E. Geriatric Assessment/Incontinence/Falls Flashcards
Overall theme from Geriatric Assessment lecture?
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
What are ADLs? What are IADLs?
Activities of daily living = being able to dress themselves, go to the bathroom …
Independent activities of daily living = managing finances, shopping …
Approximately when should screenings for geriatric patients begin & how often should they be performed?
About 65 or when the patient becomes frail
About every year
What is the preferred test for cognition?
Mini-cog
Slightly higher specificity & sensitivity + easier/faster to administer
How is a Mini-cog performed?
Do 3 item memory test
If get more than 1 wrong –> clock test
What are the advantages of the Mini-cog?
Quick to administer
Not language dependent
Not education dependent
What are the cutoffs for the MMSE? When are these cutoffs not accurate?
> 24 = OK
18-23 = mild impairment
t fluent in English get false +
What is the MMSE used for?
Screening for dementia (NOT diagnosis)
What area of cognition is not adequately tested with MMSE?
Visuospatial (test is highly verbal)
Who should the MMSE not be used on?
People with less than an 8th grade education
People who are not fluent in english
What is the test for gait assessment?
Get up & Go
Stand from chair without using arms, pause, walk forward, turn around & return
Assessment for Driving Ability?
At least 20/70 vision
Adequate cognition
Adequate Motor skills
How does focus of preventative care change with aging?
As life expectancy changes switch from things like cancer screenings to frailty screening
What type of autonomics controls the detrusor muscle? Which inhibits detrusor contraction?
Parasympathetics
Sympathetics
What type of autonomics controls the internal urethral sphincter? External?
Sympathetics
Striated muscles
Where is the micturation center located?
Pons
What changes occur as the bladder ages?
Decreased bladder capacity
Decrease in ability to inhibit reflex bladder contractions
Lower urethral closure pressure
Increased residual volume
What is detrusor instability?
Urge incontinence
Strong sudden need to urinate –> loss of urine
Usually elderly men
Due to CNS problem or excitability
What is overflow incontinence?
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)
What is Stress Incontinence?
Cough, sneeze or exercise –> loss of small amount of urine
Due to week muscles (Sphincter or pelvic floor) from estrogen excess or urology surgery
What is Functional Incontinence?
Bladder is working but due to mental capacity or physical limits cannot get to bathroom fast enough
What are the types of Urinary Incontinence?
Overflow Stress Urge/detrusor instability Functional Mixed
Criteria for referral to Urodynamics?
Prior pelvic surgery/radiation Pelvic Prolapse Prostatic obstruction Increased residual volume (>100mL) Uncertain diagnosis/doesnt respond to treatment
What is part of Urodynamics?
Post void residual volume Urine Flow (how fast can empty) Cystometry (measures created pressure) Cystoscopy (endoscopy) Electromyography (electrical activity of the bladder)
What drug(s) cause(s) polyuria?
Diuretic
What drug(s) cause(s) urinary retention?
Anticholinergics
Narcotics
Alpha & beta agonists
What drug(s) cause(s) detrusor irritation?
Caffeine
What drug(s) cause(s) bladder sphincter relaxation?
Alpha blockers
What is the treatment for Detrusor Instability? Side effects?
Anticholinergics (Bladder relaxation) or Imiprimine –> decrease detrusor contractions
Dry mouth, constipation & CNS
Lifestyle changes for Detrusor Instability?
Less caffeine
Urinary schedule
Biofeedback + Kegels
Treatment for Overflow Incontinence?
Alpha blockers or anti-androgens for blockage
Catheterization for weakness
Treatment for Stress Incontinence?
Kegels Estrogen Bladder training/scheduling Surgery Sympathomimmetrics
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?
1/3
Increase linearly with aging
Increases exponentially with aging
What are the consequences of falls when there is no injury?
The “Fear of Falling” can cause people to restrict activity, isolate themselves & become less independent even when no physical injury has occurred
The causes of falls can fall into what 2 major categories? About what percentage are related with each?
Intrinsic (IPO)
Extrinsic (enviroment or meds)
50% for each
How does homeostasis change with aging?
Lose homeostatic reserve
Input related causes of falls can fall into what 3 categories?
Input
Processing
Output
How is processing/CNS cognition altered with aging?
Decreased processing speed
Meds can effect CNS
Increased prevalence of dementia & stroke
How is output altered with aging?
Decreased muscle mass
Decreased bone strength
Increased chances of arthritis & foot deformities
Increased chances of movement disorders such as parkinsons
How is vision (input) altered with aging?
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
How is PNS effected by aging?
Decreased proprioception
Decreased sense of vibration
Increased prevalence of diabetic & alcoholic related neuropathy
How is the vestibular system (input) effected by aging?
Degeneration of ampulla mechanism of semicircular canal
Degeneration of otolithic membranes or sensory epithelium of utricle & sacule
What drugs can increase the likelihood of falls?
Psychotropic drugs (Antidepressants, antipsychotics & sedative hypnotics like lunesta)
CV drugs
Opiates
What are the key questions to ask for a complete fall histroy?
= SPLAT
Symptoms (to differentiate from syncope) Previous falls Location Activity Time of fall
