Geriatric assessment

Question 1

What are a couple questions you can ask for teach-back approach for chronic disease management in elderly?

Answer 1

Provides better chronic disease management and informed medical decision making
“What questions do you have?”
“We have covered a lot of things; can you tell me in your own words what our plan is?”

Question 2

What are the 7 components of a geriatric exam?

Answer 2

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

Question 3

What tone should you speak to an elderly patient?

Answer 3

Deep tone
Don’t be a squeaker

Question 4

What are important immunization status of geriatrics?

Answer 4

Influenza, pneumococcus, Td,
Zoster
Covid
Pertussis

Question 5

What are the preventatice health measures for geriatrics?

Answer 5

Mammography
Pap smear
Colon cancer screening
Antimicrobial prophylaxis
Estrogen replacement
Tuberculosis history and testing

Question 6

What is the brown bag technique?

Answer 6

Look at each med that they bring in a bag

Question 7

What are the social assessment for geriatrics?

Answer 7

What is your social support
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.

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 8

What are the areas of high importance for PE in geriatrics?

Answer 8

Visual and auditory acuity
Gait and ambulation
Abdomen – aortic dilation
Mental status and cognitive function
MMSE
MoCA - Montreal Cognitive Assessment

Question 9

What is the montreal cognitive assessment?

Answer 9

Used to check for cognitive impairment
Activities to try to evaluate this

Question 10

What meds can exacerbate postural hypotension?

Answer 10

antihypertensive,vasodilator, and tricyclic antidepressant therapy

Question 11

What amount of weight loss is concerning over 12 months or less?

Answer 11

5% or more

Question 12

what does diminished skin turgor mean in elderly? Where do you do this?

Answer 12

Chest or abdomen
Check mucous membrane for dehydration

atrophy of subcutaneous tissues rather than volume depletion

Question 13

What is a common site of malignancy in elderly patients?

Answer 13

Under the tongue

Question 14

Where do you typically hear crackles in elderly?

Answer 14

Lower chest

Question 15

What lesions do you often see?

Answer 15

Age spots

Question 16

What is often seen in GU of elderly?

Answer 16

Testicular atrophy normal; atrophic vaginal tissue may cause symptoms (such as dyspareunia and dysuria) and treatment may be beneficial

Common and may be unrelated to symptoms; gynecologic evaluation helpful if patient has bothersome, potentially related symptoms

Question 17

What type of edema do you need to evaluate in lower extremities?

Answer 17

DVT if unilateral
CHF if bilateral

Question 18

What lab parameters should be the same as adults in elderly?

Answer 18

Hemoglobin
Platelet
Electrolytes
BUM
Platelets
TSH
Calcium
Phosphorus

Question 19

What are common abnormal labs in elderly?

Answer 19

Sed rate
Glucose
Creatnine
Albumin
Alkaline phosphate

Question 20

When should you get a urine sample in elderly?

Answer 20

Even if they just feel crumby

Question 21

What is the central focus of geriatric care?

Answer 21

Functional assessment:

Physical, psychological, socioeconomic - which all come together to make function

Question 22

What are the differences between ADLs vs IADLs

Answer 22

Basic activities of daily living (ADLs)
Activitiesthatpeopleneed to beableto do to takecareof themselves
Ambulation, bathing, dressing, eating, transferring, continence, toileting
Instrumental ADL’s (IADL’s)
Activitiesthat allow an individual to live independently in the community
Transportation, shopping, cooking, using the telephone, managing money, taking medications, cleaning, laundry

tested on this

Question 23

If they lose the ability to do an ADL or IADL, what do you do?

Answer 23

Look for reversible causes
No identifiable cause perform an environmental assessment by PT, OT, speech therapy

Question 24

What are the environmental recommendation for geriatcs?

Answer 24

Physical tools: Ramps, grab bars, elevated toilet seats, shower chairs, walkers, bedside toilets
Special services: Meals on wheels, homehealth
Increased social contact: Friendly visits, telephone reassurance, participation in recreational activities
Provision of critical elements: Food, money

Question 25

When does BMI decrease?

Answer 25

70
Should evaluate if low BMI <20

Question 26

What are some risks for malnutrition?

Answer 26

Drugs that alter appetite (e.g., digoxin, chemo, chronic steroid use)
Chronic disease (e.g., CHF, COPD, renal insufficiency, chronic GI dz)
Depression
Dental and periodontal disease
Decreased taste and smell
Low socioeconomic level
Physical weakness
Isolation
Food fads

Question 27

When do you use a mini nutritional assessment?

Answer 27

Declining food intake over the past 3 months
Weight loss during the last 3 months
Mobility
Psychological stress or acute disease in the past 3 months
Evidence of dementia or depression
BMI
Calf Circumference

Can have the nurse do it ahead of time

Question 28

What age do you need to increase Ca2+?

Answer 28

Increases from 1000 mg/day to 1200 mg/day
Age 50 for F
Age 70 for M

Question 29

What age do you need vitamin D supplements?

Answer 29

Increase from 600 IU to 800 IU at age 70

Question 30

What is the break down of macros for elderly?

Answer 30

Same as older adults

Omega 3 and Omega 6 fatty acids are not synthesized, so must be consumed
Fat intake should not exceed 30% of the total calories consumed
Carbohydrates should make up 55% of total calorie intake

Question 31

What is the managing Undernourishment and Malnutrition

Answer 31

Eat with family/friends and increase social support
Control pain
Increase physical activity
Treat depression: preferably with a medication that has appetite stimulate as a side effect
Caloric liquid or powder supplements 1 hour before meals
Not as a replacement - unless patient refuses to eat
Powder formulation can be mixed with food
Artificial tube feeding
temporary vs permanent: consider patient overall goal

Question 32

Are pharm recommended for elderly recommended?

Answer 32

Not well studied, so not really

Question 33

What screams depression in elderly patients?

Answer 33

Atypical presentation
Have to pull it out of them

If they have pain all over

Question 34

After doing a geriatric depression scale, what scores suggest depression and risjk of depression?

Answer 34

score > 5 points is suggestive of depression and should warrant a follow-up interview. Scores > 10 are almost always depression

Question 35

What is elder abuse and how common is it?

Answer 35

Definition: Intentional or neglectful acts by a caregiver or trusted individual that led to or may lead to harm of a vulnerable older adult
Affects 2% to 10% of elders despite being underreported
Patients with cognitive impairment are at highest risk

Question 36

What are the 5 types of abuse?

Answer 36

Physical
Sexual
Psychological / emotional
Financial
Neglect

Question 37

What is often is seen in neglect of elderly patient?

Answer 37

Bed sores

Question 38

What do you do for elder abuse screening? What is a concerning score?

Answer 38

Elder Abuse Suspicion Index (EASI)
a “yes” answer to questions 2, 3, 4, 5, or 6 should raise a red flag for abuse