Geriatric: Prevention & health maintenance Flashcards
T/F Functional decline & loss of independence are NOT an INEVITABLE consequence of aging
T
Primary prevention =
Stop disease development
* Immunizations
* Lifestyle modifications
–Smoking cessation, seatbelt use, & physical
activity
* Chemoprophylaxis
–Statins for primary prevention of heart disease
Physical activity screening
Physical Activity Assessment
Physical Activity
Effective Exercise
- Specific → To improve sit to stand, practice sit to stand
- Overload → Change in tissue requires novel stress
- Progression → ↑ the overload based on response
- Recovery → Rest x time = tissue healing & reponse to stress
Heavy resistance training at retirement age induces _____
4-year lasting beneficial effects in muscle strength
Physical Activity
Tai Chi benefits
- ↓ falls by 58% compared to stretching or multimodal exercise
- ↑ walking speed & physical function
- ↑balance confidence
- Economical
Tobacco Cessation USPSTF Grade:
A
T/F A patient is NEVER too old to benefit
from smoking cessation
T
Risk factors among older adults for increased alcohol consumption
Bereavement, depression, anxiety, pain, disability, prior history of alcohol use
CAGE questions
- Cut Down
- Annoyed
- Guilty
- Eye opener
Immunizations in older adults
- Tetanus (Td)
– q 10 years for adults - Tdap
– 1 dose 19+ years–old
adults - Influenza
– q year - Pneumonia
– PCV13 at 65 years,
then
– PPSV23 1 year later - Herpes Zoster
– 2 doses 50+ yo
– 2-6 mo. apart
– 1 dose ≥60 yo
Early detection & treatment of asymptomatic disease
– Screening for cancer (Eg-mammograms)
– Hearing or vision impairment
– Osteoporosis
– Hypertension
– Abdominal aortic aneurysm (AAA)
– ASA for further cardiac arrest
Screening options for colorectal cancer
- Guaiac fecal occult blood test
– Annual - Immunochemical fecal occult
blood test (FIT)
– Annual - Flexible Sigmoidoscopy
– q 5 yr
Strong recommendation to screen men aged 35+ for _____
Lipid screening
______% pts w/ hip fracture die within 1 year
21 - 30
Clinical manifestations & risk factors for osteoporosis screening in men
– Hx of low trauma fx
– Radiographic osteopenia
– Loss >1.5 inches height
– Long-term glucocorticoids
– Androgen deprivation
– Hypogonadism
– Primary hyperparathyroidism
– Hyperthyroidism
– Some intestinal disorders
Tertiary Prevention
- Tertiary prevention identifies established conditions
to prevent further morbidity or functional decline - Hospital admission
– Usually for serious or life-threatening problem
– Less serious disorders that cannot be adequately
treated in another place
– Condition specific criteria
Main goal of hospitalization =
Restore or improve health so that
people can return home
Hospitalization among Geriatric Patients
- Cardiac Arrhythmias
- CHF
- COPD
- Coronary Atherosclerosis
- Diabetes
- Medication Complications
- Infection
– Eg Pneumonia & Urosepsis - Stroke
Preventing readmission: Modifiable factors
– Premature discharge
– Inadequate post- discharge support
– Insufficient follow-up
– Therapeutic errors
– Adverse drug events & other medication related issues
– Failed handoffs
– Post-procedures complications
– Nosocomial infections, pressure ulcers, & patient falls
Harms of driving cessation
- Adults who stop driving have ↑ rates of depression
- Shrinking world syndrome
– loss of driving ability leads to ↓ living space - Ripple effects
– Who else is affected when someone stops driving?
Driving History in older drivers
- How far do you drive each year?
- Where do you drive (local v. distant, familiar v. new places)?
- Have you had any car accidents or tickets recently?
– ~1 accident per 8-9 near misses - Have you ever gotten lost while driving?
Driving History of older drivers For family members:
– Do you ever drive with the patient?
– Are you scared to drive with them?
– Would you let your child ride with them?
– Most children will wait 2 years before bring up the
subject
Driving Assessment 4 C’s:
– Crash history
– Family Concerns
– Clinical condition
– Cognitive function
Older Drivers: driving evaluation
- Don’t just send them to driver’s ed—they lack the necessary medical training
- OTs can train in Driving Rehabilitation and become a driving rehabilitation specialist (DRS)
– Although there are only ~600 in the US
– Otherwise just refer to general OT
4 possible outcomes from a driving evaluation
- Drive without restrictions
- Driving potential
- Explore strategies & adaptations
- Limited driving with a a plan for reassessment
- Cease driving
What age can you stop screening for cervical cancer if no abnormalities have been found?
65
What are some benefits to physical activity?
- ↑ CV conditioning
- ↓HTN
- ↑ Strength
- ↑ Flexibility
- Overall physical fitness
- ↓ risk of CVD
- ↓ risk of thromboembolic stroke
– ↓depression, anxiety, & cognitive decline
– ↓risk falls & related injuries
– ↓type 2 DM
– ↓osteoporosis
– ↓obesity
– ↓colon cancer
– ↓breast cancer
What does tobacco cessation decrease risk of?
– CVD
– various cancers
– COPD
– DM II
– Osteoporosis
– Reproductive d/o
– PUD
– Periodontal disease
– Post-op complications
& infections
Abdominal Aortic Aneurysm Screening guidelines
USPSTF Grade B
* Screening ultrasound
once for AAA is
recommended for ♂ 65-
75 yo who have ever
smoked
USPSTF Grade C
* Offer screening to men
aged 65-75 who have
never smoked
– Eg. Fam hx, smoker,
aneurysms
USPSTF Grade D
* Recommend against
screening ♀ who never
smoked
Prostate Cancer Screening recommendations
USPSTF Grade C
* 55-69 yo
* Individualize
* Discuss periodic PSA
* Potential harms
USPSTF Grade D
* 70+
– Recommend against
* <10-15 yrs life left
