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Geriatrics Exam 1 > Evaluating the Geriatric Patient > Flashcards

Evaluating the Geriatric Patient Flashcards

1
Q

Activities of Daily Living (ADLs)

A
  • Necessary for self-care
    – Eating, dressing, bathing, standing sitting,
    transferring, toileting on demand
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2
Q

Instrumental Activities of Daily Living (IADLs)

A
  • Necessary for independent living
    – Cleaning, meal preparation, proper
    medication utilization, financial literacy &
    ability, communication (ie phone/devices)
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3
Q

Whats included in a welcome to medicare visit?

A
  • Record & evaluate medical & family hx,
    current health conditions, & Rx’s
  • Measure baseline blood pressure, vision,
    weight, & height
  • Make sure pt is up-to-date with
    preventive screenings & services
  • Order testing, based on pts health & Hx
  • Following the visit, give pt or caregiver a
    plan with Medicare-covered screenings &
    preventive services needed
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4
Q

What should be emphasized when asking about a social history for geriatric patients?

A

Nutrition

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5
Q

What number on a nutritional health checklist is considered high nutrition risk? what about good nutrition?

A

0-2 = Good nutrition
– Recheck 6 in months
3-5 = Moderate nutrition risk
– Improve eating habits
lifestyle
Recheck 3 months
6+ = High nutrition risk
– Professional help to improve
nutrition status

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6
Q

key factor for SNF placement

A

– Incontinence

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7
Q

Whats an important general health thing to be looking for during a comprehensive geriatric history?

A

FUNCTIONAL STATUS CHANGE

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8
Q

HEENT screening for geriatric patients

A

– Vision
* ↓acuity (close objects, low lighting)
* Light sensitivity
* Efficacy of corrective lenses
– Hearing
* Amplification device
* Hearing Handicap Inventory for the
Elderly-Short (HHIE-S)
– For symptomatic adults only
– Asymptomatic adults >50 yo
» USPSTF rating = I
Mouth
* See Geriatric Oral Health lecture

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9
Q

Cardiovascular ROS for geriatric patients

A

Orthopnea
– Edema
– Angina
– Claudication
– Palpitations
– Dizziness
– Syncope

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10
Q

Musculoskeletal ROS for geriatric patients

A

– Focal or diffuse pain
– Focal or diffuse weakness

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11
Q

Neurological ROS for geriatric patients

A

– Visual disturbances (transient or progressive?)
– Progressive hearing loss
– Unsteadiness &/or falls
– Transient focal symptoms

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12
Q

Hearing loss screening for geriatric patients

A
  • Presbycusis, acoustic neuroma, meds,
    cerumen impaction, faulty/ill-fitting
    hearing aids, Paget disease
  • 3 ft whisper test
  • Hearing Handicap Inventory for the Elderly-Short
    (HHIE-S)
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13
Q

Looking for muscle wasting in Geriatric patients

A

– atrophy
– malnutrition
– ↓ calf circumference
& hand strength

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14
Q

Patient functional outcomes are the product of
working with the patient to:

A
  1. Remedy what can be changed
  2. Develop an “environment” in which the
    patient can thrive
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15
Q

Importance of OT in geriatric rehabilitation

A

– OT environmental assessment in
asymptomatic adult ↓ subsequent
hospitalizations

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16
Q

Assessing Activities of Daily Living:

A
  1. Feeding
  2. Dressing
  3. Ambulation
  4. Toileting
  5. Bathing
  6. Transfer (bed, toilet)
  7. Continence
  8. Grooming
  9. Communication
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17
Q

What is a “Times up & go” test?

A
  1. Patient stands up from a standard arm chair.
    – clinician starts a timer on the word “Go”
  2. Pt walks 10 ft to a line on the floor at normal pace
    – wear regular footwear & may use a walking aid, prn
  3. Turn
  4. Walk back to the chair at your normal pace.
  5. Sit down again (stop the timer & record time)
    * Observe for any deficits in leg strength,
    balance, vestibular dysfunction, & gait.
18
Q

What is a 30-second chair stand used to assess?

A

Assess leg strength & endurance
1. Patient sits upright on a standard chair & places
hands on opposite shoulders, crossed, with the feet
flat on the floor.
2. Clinician starts a timer on the word “Go”
3. Patient stands up, then sits down again.
4. Repeated for 30 seconds

19
Q

Assessing Instrumental Activities of Daily Living:

A
  1. Writing
  2. Reading
  3. Cooking
  4. Cleaning
  5. Shopping
  6. Doing laundry
  7. Climbing stairs
  8. Using telephone
  9. Managing medication
  10. Managing money
  11. Ability to perform paid
    employment duties or
    outside work (eg, gardening)
  12. Ability to travel (use public
    transportation, go out of town)
20
Q

