Geriatric assessment powerpoint Flashcards
Insomnia
Pseudoephedrine
Stimulants (amphetamines)
___________
Caffeine
History of Falls
Antipsychotics
________________
Tricyclic antidepressants
Opioids
______________ (glyburide, sliding scale insulin)
Benzodiazepines
Hypoglycemics
Beers Criteria: Drug- Drug Interactions
How can we intervene?
Opioids and Benzos
Narcan
ACE inhibitors+triamterene= increased risk of ____________
hyperkalemia
Warfarin+NSAIDS increased risk of _________
GI bleeding
Oral corticosteroids and NSAIDS increased risk of __________
GI bleeding
Opioids and Benzos increased risk of_________
respiratory depression
HOW TO USE THE BEERS CRITERIA
Medications that are potentially inappropriate not definitely inappropriate
Use the rationale and recommendation section to guide decision making – why is it on the list?
Consider safe alternatives, including non-pharm options when recommending against a Beers Criteria med
Be patient-specific
If you recommend against a med/discontinuation, plan for ___________
tapering
WHAT MEDS ARE INAPPROPRIATE?
Zolpidem (CNS, falls, confusion)
Cyclobenzaprine (drowsy, falls)
Tramadol (falls, drowsy)
Omeprazole (osteoporosis)
Ropinirole (used for restless legs)
Oxybutynin (used for UI, anticholinergic SE)
Verapamil (HFrEF)
Atenolol (tired, masking hypoglycemia)
Premarin (long term use of estrogen not good)
Motor system
Assess the patient’s gait- gait can be changed by both musculoskeletal and neurologic disorders.Observe the rate, rhythm, and arm motion of the patient while walking
Ask the patient to walk away from you normally
Ask the patient to walk toward you on ___________
Ask the patient to walk away from you on the heels
Ask the patient to walk back to you in a normal gait
tiptoe
_________-stand close to catch the person in case he or she starts to falls
Ask the patient to stand up, with his or feet together and arms to the side
Once the patient is in a stable position, ask the patient to close his or her eyes and then hold that position
Wait ______ to ______ seconds
A person should be able to maintain _______and balance without visual orientation
Romberg test
20 to 30 seconds
posture
Assess risk of falling and ask pts 3 questions which are the people we ask
older adults (65 years or older)
taking more than or equal to _____chronic medications
take ____high risk medication
or any time patient presents with an acute fall
4
1
Three key questions to ask patients to assess falls
Feels unsteady when ______or walking?
Worries about ___________?
Fell in the ______year
If yes ask how many times?, were you injured
standing
falling
past
Screened not at risk
prevent future risk by recommending effective prevention strategies
Educate patient on fall prevention
Refer to community ________or fall prevention program
Reassesses ________or any time patient presents with an acute fall
___________ answers to three key questions and education provided to patient
Share answers to three key questions with the patient’s primary care provider using the Provider Consult Form
Educate
exercsise
yearly
Document
Screened at risk
_________patient’s modifiable risk factors.
Document answers to three key questions and education provided to patient
Identify medications that increase fall risk
-Schedule medication review w/patient
-Review medications utilizing the Community Pharmacy Falls Risk Checklist and a geriatric-specific medication decision-support tool (e.g., The UNC High Risk medication recommendations or the Beers Criteria)
Identify any ______________ (MTPs) associated with the use of high-risk medications
Inquire about postural hypotension
Symptoms of ____________ or dizziness from lying to standing?
Can assess for postural hypotension by measuring ________from lying to standing
Reduce risk by recommending effective prevention strategies
Educate patient on fall prevention
Refer to community exercise of fall prevention program
Assess
medication therapy problems
lightheadedness
blood pressure
Coordinate care with primary care or prescribing provider to reduce identified risk factors using effective interventions
Share answers to three key questions and education provided to patient with the patient’s provider using the Provider Consult Form
Share identified MTPs and recommendations with patient’s provider using the Provider Consult form.
Medication information should include medication name, strength, dose, and frequency.
Refer to provider for an evaluation of gait, strength, and balance using the Provider Consult Form
Response received from provider–>_________with patient in 30-90 days. Discuss ways to improve patient receptiveness to the patient-provider care plan and address barrier(s)
Follow-up
Response not received from provider within 7 days
call provider’s office to verify they received the provider consult form
_______ provider consult form if provider did not receive it.
Resend
Ask about Falls
Do you feel unsteady when __________ or walking?
Do you ________ about, or have a fear of, falling?
Have you fallen in the past year,
If yes, how many times?
Do you feel dizzy or lightheaded when getting up from laying or sitting to standing? (orthostatic hypotension)
standing,
worry
TUG=
Timed Up and Go
Timed Up and Go to assess _______
Equipment:stopwatch
Directions: Pts wear their regular footwear and can use a walking aid, if needed. Begin by having the pt sit back in a standard arm chair and identify a line 3 meters, or 10 feet away on the floor
Note: Always stay by the pt for safety
Instruct the pt
When I say “Go”, I want you to:
Stand up from the chair.
_________ to the line on the floor at your normal pace
Turn
Walk back to the chair at your normal pace.
Sit down again.
On the word “go” begin timing
Stop timing after pt sits back down.
Record Time
mobility
walk
An older adult who takes more than _____seconds to complete the TUG is at risk for falling
12
