Geriatric Health Maintenance Lecture Powerpoint

Question 1

Physical activity recommendation in geriatrics

Answer 1

30 min moderate intensity 5 days a week aerobic or 20 min vigorous 3x per week, strength training, stretching up to 10 min on exercise days (less evidence supports), balance training

Question 2

Tobacco use in geriatrics

Answer 2

Cessation significantly reduces risk of CAD, cancers, and COPD, within 5 years of cessation relative risk for all cause mortality falls below current smokers, should be promoted at every visit for current smokers regardless of age

Question 3

Alcohol risk factors for elderly (3)

Answer 3

• falls
• depression
• poor cognition

Question 4

USPSTF aspirin use policy

Answer 4

Discus benefits and harms in patients age 60-69, benefit more likely in those with 10 year cardiovascular risk of >10%, life expectancy of greater than 10 years, PPI reocmmended for all patients >50 y/o on chronic aspirin therapy

Question 5

USPSTF tetanus diptheria (Td) and (Tdap) vaccine policy

Answer 5

Every 10 years continued at all ages as patients >60 account for majority of all tetanus cases
Tdap (includes pertussis) in all patients >65 who have not received it before, important if around young children

Question 6

Influenza vaccine in geriatric patients

Answer 6

90% of flu deaths are >60 year olds, this reduces hospitalizations and mortality, flumist is not approved for >50 years old and fluzone is moderately more effective

Question 7

Pneumococcal vaccine in geriatric patients

Answer 7

All adults aged >65 shoud receive 1 dose of PPSV23, those who have received > or =1 dose of that before 65 should receive 1 additional dose of PPSV23 at age >65 at least 5 years after previous dose, can supplement with PCV13 for those who do not have immunocompromised state but don’t have to, should in those with immunocompromising conditions at least once

Question 8

Herpes zoster vaccine recommendations

Answer 8

All immunocompetent persons over 50 should get it regardless of varicella history, contraindicated in immunosuppressed state

Question 9

Recombinant zoster vaccine (shingrix)

Answer 9

2 dose series with 90-97% efficacy and very efffective against post herpatic neuraltiga

Question 10

Zoster vaccine live (zostavax)

Answer 10

1 dose series only 50% effective and not as protective against postherpetic neuralgia

Question 11

Cancer screening for elderly need to be considered on an….

Answer 11

…individual basis

Question 12

Oral cancer screening recommendations USPSTF

Answer 12

No official recommendations, concludes current evidence is insufficient to assess balance of benefits and harms of screening for oral cancer in asymptomatic adults, some studies show that screening is very simple and potentially capable of preventing many cancer deaths worldwide

Question 13

JNC8 >60 year old blood pressure recommendations

Answer 13

No DM or CKD <150/90
CKD or DM <140/90
>70 yo and CKD insufficient evidence to support more aggressive goal

Question 14

Dangers of aggressive blood pressure treatment in geriatric patients (4)

Answer 14

• orthostatic hypotension
• increased falls
• renal dysfunciton
• bradycardia

Question 15

Lipid screening USPSTF and ASCVD guidelines

Answer 15

Screen men aged 35 and older adn women 45 and older if at increased risk for CAD, age to stop has not been established, ASCVD say assess every 4-6 years in patients 40-79

Question 16

Statins ADR’s (5)

Answer 16

• myalgia
• fatigue
• liver toxicity
• new onset DM
• cognitive impairment

Question 17

Diabetes screening USPSTF

Answer 17

-screen all individuals age 40-70 with BMI greater than 25, no recommendation over 70