Evaluating and Caring for the Geriatric Patient Flashcards
how is the geriatric assessment effective?
Effective in keeping patients in the community and reducing mortality
what approach provides better chronic disease management and informed medical decision making
Teach-back approach
how can we Ensure awareness and sensitivity to cultural differences with regards to patient preferences and personal aging goals
Make every attempt to provide information in patients native language and offer interpreters
why be conscientious of a patient’s health literacy level and how to achieve this?
- Often feel less empowered when interacting with health care providers
- Assess what the patient already knows or understands
- Slow speech and avoid medical terminology
- Use pictures if ready literacy is low
- Literacy appropriate written instructions help to improve chronic disease management
- 5th grade or lower, clear heading, bright contrasting colors, large font size (14 or larger)
7 Components of a Geriatric Assessment
- Comprehensive H&P Exam
- Functional assessment
- Social assessment
- Environmental assessment
- Nutritional assessment
- Psychological assessment
- Patient goals
challenges with geriatric assessments
- communication
- underreporting of sx
- vague sx
- multiple complaints
PMHx should include?
- Previous surgical procedures
- Major illnesses and hospitalizations
- Previous transfusions - Immunization status
- Influenza
- pneumococcus
- Td
- Zoster
- Covid - Preventive health measures
- Mammography
- Pap smear
- Colon cancer screening
- Antimicrobial prophylaxis
- Estrogen replacement - Tuberculosis history and testing
what should be included in medication hx?
“Brown bag” technique
Knowledge of current medication regimen
Compliance
Perceived beneficial or adverse drug effects
Previous allergies
A strong social support network can be the determining factor of whether the patient can ____ or needs placement in an ______.
remain at home
institution
how can social assessments be helpful?
- Determine who would be available to help if your patient becomes ill.
- Early identification of social support problems can help with planning and timely development of resource referrals.
- For patients with functional impairment, ascertain who can help your patient with ADLs and IADLs.
areas of high importance in PE
- Visual and auditory acuity
- Gait and ambulation
- Abdomen – aortic dilation
- Mental status and cognitive function
- MMSE
- MoCA - Montreal Cognitive Assessment
Pathologic findings can be superimposed on age-related physical changes
more sensitive in detecting milder forms of cognitive impairment compared to MMSE
comes in multiple languages, versions for audiovisual impairments and lower literacy
what is this assessment?
MoCA - Montreal Cognitive Assessment
causes of postural changes in blood pressure for geriatric assessment vitals
May be asx and occur in the absence of volume depletion
Aging changes, deconditioning, and drugs may play a role
Can be exaggerated after meals
Can be worsened and become symptomatic with antihypertensive,vasodilator, and TCA
Poor personal grooming and hygiene can be signs of what?
poor overall function, caregiver’s neglect, and/or depression; often indicates a need for intervention
Slow thought processes and speech usually represents what?
Usually represents an aging change; Parkinson disease and depression can also cause these signs
Diminished turgor often results from ?
- atrophy of subcutaneous tissues rather than volume depletion
- when dehydration suspected, skin turgor over chest and abdomen most reliable
with decreased visual acuity, what is often overlooked?
Hemianopsia is easily overlooked and can usually be ruled out by simple confrontation testing
an irregular pulse could indicate what?
Arrhythmias
relatively common in otherwise asx elderly; seldom need specific evaluation or treatment
what types of ulcerations are common in geriatric assessments?
Lower extremity vascular and neuropathic ulcers
Pressure ulcers common and easily overlooked in immobile patients may indicate a lack of adequate patient care
what diminished hearing is common? what can be helpful with these assessments?
High-frequency hearing
pts with difficulty hearing normal conversation or a whispered phrase next to the ear should be evaluated further
Portable audioscopes - helpful in screening for impairment
what is the common site for early sign of malignancies
Area under the tongue
what abnormal lung sounds can be heard in geriatric assessments?
Crackles can be heard in the absence of pulmonary dz and HF
often indicate atelectasis
systolic murmurs are common and most often ____; clinical history and bedside maneuvers can help to differentiate those needing further evaluation
Carotid bruits may need further evaluation
benign
Prominent aortic pulsation is suspicious of ?
abdominal aneurysms
