Elderly Flashcards

1
Q

Psychosocial things to discuss w/ elderly

A

Safety
Driving Ability
Power of Attorney/Wills
End of Life Care
Caregiver Support
Family Education
Living Arrangements
Financial Responsibility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Beers criteria

A

List of meds not appropriate for elderlyHypotension: BP meds, alpha-adrenergic blockers
Over sedation: opioids, benzos, antihistamines
Impaired postural reflexes: anti-convulsants
Parkinsonism: CCB, antiemetics, APs, SSRIs
Complicating: PPI (increased # risk), antithrombotics, diuretics, laxatives

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

RF for falls

A

Previous fall
Advanced age
Meds (psychotropics, sedatives, antidepressants)
Functional decline
Risk taking behaviours, impulsivity, inappropriate footwear, dehydration
Environment: stairs, home hazards, poor lighting, lack of handrails, obstacles
Medical: weakness, gait difficulties, visual impairment, incontinence, stiffness, pain, depression
Cardio: arrhythmia, postural hypotension, AS, HF, PAD
Neuro: delirium, dementia, MS, Parkinson’s, vertigo
Sensory: hearing or visual impairment
MSK: cervical spondylosis, gout, lumbar stenosis, muscle atrophy, OP, arthritis
Metabolic: DM, thyroid, obesity, low B12, hepatic encephalopathy
MH: MDD, SUD
Sleep: OSA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What to do on physical exam for elderly

A

Postural vitals
Cardiac exam
Eye exam
Neuro
MSK
Gait
Cognition/ mood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Ix for elderly

A

CBC, lytes, B12, BG, TSH, Cr, BUN
BMD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Management of elderly pts in hospital

A

Vit D 700 IU/ day
Bowel protocol
Compression stockings
OT, PT, RD, optometry, podiatry

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Screening for falls

A

Have you fallen? How many times? Were you injured?
Do you ever feel unsteady?
Do you worry about falling?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Risk assessment areas for falls

A

Medications
Medical conditions
Mobility
Home environment
OP review

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Description of gait disturbances: arthralgic, peripheral sensory, vestibular, spastic, cerebellar, parkisonism, frontal, subcortical

A

Arthralgia = antalgic
Peripheral sensory = high step gait
Vestibular = drunken
Spastic/ hemiplegic = scissor
Cerebellar ataxia = uncoordinated
Parkinsonism = shuffling
Frontal = lower half parkinsonism, upper half normal
Subcortical = cautious gait

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Management of elderly in office

A

Avoid polypharmacy
Periodically review meds - monitor for interactions + SE
Enquire about OTC meds
Screen for modifiable RF e.g. visual changes, impaired hearing
Assess functional status + ensure good social support

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Types of incontinence

A

Stress Incontinence
Urge Incontinence
Mixed Incontinence
Overflow Incontinence
Functional Incontinence
Total Incontinence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

RF for incontinence

A

Advanced Age
Multiple Pregnancies
Obesity
Smoking
Post Menopausal
Pelvic Surgery
Genital Prolapse
Cognitive Impairment
Chronic Coughing (COPD)
Neurological Conditions (MS, Stroke etc.)
Constipation
Vaginal Deliveries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Ix for incontinence

A

Urinalysis
Urine Culture & Sensitivity
Creatinine
Pelvic Ultrasound (+/- Post Void Residuals)
Urodynamic Studies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Rx for urge vs stress incontinence, and lifestyle measures for both

A

Lifestyle:
- lose weight
- stop smoking
- reduce caffeine + alcohol

Stress:
- pessaries
- duloxetine (SNRI)
- surgery (mid urethral sling)
- botox injections

Urge:
- bladder training
- mirabegron (beta 3 adrenergic agonist)
- oxybutynin (antimuscarinic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Causes of incontinence

A

Delirium
Infection
Atrophic Vaginitis
Pharmaceuticals
Psychological
Excessive Urinary Output
Reduced Mobility
Stool Impaction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Geriatric giants - who to ask about?

A

frailty, sarcopenia, anorexia of aging, cognitive impairment, falls, hip fractures, depression, dementia, delirium, immobility, instability, incontinence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Risks in elderly?

A

RISKS - roaming, imminent danger (fire, falls), self neglect/ suicide, kinship (abuse, supports), safe driving, substance use

18
Q

CFP frail elderly checklist

A

cognition, mobility, ulcers, pain, med review, rx monitoring

19
Q

ADLs

A

DEATH - dressing, eating, ambulating, toilet, hygiene

20
Q

iADLs

A

SHAFT - shopping, housework, accounting, food + meds, telephone/ transportation

21
Q

5 ways to improve function in eldrely

A

hearing aid, dentures, glasses, walker/ wheelchair, refer to SW/ OT

22
Q

What to look at in a med review?

A

SE, are they appropriate, interacting w/ each other

23
Q

What meds to deprescribe in elderly?

A

Benzos for insomnia, APs for insomnia or dementia (taper if >3mos or ineffective)

24
Q

Guidelines for alcohol in elderly

A

age >65, women 1 SD/d, no more than 5/wk. Men 1-2 SD/d, no more than 7/wk

25
Q

Advice for alcohol in elderly

A

non-drinking day every wk, chronic heavy drinkers - give thiamine 50mg daily, pre-op taper

26
Q

How to manage neglect in elderly

A

optimize community assistance, identify alternative caregivers, consider respite/ day home

27
Q

How to manage verbal abuse in elderly

A

SW, assess MH + SU, address caregiver burden

28
Q

How to manage financial abuse in elderly

A

stop loss ASAP, consider power of attorney, alert banks, police, SW

29
Q

How to manage sexual or physical abuse in elderly

A

evaluate, treat, document, refer to police, consider shelter, emphasize safety plan

30
Q

Definition of wt loss in elderly

A

reduction >5% body wt over 1 month or >10% in 6mo

31
Q

Modifiable causes of wt loss in elderly

A

STOP WEIGHT LOSS =
Side effects of meds
treatment effects (chemo)
other med dx (CHF)
pain

wandering (dementia)
emotional problems (depression)
impaired function (can’t feed self)
GI dz (malabsorption d/t celiac)
hyperthyroidism
texture of food

loss of appetite
oral health
swallowing disorder
social issues (poverty)

32
Q

What CK level is diagnostic for rhabdo?

A

> 5000

33
Q

Rx for rhabdo

A

fluids, rest x72 hrs, exercise restriction

34
Q

Approach to altered MS

A

DIMS - drugs, infection/ inflammation, metabolic + endocrine, environmental, retention, structural

35
Q

Pneumonia vaccines

A

PCV 13 + PPSV23 + PPSV23 booster 5 yrs later - PPSV23 for people w/ comorbidities

36
Q

Pts at risk of PNA that need vax

A

asthma, alcoholism, chronic liver dz, chronic lung dz, neuromuscular disorders, RA, Crohns, lupus, smokers

37
Q

Pts at HIGH risk of PNA that need vax

A

CKD, cochlear implant, congenital immunodeficiency, dz of WBC, functional asplenia, HIV, immunosuppressant drugs

38
Q

RF for hearing loss

A

male, age, light skin, noise exposure

39
Q

Gold standard for hearing test

A

pure tone audiogram

40
Q

Reasons to refer hearing loss

A

asymmetric, sudden, otitis media, vertigo