Anticholinergics
Narcotics
Alpha & beta agonists

27
Q

What drug(s) cause(s) detrusor irritation?

A

Caffeine

28
Q

What drug(s) cause(s) bladder sphincter relaxation?

A

Alpha blockers

29
Q

What is the treatment for Detrusor Instability? Side effects?

A

Anticholinergics (Bladder relaxation) or Imiprimine –> decrease detrusor contractions

Dry mouth, constipation & CNS

30
Q

Lifestyle changes for Detrusor Instability?

A

Less caffeine
Urinary schedule
Biofeedback + Kegels

31
Q

Treatment for Overflow Incontinence?

A

Alpha blockers or anti-androgens for blockage

Catheterization for weakness

32
Q

Treatment for Stress Incontinence?

A 
Kegels
Estrogen
Bladder training/scheduling 
Surgery
Sympathomimmetrics
33
Q

About what % of elderly will fall in a given year? How does the chances of falls & the chances of fall related mortality change with age?

A

1/3
Increase linearly with aging
Increases exponentially with aging

34
Q

What are the consequences of falls when there is no injury?

A

The “Fear of Falling” can cause people to restrict activity, isolate themselves & become less independent even when no physical injury has occurred

35
Q

The causes of falls can fall into what 2 major categories? About what percentage are related with each?

A

Intrinsic (IPO)
Extrinsic (enviroment or meds)
50% for each

36
Q

How does homeostasis change with aging?

A

Lose homeostatic reserve

37
Q

Input related causes of falls can fall into what 3 categories?

A

Input
Processing
Output

38
Q

How is processing/CNS cognition altered with aging?

A

Decreased processing speed
Meds can effect CNS
Increased prevalence of dementia & stroke

39
Q

How is output altered with aging?

A

Decreased muscle mass
Decreased bone strength
Increased chances of arthritis & foot deformities
Increased chances of movement disorders such as parkinsons

40
Q

How is vision (input) altered with aging?

A

Decreased light dark adaption & decreased contrast sensitivity (cant see at night)
Decreased dynamic visual acuity (cant see moving objects well)
Presbyopia (decreased ability to focus on near objects)
Increased chances of cataracts, glaucoma & diabetic retinopathy

41
Q

How is PNS effected by aging?

A

Decreased proprioception
Decreased sense of vibration
Increased prevalence of diabetic & alcoholic related neuropathy

42
Q

How is the vestibular system (input) effected by aging?

A

Degeneration of ampulla mechanism of semicircular canal

Degeneration of otolithic membranes or sensory epithelium of utricle & sacule

43
Q

What drugs can increase the likelihood of falls?

A

Psychotropic drugs (Antidepressants, antipsychotics & sedative hypnotics like lunesta)
CV drugs
Opiates

44
Q

What are the key questions to ask for a complete fall histroy?

A

= SPLAT

Symptoms (to differentiate from syncope)
Previous falls
Location
Activity
Time of fall

CLINDX Unit 2 UFCOM (8 decks)

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