elderly Flashcards
10 minute geriatric screener
-physical, cognitive, psychosocial factors
-risk of falls
-function assessment
-vision- inability to read > 20/40
-hearing- inability to hear 1000 or 2000
-TUG test- get up and go
-urinary incontinence- DIAPPERS -> wet themself in last year and lost urine on 6 diff times
-nutrition/wt loss- 10lbs wt loss or < 100
-memory- 3 item recall after 1 min
-depression
-physical disability- strenuous exercise (fast walking, bike), heavy work around the house, shopping, go places walking, bathe, dress
frail
-weight loss of > 5% in last year
-exhaustion- what they can do, ADLs
-activity of daily living- eat, dress
-instrumental activity of daily living-cook, shop
-weakness- grip strength, can stop from falling, walker grip
-speed- get up and go test
-physical activity- specific calories
common geriatric syndrome
-cognitive impairment- depression, dementia, delirium
-falls- screening, 1st fall- beginning of the end
-urinary incontinence
-failure to thrive (low BMI, frailty)
-dizzy/syncope
-impaired vision and hearing
-polypharmacy
-pressure ulcers
-fraility
-delirium
-depression
initial convo: cultural identity
-life expectancy
-goals
-functional status
-community involvement
-screenings or not…
-ask pt and family directly
beers criteria
-orthostatics
-warfarin - many interactions
-alternatives
-cost$
ETHNICS
-explanation- educate and listen
-treatment- options
-healers- alternative meds
-negotiate- prioritize concerns, timelines if pt doesnt want to take a med…trial diet and exercise
-intervention- goals, taking car keys away, you may need to insert yourself
-collaborate- family, social workers
-spirituality
setting up the room
-warm, well lit
-low tones
-help on the chair
-check if need hearing aids, glasses, dentures
-go slow- stamina -> consider 2 visits
-include family, social worker especially if cognitive impairment
-large print, easy to read
-assess fatigue, appetite, dizzy, pain
ADL vs IADL
-ADL- MUST BE ABLE TO DO if living alone
-bath
-dress
-toilet
-transferring- bed to toilet
-continence- risk of falling when rushing
-eat
-IADL
-using phone
-shopping
-cooking
-housekeeping
-laundry
-transportation
-taking meds
-managing money
delirium vs dementia
-DELIRIUM
-acute
-underlying cause- infection
-can tx
-DEMENTIA
-insidious
-alzheimers, strokes
-progresses
-can delay process but not tx
vitals
-widened pulse pressure- >140/<90 and pulse pressure > 60
-isolated systolic HTN -> >50yo 3x risk of CHD
->60 <150/90
-RR- unchanged -> can change bc COPD, kyphosis
-HR- poor response to exertion, arrythmias
-temperature regulation -> loss of fat -> hypothermia susceptibility
skins, nails, hair
-skin- loose, fragile, transparent
-actinic purpura- purple patches/macules
-nails- yellow, thicken (especially toes)
-hair- lose pigment, hairline receeds, loss of hair (trunk, pubic, axilla, limbs)
eyes and ear
-presbycusis- loss of hearing
-decrease taste
-presbyopia- aging sight, cant read up close
-farsighted
-dry eye
-cant hear high pitch
cardio
-arteriosclerosis- physiologic
-atherosclerosis- pathologic
-S3- CHF
-S4- healthy older people -> often suggests decrease ventricular compliance and impaired ventricular filling
-systolic bruits in middle or upper carotids
-aortic murmurs
-aortic sclerosis- does not impede blood flow
-mitral regurgitation (MC) after aortic sclerosis
breast, abdomen, male genitalia
-breast decrease in size, ducts are firm and stringy
-abdomen- fat in belly and hips
-male genitalia- decrease frequency of sex drive, erection dependent on tactile, ED
-10 years after menopause- ovaries no longer palpable
-5 years after- hot flashes
-prostate- BPH
mimi mental status exam- TRAP
-mimi-cog test
-1. 3 unrelated items
-2. clock drawing
-3. repeat 3 items
-recall all 3 = good
-recall 1 or 2 -> clock drawing abnormal = impaired
-no recall = impaired
