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SUMGERI > GERI-Assess > Flashcards

GERI-Assess Flashcards

1
Q

What are the goals in geriatrics?

A
  • measure, preserve and nurture their functional status
  • maintaining quality of life
  • recognize decline-cognition, mobility
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2
Q

What are some key points to make sure we don’t miss in the geriatric assessment?

A
  • KEY; observation, ROS , medications
  • problem lists are invaluable
  • caregivers & situation: do they live alone, do they live with family, etc.
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3
Q

What are some unique barriers to the care of the elderly?

A
  • beliefs about “normal” symptoms of aging –> what we think is normal and what someone else thinks might be different
  • access to care- harder in the elderly
  • denial, fear, past experience
  • cultural barriers
  • western medicine doesn’t “let people be”
  • it takes a long time for both
  • multiple medical diagnoses, issues
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4
Q

What are some reasons why the elderly may present differently?

A

Altered central processing:

  • cellular aging
  • pre-existing brain dz (dementia)
  • current illness affecting brain function Neuronal degeneration
  • reduced muscle strength, balance
  • reduced peripheral sensitivity
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5
Q

What are some very significant symptoms you should not miss in an elderly person?

A
  • confusion
  • fatigue
  • loss of appetite
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6
Q

How else might an elderly pt present differently than we would expect?

A

they present with vague, non-specific symptoms: -“i’m worn out”, “i feel weak, dizzy”,

  • sx’s may be delayed or absent,
  • sx appear abruptly or rapidly over a few days, physical, psychological, behavioral
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7
Q

What is something that is ALWAYS significant in an elderly pt, especially when told to you by a family member that has close contact with them?

A

they’re “not acting right”

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8
Q

How might an elderly pt with infection present differently than expected?

A
  • delirium, altered mental status

- fever, leukocytosis may be absent

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9
Q

What should you think of first when your elderly pt present with some kind of infection?

A

urinary tract infection! *both men and women

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10
Q

How might an elderly pt with acute/surgical abdomen present differently than expected?

A
  • minimal abdominal complaints
  • change in mental status
  • stops eating/drinking
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11
Q

How might an elderly pt with acute MI present differently than expected?

A

-MC ***SOB
-fatigue, weak, dizzy,
epigastric pain

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12
Q

How might an elderly pt with depression present differently than expected?

A

-confusion, isolation, weight loss

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13
Q

What are some disease states that are common in elderly pts that might mimic depression?

A

EtOH abuse,
vitamin deficiency,
anemia

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14
Q

How might an elderly pt experiencing abuse present differently than expected?

A
  • delayed presentation, often cannot transport self to office/hospital, MC- fear care would change, may have to go to SNF
  • neglect, wounds, fractures
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15
Q

What are the important assessment components for an elderly pt?

A 
ADL's, IADL's physical ability/mobility 
cognition, memory 
falls vision,
hearing 
incontinence 
nutrition 
depression, emotional state alone vs social/familial resources safety, 
transportation preferences, 
values advanced directives 
safety exercise 
sexual activity/issues tobacco/EtOH/drugs
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16
Q

How can pre-appointment questionnaires help you with an assessment of an elderly pt?

A

-save time!!! -can address function, nutrition, cognition, depression, advance care planning

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17
Q

What are important things to not forget in PMH during assessment of an elderly pt?

A
  • get old medical records if you can
  • specialists, recent labs, hospitalizations
  • BE FAMILIAR with someone’s PMH!!! Look at their problem list, address
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18
Q

What are some important things to gather about medications during assessment of an elderly pt?

A

-have them bring all their meds to their appointment
-drug and dosage errors/interactions
-goal = minimum possible
organize, label, discard old bottles
-verifying pts understanding of how to take, what to avoid

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19
Q

What are some important things to keep in mind when conducting your interview with an elderly pt?

A

-adequate time; review old records, questionnaires,
-may undress after history,
-pace of questions, volume of your voice, manners, face the pt, get hx from pt and caregiver.
Balance listening, effecity, time. HOLD PLACE

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20
Q

What are some important ROS topics to not miss in your elderly pt?

