Eval and Caring - Exam 1 Flashcards
What is the goal of the geriatric assessment? What makes it challenging?
Goal of assessment = keeping patients in the community and reducing mortality
making the assessment efficient
What is a great resource for patient who have a low reading literacy?
UpToDate “The Basics” is a good resource, on a 5th grade reading level
What are the 7 aspects of the geriatric assessment?
Comprehensive History and Physical Exam
Functional assessment
Social assessment
Environmental assessment
Nutritional assessment
Psychological assessment
Patient goals
What are some important aspects of the social hx?
Living arrangements
Relationships with family and friends
Expectations of family or other caregivers
Economic status
Social activities and hobbies
Mode of transportation
Advance directives
**What are the 2 recommended tests for mental status and cognitive function testing?
MMSE: mini mental status exam
MoCA: Montreal Cognitive Assessment
**Which mental status tests is more sensitive and detects milder forms of cognitive impairment?
MoCA
**Which mini mental status test comes in multiple languages, versions for audiovisual impairment and lower literacy?
MoCA
When are postural changes in BP usually worse in the elderly?
can be worse after meals because all the blood goes to your gut
When is unintentional weight loss become a problem in the elderly? What does weight gain make you think of?
Gradual loss of small amounts of weight common; losses in excess of 5% of usual body weight over 12 months or less should prompt search of underlying disease
weight gain-> edema or ascites
What does poor personal grooming/hygiene clue you in to?
Can be signs of poor overall function, caregiver’s neglect, and/or depression; often indicates a need for intervention
Where should you check the skin turgor in an elderly pt? Why?
check skin turgor over the sterum
checking it other place might not be accurate because atrophy of subcutaneous tissues rather than volume depletion
What kind of vision loss in common in the elderly? What area of the mouth is a common site for early malignancies?
Hemianopsia
area under the tongue
What should you order if prominent aortic pulsation are found on PE in an elderly person?
Suspected abdominal aneurysms should be evaluated by ultrasound
If you see unilateral LE edema on PE, what should you work the pt up for?
Unilateral edema should prompt search for a proximal obstructive process
What is the general rule of thumb when it comes to ordering labs?
Life expectancy is >10 years no change in recommendation on management of disease
Life expectancy is <10 years (and especially when it is much less) order labs only if it will improve the patient’s prognosis and quality of life
What labs remain unchanged by aging?
What age-related change seen with sedimentation rate?
Mild elevations (10-20 mm) may be an age-related change
What age-related change seen with glucose?
Glucose tolerance decreases; elevations during acute illness are common
What age-related change seen with creatinine?
Because lean body mass and daily endogenous creatinine production decline, high-normal and minimally elevated values may indicate substantially reduced renal function
What is the age-related change with albumin?
Average values decline (<0.5 g/mL) with age, especially in acutely ill, but generally indicate undernutrition
What is the age-related change with alkaline phosphatase?
Mild asymptomatic elevations common; liver and Paget disease should be considered if moderately elevated
What is the age-related change with serum iron/ iron-binding capacity/ferritin?
Decreased values are not an aging change and usually indicate undernutrition and/or gastrointestinal blood loss
What is the age-related change with PSA?
May be elevated in patients with benign prostatic hyperplasia. Marked elevation or increasing values when followed over time should prompt consideration of further evaluation in patients for whom specific therapy for prostate cancer would be undertaken if cancer were diagnosed
What is the age-related change in urinalysis?
Asymptomatic pyuria and bacteriuria are common and rarely warrant treatment; hematuria is abnormal and needs further evaluation
What is the age-related change with CXR?
Interstitial changes are a common age-related finding; diffusely diminished bone density generally indicates advanced osteoporosis
What is the age related change with electrocardiogram?
