Eval and Caring - Exam 1

Question 1

What is the goal of the geriatric assessment? What makes it challenging?

Answer 1

Goal of assessment = keeping patients in the community and reducing mortality

making the assessment efficient

Question 2

What is a great resource for patient who have a low reading literacy?

Answer 2

UpToDate “The Basics” is a good resource, on a 5th grade reading level

Question 3

What are the 7 aspects of the geriatric assessment?

Answer 3

Comprehensive History and Physical Exam
Functional assessment
Social assessment
Environmental assessment
Nutritional assessment
Psychological assessment
Patient goals

Question 4

What are some important aspects of the social hx?

Answer 4

Living arrangements
Relationships with family and friends
Expectations of family or other caregivers
Economic status
Social activities and hobbies
Mode of transportation
Advance directives

Question 5

**What are the 2 recommended tests for mental status and cognitive function testing?

Answer 5

MMSE: mini mental status exam

MoCA: Montreal Cognitive Assessment

Question 6

**Which mental status tests is more sensitive and detects milder forms of cognitive impairment?

Answer 6

MoCA

Question 7

**Which mini mental status test comes in multiple languages, versions for audiovisual impairment and lower literacy?

Answer 7

MoCA

Question 8

When are postural changes in BP usually worse in the elderly?

Answer 8

can be worse after meals because all the blood goes to your gut

Question 9

When is unintentional weight loss become a problem in the elderly? What does weight gain make you think of?

Answer 9

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

Question 10

What does poor personal grooming/hygiene clue you in to?

Answer 10

Can be signs of poor overall function, caregiver’s neglect, and/or depression; often indicates a need for intervention

Question 11

Where should you check the skin turgor in an elderly pt? Why?

Answer 11

check skin turgor over the sterum

checking it other place might not be accurate because atrophy of subcutaneous tissues rather than volume depletion

Question 12

What kind of vision loss in common in the elderly? What area of the mouth is a common site for early malignancies?

Answer 12

Hemianopsia

area under the tongue

Question 13

What should you order if prominent aortic pulsation are found on PE in an elderly person?

Answer 13

Suspected abdominal aneurysms should be evaluated by ultrasound

Question 14

If you see unilateral LE edema on PE, what should you work the pt up for?

Answer 14

Unilateral edema should prompt search for a proximal obstructive process

Question 15

What is the general rule of thumb when it comes to ordering labs?

Answer 15

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

Question 16

What labs remain unchanged by aging?

Answer 16

Question 17

What age-related change seen with sedimentation rate?

Answer 17

Mild elevations (10-20 mm) may be an age-related change

Question 18

What age-related change seen with glucose?

Answer 18

Glucose tolerance decreases; elevations during acute illness are common

Question 19

What age-related change seen with creatinine?

Answer 19

Because lean body mass and daily endogenous creatinine production decline, high-normal and minimally elevated values may indicate substantially reduced renal function

Question 20

What is the age-related change with albumin?

Answer 20

Average values decline (<0.5 g/mL) with age, especially in acutely ill, but generally indicate undernutrition

Question 21

What is the age-related change with alkaline phosphatase?

Answer 21

Mild asymptomatic elevations common; liver and Paget disease should be considered if moderately elevated

Question 22

What is the age-related change with serum iron/ iron-binding capacity/ferritin?

Answer 22

Decreased values are not an aging change and usually indicate undernutrition and/or gastrointestinal blood loss

Question 23

What is the age-related change with PSA?

Answer 23

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

Question 24

What is the age-related change in urinalysis?

Answer 24

Asymptomatic pyuria and bacteriuria are common and rarely warrant treatment; hematuria is abnormal and needs further evaluation

Question 25

What is the age-related change with CXR?

Answer 25

Interstitial changes are a common age-related finding; diffusely diminished bone density generally indicates advanced osteoporosis

Question 26

What is the age related change with electrocardiogram?

Answer 26

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

Question 27

**What is the difference between ADLs and IADLs?

Answer 27

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

Question 28

according to the textbook, What are each of the following classified as? Washing clothes Standing in the shower Driving Climbing stairs

Answer 28

Washing clothes : I Standing in the shower: A Driving:I Climbing stairs: A

Question 29

according to the textbook, What are each of the following classified as? Cooking Eating Male shaving face Paying bills

Answer 29

Cooking: I Eating: A Male shaving face: A Paying bills: I

Question 30

Loss of ADL or IADL function often signals a _______

Answer 30

worsening disease

Question 31

Why would an environmental assessment be helpful? Who should perform it?

Answer 31

An evaluation of a patient in their living space to provide more independence PT, OT or speech therapist

Question 32

When should weight loss and malnutrition be evaluated?

Answer 32

A low BMI (< 20) or an unintentional weight loss of > 10 pounds in 6 months suggests poor nutrition and should be evaluated

Question 33

The mini nutritional assessment if the score is _____ considered malnourished. ______ at risk of malnutrition. ______ normal nutrition status

Answer 33

0-7 malnourished 8-11 risk of malnourishment 12-14 normal nourishment

Question 34

T/F: Macronutrient needs decline as a person ages

Answer 34

FALSE!! No change in macronutrient recommendations in older adults

Question 35

Fat intake should not exceed ____ of the total calories consumed Carbohydrates should make up _____ of total calorie intake

Answer 35

30% 55%

Question 36

When should meal shakes be used in the elderly?

Answer 36

in ADDITION to regular meals 1 hour before meal time. NOT as a replacement

Question 37

T/F: With regards to geriatric obesity, pharmacologic agents are recommended in addition to diet and exercise.

Answer 37

FALSE!! Pharmacologic agents have NOT been adequately investigated in the geriatric population

Question 38

** What 2 vitamins in particular do elderly people need to INCREASE their consumption of as they age? What is the recommendation?

Answer 38

Calcium and Vit D Calcium recommendations increases from 1000 mg/day to 1200 mg/day Vitamin D increases from 600 IU to 800IU

Question 39

______ is one of the most stressful transitions in later life

Answer 39

Widowhood

Question 40

**What are 5 important areas of the PE for an elderly person?

Answer 40

Visual/auditory acuity Gait/ambulation Abdomen Mental status Cognitive function

Question 41

What are 5 factors that may interfere with functional status in the elderly?

Answer 41

bereavement widowhood medical condition with poor prognosis financial burden caregiver neglect depression

Question 42

How would an elderly person describe their depression? What is the highlighted one?

Answer 42

Fatigue, weakness, anorexia, weight loss Anxiety, insomnia **“Pain all over”** Apathy Feelings of guilt Lack of concentration

Question 43

the geriatric depression scale, a score of ____ is suggestive of depression and _____ are almost always depression

Answer 43

greater than 5 suggestive of depression greater than 10 is almost always depression

Question 44

Define elder abuse. Patients with ______ are at highest risk

Answer 44

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

Question 45

What are the 5 types of elder abuse?

Answer 45

Physical Sexual Psychological / emotional Financial Neglect

Question 46

What does decubitus ulcers/bedsores make you think if you see them on an elderly person?

Answer 46

elder abuse

Question 47

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?

Answer 47

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?

Question 48

What should you do if you were concerned about elder abuse? immediate and non-emergent

Answer 48

immediate: admit to hospital and contact local law enforcement if necessary non-emergent: contact adult protective services