Global measure of function & well-being used in outpatient settings

A

Medical outcomes study questionaire short form-36

21
Q

Comprehensive assessment mandated on
admission to SNFs

A

Minimum data set
* Most current version = MDS 3.0
* Medicare/Medicaid-Certified Nursing Facilities

22
Q

Part of the Inpatient Rehabilitation Facility–
Patient Assessment Instrument [IRF-PA

A

Functional independence measure

23
Q

Medicare mandated comprehensive data
collection system

A

The outcome & assessment information set (OASIS)

24
Q

Delirium

A

Acute, confused state, common in the elderly
* ↓ attention & awareness
* Quick onset (hours – days), with ↑↓ course
* Altered cognition
* Not the result of another neurocognitive d/o
* Caused by medical condition or substance (ie meds)

25
Q

Assessment tool for Delirium

A

Confusion Assessment Method (CAM)

26
Q

Dementia

A

Chronic decline in 1+ cognitive domains
* Learning & memory
* Language
* Executive function
* Complex attention
* Perceptual-motor
* Social cognition
* Must be acquired & represent a significant
↓ of prior functioning
* Cognitive deficits must interfere with
independence in everyday activities
* Disturbances do not occur exclusively during
delirium
* The disturbances are not better accounted
for by another mental disorder (eg, major
depressive disorder, schizophrenia)

27
Q

MMSE Cognitive Domains

A
  • Attention
  • Language
  • Memory
  • Orientation
  • Visuo-construction
  • Praxis
28
Q

MoCA cognitive domains

A
  • Attention
  • Language
  • Memory
  • Orientation
  • Visuo-construction
  • Executive functioning
29
Q

Mini-Cog cognitive domains

A
  • Memory
  • Visuo-construction
  • Executive-functioning
30
Q

MMSE Strengths and limitation

A

Strengths
* Moderate strength for
detection of dementia
* Likely distinguishes pts with
& without dementia

Limits
Optimal cutoff scores affected by
age, education, literacy, &
cultural background

31
Q

MoCA Strengths and limitations

A

Strengths
* Sensitive for detection of
mild Alzheimer & cognitive
impairment
* High sensitivity for dementia
in pts with stroke

Limitations
Low specificity for dementia in
pts with stroke

32
Q

Mini-Cog Strengths and limitations

A

Strengths
Some studies suggest
moderate sensitivity &
specificity for dementia
screening

Limits
Some studies suggest
very low sensitivity
(43%)

33
Q

Depression

A
  • Late-life depression is underdiagnosed &
    inadequately treated
    – Most common psychiatric disorder in
    older adults who commit suicide
  • PCPs provide >80% of depression treatment
    in older adults
  • Often undiagnosed or untreated
34
Q

5-item geriatric depression scale:

A
  1. Are you basically satisfied with your life? Yes/No
  2. Do you often get bored? Yes/No
  3. Do you often feel helpless? Yes/No
  4. Do you prefer to stay at home rather than going out
    & doing new things? Yes/No
  5. Do you feel pretty worthless the way you are now?
    Yes/No
35
Q

New Evidence on
Grief Theory

A
  1. Disbelief
  2. Yearning
  3. Anger
  4. Depression
  5. Acceptance
36
Q

Elder Mistreatment

A

Behavior by someone with an
ongoing relationship to an elder, & a duty
towards that elder, that may constitute:
– Willful infliction of physical pain or injury
or unnecessary restraint (physical abuse)
– Willful nonconsensual sexual contact
(sexual abuse)
– Willful infliction of emotional harm
(psychological abuse)

37
Q

Failure to provide for the needs &
protection of a vulnerable elder when that
person had an ongoing relationship with the
elder & a duty to provide for those needs &
protection.

A

Neglect

38
Q

Risk Factors for elder mistreatment

A

Dementia
– Living in the same household as the abuser
– Socially isolated
– Advanced age, ↓ financial literacy,
disability, bereavement

39
Q
A
40
Q

Signs of Elder Mistreatment

A
  • Signs of dehydration
  • Weight loss
  • Poor hygiene
  • Skin breakdown
  • Fractures/prior fractures
  • Signs of cognitive impairment
  • ↓ anal sphincter tone
  • Perineal excoriation
  • Vaginal bleeding
  • Vaginitis
  • Cystocele
  • Fecal impaction
  • Burns
  • Excessive/repeat bruising
  • Subdural hematoma
  • Skin tears
  • Rhabdomyolysis
41
Q

Frailty =

A

susceptibility to poor outcomes
* Calculated with medical history & functional status
* Performance tests & nutritional status

42
Q

COMPREHENSIVE GERIATRIC
ASSESSMENT:
FRAILTY INDEX (CPA-FI) interpretation

A

– Score is expressed as a proportion of potential
abnormalities, actually present in the patient
– CGA-FI can range from 0 to 1
– Higher values = Greater frailty
* E.g. FI = 20/50 = 0.4

Geriatrics Exam 1 (4 decks)

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