Elderly Flashcards
Psychosocial things to discuss w/ elderly
Safety
Driving Ability
Power of Attorney/Wills
End of Life Care
Caregiver Support
Family Education
Living Arrangements
Financial Responsibility
Beers criteria
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
RF for falls
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
What to do on physical exam for elderly
Postural vitals
Cardiac exam
Eye exam
Neuro
MSK
Gait
Cognition/ mood
Ix for elderly
CBC, lytes, B12, BG, TSH, Cr, BUN
BMD
Management of elderly pts in hospital
Vit D 700 IU/ day
Bowel protocol
Compression stockings
OT, PT, RD, optometry, podiatry
Screening for falls
Have you fallen? How many times? Were you injured?
Do you ever feel unsteady?
Do you worry about falling?
Risk assessment areas for falls
Medications
Medical conditions
Mobility
Home environment
OP review
Description of gait disturbances: arthralgic, peripheral sensory, vestibular, spastic, cerebellar, parkisonism, frontal, subcortical
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
Management of elderly in office
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
Types of incontinence
Stress Incontinence
Urge Incontinence
Mixed Incontinence
Overflow Incontinence
Functional Incontinence
Total Incontinence
RF for incontinence
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
Ix for incontinence
Urinalysis
Urine Culture & Sensitivity
Creatinine
Pelvic Ultrasound (+/- Post Void Residuals)
Urodynamic Studies
Rx for urge vs stress incontinence, and lifestyle measures for both
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)
Causes of incontinence
Delirium
Infection
Atrophic Vaginitis
Pharmaceuticals
Psychological
Excessive Urinary Output
Reduced Mobility
Stool Impaction
Geriatric giants - who to ask about?
frailty, sarcopenia, anorexia of aging, cognitive impairment, falls, hip fractures, depression, dementia, delirium, immobility, instability, incontinence
Risks in elderly?
RISKS - roaming, imminent danger (fire, falls), self neglect/ suicide, kinship (abuse, supports), safe driving, substance use
CFP frail elderly checklist
cognition, mobility, ulcers, pain, med review, rx monitoring
ADLs
DEATH - dressing, eating, ambulating, toilet, hygiene
iADLs
SHAFT - shopping, housework, accounting, food + meds, telephone/ transportation
5 ways to improve function in eldrely
hearing aid, dentures, glasses, walker/ wheelchair, refer to SW/ OT
What to look at in a med review?
SE, are they appropriate, interacting w/ each other
What meds to deprescribe in elderly?
Benzos for insomnia, APs for insomnia or dementia (taper if >3mos or ineffective)
Guidelines for alcohol in elderly
age >65, women 1 SD/d, no more than 5/wk. Men 1-2 SD/d, no more than 7/wk
Advice for alcohol in elderly
non-drinking day every wk, chronic heavy drinkers - give thiamine 50mg daily, pre-op taper
How to manage neglect in elderly
optimize community assistance, identify alternative caregivers, consider respite/ day home
How to manage verbal abuse in elderly
SW, assess MH + SU, address caregiver burden
How to manage financial abuse in elderly
stop loss ASAP, consider power of attorney, alert banks, police, SW
How to manage sexual or physical abuse in elderly
evaluate, treat, document, refer to police, consider shelter, emphasize safety plan
Definition of wt loss in elderly
reduction >5% body wt over 1 month or >10% in 6mo
Modifiable causes of wt loss in elderly
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)
What CK level is diagnostic for rhabdo?
> 5000
Rx for rhabdo
fluids, rest x72 hrs, exercise restriction
Approach to altered MS
DIMS - drugs, infection/ inflammation, metabolic + endocrine, environmental, retention, structural
Pneumonia vaccines
PCV 13 + PPSV23 + PPSV23 booster 5 yrs later - PPSV23 for people w/ comorbidities
Pts at risk of PNA that need vax
asthma, alcoholism, chronic liver dz, chronic lung dz, neuromuscular disorders, RA, Crohns, lupus, smokers
Pts at HIGH risk of PNA that need vax
CKD, cochlear implant, congenital immunodeficiency, dz of WBC, functional asplenia, HIV, immunosuppressant drugs
RF for hearing loss
male, age, light skin, noise exposure
Gold standard for hearing test
pure tone audiogram
Reasons to refer hearing loss
asymmetric, sudden, otitis media, vertigo