A
  • sleep, weight, appetite
  • skin, sores
  • vision, hearing, teeth, swallowing
  • SOB, chest pain, palpitations
  • abd pain, digestion, changes in stool -urinary sx’s and bladder function
  • syncope, weakness -depression, mood changes
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21
Q

What are the basic activities of daily living (ADLs?)

A

bathing dressing toileting transferring (in-out of bed/chair) continence (bladder, bowel) eating

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22
Q

What are the instrumental activities of daily living (IADLs)?

A

use the telephone
public transportation do grocery shopping prepare meals handle own medications
handle finances
do housekeeping, laundry

23
Q

Who should you ask about falls?

A 
EVERYONE!, 
S: symptoms - before/after
 P: previous falls
 L: location 
A: activity 
T: time of day
 T: trauma
24
Q

What is something you should have your pts try before prescribing them a pill?

A

behavior changes!

25
Q

What are common OTC meds that the elderly population takes?

A 
aspirin tylenol, NSAIDs 
calcium, 
vit D, MVI,
glucosamine herbal supplements 
cough/cold meds 
stool softener, laxatives mylanta,
 tums H2 blockers, PPIs 
nutritional drinks 
CBD products viagra/cialis

OTC still interact with other medications!

26
Q

What is often the first sign of cognitive impairment?

A

impairment of **IADLs

27
Q

Why is uncovering cognitive impairment in an elderly pt so important?

A

IF NEW OR RAPID think illness! -delirium

  • can’t tell by looking at them; some pts can also mask it very well
  • affects their cognition, behavior, judgment
  • referral
  • assess for dementia using validated, bedside tools
28
Q

What is the Modified Mini Mental Status Exam?

A

tests cognitive impairment:
-mental/psychiatric d/os (depression, psychiatric illness)
-CNS/organic illness (dementias, Alzhemiers, metabolic imbalances)
speech and language
mood thoughts and perceptions insight and judgment cognitive function information and vocabulary
*takes 30-45min to administer

29
Q

What is the Mini Mental Status Exam (MMSE)?

A

-shortened, screening version of formal MSE
-falling out of favor due to copyright fees
Scores: <23 out of 30 = concern for cognitive, neuro disease

30
Q

What is the Mini-Cog test?

A

Consists of three actions/questions from MMSE:
1. three word registration, repeat (have to pick from their specific words)
2. draw a clock, put in all the numbers and draw the hands to 10 min past 11 (0-2pts)
3. three word recall (0-3pts)
Score <4 is concerning - may need further testing

31
Q

What is the “set test” or category fluency?

A

-tests for cognitive function,
MMSE alternative -tests verbal fluency, memory, executive function,
concentration name 10 items in categories: fruits, animals, colors, towns - 1 minute each category <15 out of 40 = abnormal wandering, repeating also abnormal

32
Q

When should you do a cognitive assessment on someone?

A

New pt assessment: -outpt
-SNF Inpatient assessment: -various times of the day if fluctuating mental status
Health maintenance visits
Perform q6mo after first sign cognitive decline

33
Q

Which pts of the elderly population are more likely to have depression?

A
  • common with multiple medical problems

- common in nursing homes, care centers

34
Q

What should you do to plan ahead for your physical exam with an elderly pt?

A
  • warm room, warm stethoscope
  • low exam table, chairs for hx -positioning - they can’t move well or lie flat, etc
  • modesty
  • be gentle but thorough in exam
35
Q

What are important aspects not to miss on the physical exam of an elderly pt?

A
  1. General - dress, hygiene, mood, fitness
  2. Vitals - pulse, orthostatics, ht/wt/BMI
  3. Skin - thinning, pressure sores, bruising, lesions
  4. HEENT - vision, cataracts, ears, hearing, teeth, tongue, mucosal membranes
  5. Neck - bruits, thyroid, JVD, masses
  6. Lungs - adventitious sounds, include chest wall (bruising)
  7. Cardiac - RRR? murmur? PMI?
  8. Abd - aorta, bruits, liver, hernias, bladder
  9. Extremities - edema, bruising, hair
  10. GU - special considerations
  11. Rectal - stool guaiac, impaction, prostate, hemorrhoids
  12. Buttocks/sacrum - pressure sores
  13. Musculoskeletal - ROM for IADLs
  14. Neuro - mental status, memory, balance, strength, gait, tremors, sensation
36
Q

Why is dental and oral health so important in the elderly?

