Geriatric Assessment Flashcards
1
Q
the goal in geriatrics
A
- measure, preserve and nurture the functional status of our elderly patients
- assist in maintaining quality of life
- recognize decline
2
Q
geriatric assessment
A
- Observation is key
- ROS is key
- Medications are key
- Problem Lists are invaluable
- Caregivers and situation
3
Q
Barriers to care of the elderly
A
- Beliefs about “normal” symptoms of aging
- Access to care
- Denial, fear, negativity
- Cultural barriers
- Western medicine does not“let people be”
- It takes a long time (for us, for them)
- Multiple medical diagnoses, issues
4
Q
Why do the elderly present differently
A
- Biologic, genetic, social
- Altered central processing (Cellular aging, Pre-existing brain dz (dementia), Current illness affecting brain function)
- Neuronal degeneration (Reduced muscle strength, balance, Reduced peripheral sensitivity)
5
Q
how do the elderly present differently
A
- Confusion, fatigue, anorexia
- Vague, non specific symptoms (“I’m just worn out”,“I feel weak, dizzy”)
- Typical sx’s may be delayed or absent (High suspicion for sx’s which appear abruptly or rapidly over a few days - Dementia takes a LONG time!!, Physical and psychological sx’s)
- “Not acting right” is always significant – always start with your ROS!! (The person who says this knows them! You don’t know them!)
6
Q
common atypical presentations
A
- Delirium vs. Dementia
- Infection (Delirium, altered mental status, Fever, leukocytosis may be absent, Think urinary tract infection first, Both men and women)
- Acute abdomen (May have minimal abdominal complaints, Change in mental status, Stop eating/drinking)
7
Q
common atypical presentations
A
- Acute MI (SOB is most common symptom – nausea and “don’t feel right” are the other common sxs, Epigastric pain can be a presenting sx of inferior wall MI until proven otherwise, Fatigue, weak, epigastric pain, low energy)
- Depression (Confusion, EtOH, isolation, weight loss, vitamin deficiency, anemia)
- Abuse (Delayed presentation, often cannot transport self to office/hospital, Neglect, wounds, fractures)
- Why is abuse so under-reported? What happens to the patient if caretaker goes to jail?
8
Q
elderly assessment
A
- Pre-appointment questionnaires
- PMH (Illnesses, Hosp/Surg, Recent labs/tests, Get old medical records, Specialists)
- Meds/CAM/OTC Meds (Bring all meds to appointment!! - This includes OTC!!, Drug and dosage errors)
9
Q
special ROS
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, Hx mental illness
10
Q
elderly history: social history
A
- Caregivers/Contacts/Support
- Sexual function/activity
- Exercise
- Dietary habits/Nutrition
- Tobacco/Alcohol/drugs
11
Q
elderly history: comp assessment
A
- Function – ADL’s, IADL’s, vision, hearing, etc
- Cognitive - memory, confusion, etc
- Safety - stairs, lighting, abuse, etc
- Falls
- Transportation
- Activities
- Advanced Directives
12
Q
elderly falls
A
-SPLATT
- Symptoms - before/after
- Previous falls
- Location
- Activity
- Time of day
- Trauma
13
Q
the elderly interview
A
- Adequate time. Review old record
- May undress after history
- Pace of questions, volume of your voice, manners
- Face the patient, interpreter
- Obtain history from patient when possible. Include spouse, family, caregiver when appropriate
- Balance between listening and efficiency
- Hold your place
14
Q
planning for the physical examination
A
- Warm room, warm stethoscope
- Low exam table, chairs for Hx
- Positioning – can’t move well, lie flat, etc (Be creative in accommodating physical ability)
- Modesty - undressing and gowning the patient
- Be gentle but thorough in exam
15
Q
important aspects of the physical exam
A
- General - dress, hygiene, mood, fitness
- Vitals - pulse, orthostatics, height/weight
- Skin – thinning, pressure sores, bruising, lesions
- HEENT – trauma, vision, cataracts, ears, teeth, tongue, MM’s
- Neck - bruits, thyroid, JVD, masses?
- Lungs - chest wall, kyphosis, rales?
- Cardiac - RRR? Murmur? PMI?
- Abdomen - aorta, bruits, liver, hernias, bladder
