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Summer 2 > Geriatric assessment > Flashcards

Geriatric assessment Flashcards

1
Q

What is a geriatric assessment

A

assessment to help identify common health conditions (medical, psychosocial, and functional limitations)
diagnostic and Tx processesGoals to coordinate a plan to maximize overall health with aging

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2
Q

Examples of health conditions in older adults are

A 
Cogniive impairment 
delirium 
incontinence
malnutrition 
falls
gait disorders 
pressure ulcers 
sleep disorders 
sensory deficits 
fatigue 
dizziness
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3
Q

Who needs a comprehensive geriatric assessment

A

Medical problems (CHF, cancer)
Psychosocial d/o (depression, isolation)
dementia
falls
functional disability
previous or high health care utilization
change in living situations

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4
Q

Who does NOT need a comprehensive geriatric assessment

A

Patients too well or too sick to benefit

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5
Q

What are NOT inevitable consequences of aging

A

Decline in function and loss of independence

AKA, they can be helped!

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6
Q

There is a strong dependence between presence of geriatric syndromes and

A

dependency in ADL

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7
Q

A CGA may include these components

A 
physical
cognitive
affective
social
financial
environmental 
spiritual
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8
Q

How are CGA and normal medical evaluation similar and different

A

CGA incorporates all normal medical Hx (Rx and non-Rx meds, vitamins, herbs, immunizations) PLUS
non medical domains and a focus on functional capacity and QoL
-CGA also uses a multidisciplinary approach (PT, OT, PCP, nutritionist, psychologist, dentist, audiologist, podiatrist, optician)

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9
Q

What is you have a very busy clinical practice?

A

Do a “rolling” assessment over several visits, screening one domain per visit
Patient driven assessment instruments are very time efficient

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10
Q

What is the 4 step structured approach to a CGA

A
  1. Functional capacity
  2. Physical health (pharmacy)
  3. Cognition/mental health
  4. Socio-environmental
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11
Q

What is functional capacity

A

The ability to preform tasks that are required for living

Basic and Instrumental ADL

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12
Q

What are examples of basic ADL

A 
Eating 
dressing 
bathing
grooming 
transferring 
using toilet 
controlling bowel and bladder function 
(Use Katz index of independence in ADL)
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13
Q

What are instrumental ADL

A 
Housework 
preparing meals 
taking meds properly 
managing finances 
using phone 
(Use Lawton IADL scale)
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14
Q

What does “physical health” encompass

A 
Nutrition 
vision/hearing 
fecal and urinary continence 
balance and fall prevention (osteoporosis) 
polypharmacy
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15
Q

Sample geriatric PE findings

A 
HTN, orthostatic hypotension 
Bradycardia, Irregularly irregular 
RR >24
Hyper or hypothermia (2/2 thyroid d/o) 
S4, regurg murmur 
barrel chest, SOB 
Breast mass
Pulsatile abdominal mass 
Atrophy of vaginal mucosa, constipation, fecal incontinence, prostate enlargement/nodules, rectal mass, occult blood 
Foot bunions, onychomycosis; diminished LE pulses, Herberden nodes
diminished ROM, pain, dorsal kyphosis, back pain, gait disturbance, leg pain, muscle wasting, proximal muscle pain
Erythema
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16
Q

What vitamins are often deficient in older people

A

Vitamin A, C, D, and B12
calcium
iron
zinc

17
Q

What 4 components of nutrition are specific to geriatric assessment

A
  1. Nutritional history (use checklist)
  2. 24 hour dietary recall
  3. PE regarding inadequate nutrition or overconsumption
  4. Labs (if applicable)- IE B12
18
Q

Loss of vision in geriatrics is associated with

A

increased risk of falls, decline in cognition, and increased rate of depression
If functionally impaired, recent cognitive decline, or fall Hx, screen vision