ST-segment and T-wave changes, atrial and ventricular arrhythmias, and various blocks are common in asymptomatic elderly and may not need specific evaluation or treatment
**What is the difference between ADLs and IADLs?
ADLs are basic needs: Ambulation, bathing, dressing, eating, transferring, continence, toileting
vs
IADLs: not life threatening but would be nice to be able to complete independently. Transportation, shopping, cooking, using the telephone, managing money, taking medications, cleaning, laundry
aka NOT essential to everyday life
according to the textbook, What are each of the following classified as?
Washing clothes
Standing in the shower
Driving
Climbing stairs
Washing clothes : I
Standing in the shower: A
Driving:I
Climbing stairs: A
according to the textbook, What are each of the following classified as?
Cooking
Eating
Male shaving face
Paying bills
Cooking: I
Eating: A
Male shaving face: A
Paying bills: I
Loss of ADL or IADL function often signals a _______
worsening disease
Why would an environmental assessment be helpful? Who should perform it?
An evaluation of a patient in their living space to provide more independence
PT, OT or speech therapist
When should weight loss and malnutrition be evaluated?
A low BMI (< 20) or an unintentional weight loss of > 10 pounds in 6 months suggests poor nutrition and should be evaluated
The mini nutritional assessment if the score is _____ considered malnourished. ______ at risk of malnutrition. ______ normal nutrition status
0-7 malnourished
8-11 risk of malnourishment
12-14 normal nourishment
T/F: Macronutrient needs decline as a person ages
FALSE!! No change in macronutrient recommendations in older adults
Fat intake should not exceed ____ of the total calories consumed
Carbohydrates should make up _____ of total calorie intake
30%
55%
When should meal shakes be used in the elderly?
in ADDITION to regular meals 1 hour before meal time. NOT as a replacement
T/F: With regards to geriatric obesity, pharmacologic agents are recommended in addition to diet and exercise.
FALSE!! Pharmacologic agents have NOT been adequately investigated in the geriatric population
** What 2 vitamins in particular do elderly people need to INCREASE their consumption of as they age? What is the recommendation?
Calcium and Vit D
Calcium recommendations increases from 1000 mg/day to 1200 mg/day
Vitamin D increases from 600 IU to 800IU
______ is one of the most stressful transitions in later life
Widowhood
**What are 5 important areas of the PE for an elderly person?
Visual/auditory acuity
Gait/ambulation
Abdomen
Mental status
Cognitive function
What are 5 factors that may interfere with functional status in the elderly?
bereavement
widowhood
medical condition with poor prognosis
financial burden
caregiver neglect
depression
How would an elderly person describe their depression? What is the highlighted one?
Fatigue, weakness, anorexia, weight loss
Anxiety, insomnia
“Pain all over”
Apathy
Feelings of guilt
Lack of concentration
the geriatric depression scale, a score of ____ is suggestive of depression and _____ are almost always depression
greater than 5 suggestive of depression
greater than 10 is almost always depression
Define elder abuse. Patients with ______ are at highest risk
Intentional or neglectful acts by a caregiver or trusted individual that lead to or may lead to harm of a vulnerable older adult.
cognitive impairment
What are the 5 types of elder abuse?
Physical
Sexual
Psychological / emotional
Financial
Neglect
What does decubitus ulcers/bedsores make you think if you see them on an elderly person?
elder abuse
What is the screening for elder abuse? **What are the 2 major questions that if the pt answers “yes” to should be major red flags?
Abuse Suspicion Index (EASI)
**Has anyone prevented you from getting food, clothes, medication, glasses, hearing aides or medical care or from being with people you wanted to be with?
or
**Doctor: Elder abuse may be associated with findings such as poor eye contact, withdrawn nature, malnourishment, hygiene issues, cuts or bruises, inappropriate clothing, or medication compliance issues. Did you notice any of these today or in the last 12 months?
What should you do if you were concerned about elder abuse? immediate and non-emergent
immediate: admit to hospital and contact local law enforcement if necessary
non-emergent: contact adult protective services
