Framework for Assessing/Managing Older Adults Flashcards
What are chronic conditions?
Persistent, recurring health consequences
Cannot be cured
Can cause significant limitations with ADLs
Often require social, personal, or rehabilitative care Major cause of illness, disability, death
Currently affect nearly 100 million Americans
By 2040, will affect almost 160 million
Most common chronic conditions all ages
All Ages Sinusitis Arthritis Orthopedic impairments Hypertension Hay fever
Most common chronic conditions age 75+
Arthritis: Women > Men Hypertension Heart disease Men > Women Respiratory disease Diabetes mellitus Cancer Stroke
leading causes of death in older adults
Heart Disease Cancer Stroke Chronic Respiratory Disease Pneumonia Influenza DM
Talk about disability in older adults
Limitations on activities
2010: 27% of those >65 report some type of disability; increasing age increases risk for ADL impairments
Functional disability expected to increase by at least 300% by 2049
Severe disability associated with lower income and education
How do chronic conditions affect emotional health?
51-61 year olds with chronic conditions: more likely to rate emotional health as fair or poor
AA women with chronic conditions give least positive assessment
Fair or poor emotional health: highly reported among those who have hearing impairmentsBalancing positive changes with challenges of aging
What are some hallmark atypical presentations of illness in older adults?
Cognitive change Vague symptomatology--weakness Loss of appetite Recurrent falls Activity change Loss of bladder control
What are some impacts of hospitalization of older adults?
Threat of institutionalization Multiple losses Environmental adjustment Social/family/economic crisis Powerlessness Functional decline Re-hospitalization/ER visits
General physiologic changes with age
Decreased temperature response Bone and muscle loss Altered fat distribution Decreased thirst Pharmacodynamic changes Pharmacokinetic (what the body does to the drug) changes: Absorption Distribution Metabolism Elimination
C/V changes with age
Valvular & LV wall thickness Decreased cardiac output Decreased myocardial contractile efficiency Systolic murmurs, S4 Decreased baroreflex sensitivity No change in overall function
Respiratory changes with age
Thoracic size altered Decreased forced expiratory volume Increased residual volume Rigidity of respiratory structures Alveolar loss No change in overall function
Renal changes with age
30% nephron loss 46% decrease in GFR Decreased urine concentration Assess with estimated creatinine clearance Adequate residual function
GI changes with age
Decreased saliva
Decreased gastric secretion & motility
Decreased mucosal surface in small intestine
Mucosal atrophy in colon
Decreased liver metabolic activity
Decreased pancreatic cells
System changes with age – overall
Mobility Skin integrity Sleep-reduced deep sleep Sensory-perceptual changes Independence in activity Nutrition
How are lab values different with age?
Based on healthy, young samples
Consider confidence intervals
Impact of disease, drugs
Many NOT changed with age
What specific aspects of assessment should be included in assessing the older adult?
Physical domain
Psychological domain
Social/economic domain
Functional domain
What does a physical assessment include?
History - patient/family/friends Illness Medications - Rx & OTC Sensory-perceptual abilities Nutrition Sexual health history
What does a psychological assessment include?
Cognitive
Emotional
Alcohol/Substance abuse
What does a social/economic assessment include?
Support system/resources Financial Problem-solving skills/style Activity/leisure Domestic violence/abuse
Name some instrumental ADLs?
(Household Management) Shopping Cooking Cleaning Laundering Using Telephone Paying Bills
Name some basic ADLs
(Personal Care) Bathing Hygiene Grooming Dressing Feeding Toileting
What is the recommendation for colon cancer screening?
Colon, Rectal Cancer*: Age 50-75: Evidence level A JAMA (2016), 315(23); pp. 2564-2575. Age 76-85 Recommends individualized approach (C) Over age 86 Screening not recommended
Recommendations for skin care prevention?
Monthly self skin examination, clinical exam at periodic exam (ACS 2009)
Recommendations for glaucoma screening?
Open Angle Glaucoma: Comprehensive eye exam every 1-2 yrs > 65; USPTF (2013) inconclusive re: benefits/burdens of screening
When do you do hearing exams?
If symptomatic
How should you screen for osteoporosis?
Bone density screening for all women > 65; younger women with fracture risk equal to women > 65 (USPTF 2011). Bone density testing for women > 65 and men > 70 (NOF, 2010).
What is the recommended Immunization Schedule for Older adults
Annual influenza vaccine
Single dose pneumococcal-13 valent; single dose pneumococcal 23-valent, ideally 1 year apart
Single dose zoster
At least one dose Tdap, plus booster (Td) every 10 years
Name 3 principles of drug management in older adults
- Medication reconciliation: careful history*
Medications may be cause of a problem
Current medications may interact with meds to be rxed.
OTCs - Start low & go slow
- Whenever possible reduce the # of medications being taken
What are some obstacles to prescription compliance specifically in older adults?
Costs of medications
Confusion re instructions or symptoms improve so stop taking
Physical disabilities.
Arthritis, tremor, visual problems
Nonadherence
intentional- pt may not take med due to prior experience