19
Q

Common causes of vision impairment include

A 
Presbyopia 
glaucoma
diabetic retinopathy
cataracts 
ARMD
20
Q

Hearing loss in geriatrics is associated with

A 
depression 
social isolation 
poor self esteem 
increased hospitalization 
cognitive decline 
functional disability 
*Screen if 65+*
21
Q

How do you test hearing

A

surveys
whispered voice test
audiometry
Screen if 65+

22
Q

How do you read the hearing handicap inventory scores

A 
0-8= 13% probability of hearing impairment; no handicap
10-24= 50% probability; refer, mild-mod handicap
26-40= 84% probability; refer, severe handicap
23
Q

How do you Tx hearing loss

A

Refer to otolaryngologist for hearing aids

24
Q

Complications of urinary incontinence include

A 
Decubitus ulcers 
sepsis
renal failure
UTI 
increased mortality 
-->loss of self esteem, restriction of social and sexual activities, depression
25
Q

What should your H&P for urinary incontinence include

A

H: review meds and Hx of uro surgeries, differentiate stress (coughing) and urge (leak before reaching toilet) incontinence
P: Evaluate fluid overload, neuro Fxn, mobility
*Deciding factor is the need for nursing home placement

26
Q

What is the Tinetti Balance and Gait Eval

A

Observe patient as they get up from chair without using arms, walk 10 feet, turn around, walk back, and return to seated position
7-10 seconds is norm; 10-19 is fairly mobile; 20-29 seconds variably mobile; 30+ is functionally dependent

27
Q

How can old people decrease their fall risk

A

With exercise, PT, home hazard assessment, and d/c psychotropic drugs
Falls are leading cause of hospitalization and injury related death in those 75+

28
Q

Osteoporosis can lead to

A

low impact/spontaneous fractures
USPSTF recommends routine screening of women 65+ with DEXA of femoral neck
Treating osteoporosis can prevent further bone loss and reduce risk of fracture

29
Q

What is DEXA

A

Dual energy X-ray absorptiometry
Assess hip, femoral neck, and lumbar spine
T score -2.5 or lower= osteoPOROSIS
T score -1 - -2.5= osteoPENIA

30
Q

What is Beers criteria

A

list of meds considered inappropriate for older patients (developed by expert panel, recent update in 2015)
30% of admissions and many preventable problems are 2/2 polypharmacy

31
Q

How do older patients present with depression

A

To PCP with atypical complaints; somatic complaints, cognitive, functional problems, sleep problems, fatigue

32
Q

what is the two question screen

A

During the past month have you been bothered by:

  1. Feeling down, depressed, or hopeless?
  2. Little interest or pleasure in doing things?
    - If yes, positive- supplement with seven additional questions to complete the patient health questionnaire
33
Q

What are the PHQ9 scores

A 
1-4 minimal depression 
5-9 mild
10-14 moderate 
15-19 moderately severe 
20-27 severe depression
34
Q

Early dementia diagnosis allows

A

patient timely access to meds to DELAY progression

prepares families for the future

35
Q

How do you evaluate dementia

A 
thorough Hx 
brief cognition screens 
detailed mental status exam 
Neuropsych testing 
labs (B12, TSH) Depression assessment 
Radiographic imaging
36
Q

What is the mini cognitive assessment

A

quick initial screening for dementia
1. Ask patient to repeat 3 unrelated words (ball, dog, window)
2. Ask pt to draw a clock set to 10 min after 11 o’clock
3. Ask pt to recall 3 words from step 1
(If you draw the clock right and recall even just 1 word, negative for dementia)
(If you cant draw the clock, must remember all 3 words to be “negative” for dementia)

37
Q

What is the MC used dementia screening

A

MC used for cognitive eval in dementia

38
Q

What are socioenvironmental circumstances

A

Must determine most suitable living arrangements for pt
Brief screen of social support (socialHx, who can help if they are ill, etc.)
EARLY identification helps plan!

39
Q

In closing, what must you do in a CGA

A

Formulate a problem list
Necessary intervention
Appropriate referral

Summer 2 (8 decks)

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