A 
lead to poor nutrition!
MC -periodontal disease 
-candida from dentures 
-denture sore 
-soft palate hyperplasia (dentures)
37
Q

What is benign; food can get stuck in them which can lead to malodorous breath and maceration
-scrotal tongue

A

Fissure tongue

38
Q

What is caused by dentures

-B12/folate deficiency, low estrogen

A

Smooth tongue

39
Q

What is benign-cause unknown; psoriatic?

A

Geographic tongue

40
Q

What is caused by fungal

  • poor oral hygiene, abx, immunocompromised, tobacco
  • look for leukoplakia on the side - classic for HIV
A

Hairy tongue

41
Q

What is the Timed Up and Go Test?

A

watch your pt walk!
10ft (3m) in 11 seconds
12 or more seconds = fall risk

42
Q

What is a super important place to make sure you don’t forget about checking during your physical exam?

A

FEET!

43
Q

What basic tests should you have on file for your elderly pts?

A 
-CBC, 
CMP (Ca++, LFTs) 
-lipid panel 
-TSH 
-UA w/ micro -stool guaiac 
-PSA (maybe) 
-Vit D, B12 
-CXR 
-EKG
44
Q

What screening tests should elderly pts get? Do they need them all?

A
  • mammogram, colonoscopy, prostate, pap, DEXA, PPD/Quantiferon Gold
  • NO! decision should be based on pt condition
  • pts needs to be part of the decision
45
Q

What are lifestyle changes that elderly pts can make to help reduce their risk of other diseases?

A
  • smoking cessation
  • limit EtOH
  • nutrition/diet: overall and disease specific, refer to RD -exercise: endurance, strength, mobility, balance, joints, weights
  • PT/OT referrals
46
Q

What are goals for treatment in the elderly pt?

A
  • problem list
  • short-term plan
  • longer term plan
  • anticipatory guidance
  • address social and environmental issues
  • multidisciplinary
  • don’t only treat physical disease- the whole pt including the home, family, support system
47
Q

What goes into the problem list?

A
  • today’s issue
  • acute and chronic illnesses/issues
  • new findings
  • problematic medications
  • major life events/changes *update this every visit
48
Q

What goes into the short term plan?

A

-treat today’s problem
-medication adjustments, lab monitoring
-address patient or caregiver concern,
questions
-discuss and schedule plan for health maintenance -discuss follow-up plan, visit frequency

49
Q

What goes into the long term plan?

A

-family involvement
-health maintenance (dates)
-management of chronic conditions
-goals for diet, exercise, habits -
safety (concerns about their safety? concerns about falling?) -
discuss warning signs and sx’s
-advanced directives - POLST

50
Q

What goes into anticipatory guidance?

A
  • discuss progression of current illnesses, plan to mitigate effects (are there things we can do to make your house safer?)
  • long term side effects of meds
  • future plans: driving, meals, need for increased level of care, inability to live alone
  • be gentle in your approach to these subjects!
51
Q

What are some important points to remember about the hospital assessment?

A

-often complex, fragile pts -don’t lose sight of chronic issues “discharge planning begins on day of admission”

52
Q

What are some important points to remember about nursing home assessment?

A
  1. unique setting/pts - chronic/acute issues
  2. multiple meds, illnesses, past procedures - chart review, problem lists, goals
  3. ultimate goal to stay or leave?
  4. cognitive changes very common –> chemical/physical restrain common
  5. -tricky Hx/PE but same skills needed
  6. home care goal? coordinate, educate family, multidisciplinary
53
Q

What are important things to know about the pts caregiver?

A
  • key role but what exactly is their role?
  • who are they?
  • how long have they been involved in care?
  • live-in? visit? how often?
  • giving/monitoring medications?
  • participate in ADLs or IADLs or both
54
Q

Why is it important to recognize and address caregiver stress?

A
  • they need to be supported too
    -fragility of the caregiver themselves
    -depression
    -other obligations
    -decline in pts abilities/faculties/health/mental status
    -do they need help? -
    may schedule appt for them alone

SUMGERI (14 decks)

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