Geriatrics Flashcards
1
Q
Why do you want to be careful with sending older adults to the hospital?
A
- nosocomial infections
- delirium
- fall prevention
- mobility
- skin care/pressure sore development
- transitions of care can be challenging
2
Q
What percentage of older adults have type II DM?
A
about 25%
3
Q
Diabetes in older adults can lead to:
A
- incontinence → polyuria
- falls → from low blood sugar
- frailty
- cognitive impairment
- depression
- have a 10-year reduction in life expectancy and a mortality rate 2x that of people without DM
4
Q
Common geriatric Sxs of DM
A
- urinary incontinence
- falls
- pain
- cognitive impairment
- depression
5
Q
Hypoglycemia in elderly
A
- more likely in older patients
- reduced ability to sense warning signs
- shakiness
- irritability
- confusion
- tachycardia
- severe hypoglycemia
- LOC
- seizure
- coma
- death
6
Q
Who benefits most from intensive glycemic control?
A
- older adults in good health
- those with microvascular complications
- frail elderly without microvascular complications will probably not live long enough to develop them
7
Q
How many years required before benefits of glycemic control are reflected in reduced microvascular complications such a diabetic retinopathy or kidney disease?
A
8 years
8
Q
How many years are required to see benefits from better control of BP and lipids?
A
2-3 years
9
Q
For adults ≥ 65 yo, avoid using medications to achieve a hgb a1c < ____?
A
7.5%
10
Q
Reasonable a1c targets for:
- a. healthy adults with long life expectancy
- b. in those with moderate comorbidity and a life expectancy < 10 years,
- c. in those with multiple morbidities and shorter life expectancy.
A
- a. 7-7.5%
- b. 7.5-8.0%
- c. 8.0-9.0%
11
Q
T or F: Home monitoring of blood glucose has NOT been found to be cost effective
A
True
12
Q
How to Dx HTN in Elderly
A
requires at least 3 BP readings taken on 2 separate visits
13
Q
What is the benefits of HTN treatment?
A
- reduces overall mortality, CVD events, HF, and stroke
14
Q
HTN Treatment Target
A
For adults ≥ 60yo :
- <150/90
- acceptable target. < 140/90 if no adverse effects on health or quality of life
- diabetics: < 140/90
- ***Systolic BP = stronger predictor of adverse outcomes than DBP in older adults
15
Q
General Tx recommendations for HTN in geriatrics
A
- start with nonpharm approach
- when using pharm: start at half of usual dose then increase slowly, and continue nonpharm tx
- tx goals gauged by SBP not DBP → BUT avoid excessive reduction in DBP (<60-65 mmHg)
16
Q
When BP has not be successfully reduced to target level, consider:
A
- cautiously increasing dose
- want to lower BP slowly to avoid Falls
- adding another med (esp. a thiazide type diuretic)
- switching to another class of med
17
Q
Consider Stepping down HTN tx once patient has maintained target BP for how long?
A
- > 1 year
18
Q
4 groups of older adults most likely to benefit from statin therapy
A
- pats with any form of clinical ASCVD
- pts with primary LDL level > 190
- pts with DM, 40-75 yo with LDL elvels of 70-189
- Pts without DM, 40-75 yp with an estimated 10 yr ASCVD risk of ≥ 7.5%
19
Q
Afib in Elderly
A
- Prevalence: 10% in 80+ yos
- Risk factors:
- age, DM, HTN, Smoking, EtOH, OSA, Obesity
- Goal:
- rate control (beta-blockers)
- clot prevention (anticoags)
20
Q
CHF in Elderly
A
- Beta blockers help function and survival in CHF
- Precipitants: (DAMN IT)
- Drugs, Arrhythmia, MI, Noncompliance, IV fluids (overload), Thyroid (hyper)
- Diuretics: Monitor potassium!
21
Q
TIAs and Stroke in elderly
A
- prevalence: stroke is leading cause of disability
- mortality has decreased: 4th leading cause of death in US
-
Risk Factors:
- Age, HTN, HLD, Genetics/prior hx
22
Q
Thyroid Disorders in Elderly
A
- Hypo = more common
- impact on mental illness: depression
- Impact on: lipid abnormalities, BP, weight, anemia, activity, temp intolerance
- Med titration and monitoring:
- TSH and free T4
23
Q
When to bone scan for osteoporosis?
A
age 50+
24
Q
Major SE of iron supplementation
A
constipation
25
Unusual sxs of PNA in LTC residents
loss of appetite, change in functional capacity
26
Functional Independence Measure (FIM)
* 18 items
* rated on a 7-point ordinal scale
* lowest = 18, highest level of function = 126
* takes 30-45 min to administer
*
27
What do ADL and IADL stand for?
* ADL: activities of daily living
* IADL: Instrumental activities of daily living
28
Katz ADL
* Excellent to assess functional status related to ability to perform ADLs
* Targets older adults in all settings
* valid & reliable in this population
* not useful for looking at small incremental changes
* Scoring:
* 0-6
* 6 = full function
* 2 = severe functional impairment
29
Lawton-Brody IADL
* Tests independent living skills
* executive functions
* more complex than ADLs
* Good for:
* older adults
* not for “institutionalized” populations
* 10-15 min
* Scores:
* Women 0-8
* 0 = low function
* 8 = high function
* Men: 0-5
* 0 = low function
* 5 = high function
30
When to use ADLs or IADL screening Tools? And how can administer/score them?
* when?
* potential admission to nursing home
* after acute hospitalization
* Who can admin?
* MAs, LVNs, RNs
* Home health nurses
* community health workers if trained
31
What is the FRAT?
Fall Risk Assessment Tool
* Pros:
* comprehensive
* post-fall assessment
* action plan
* Cons:
* LONG
32
FRAT vs JHFRAT
FRAT = Fall Risk Assessment Tool; JHFRAT = John Hopkins FRAT
* JHFRAT:
* similar to FRAT but used only for acute care and age is a risk factor
* Pros:
* simplified, one-page
* Cons:
* no action plan
33
TUG Test
Timed Get Up & Go (TUG) Test
* \> 20 seconds = increased risk of falling
34
Hendrich II Fall Risk Model
* Target Population:
* acute ambulatory, assisted living, LTC
* Gender (male) = risk factor
* Pros:
* useful in most patient care settings
* incorporates Get up and Go Test
* Cons:
* med list not inclusive
35
STRATIFY risk Assessment Tool
* for hospitalized pts
* Pros:
* simple Y/N Format
* Cons:
* room for interpretation
36
STEADI Algorithm
* Stopping Elderly Accidents, Deaths, and Injuries
* Made by CDC
* 3 core elements: screen, assess, interventions
* Pros:
* easy to follow
* clear guidelines & recommendations
* Cons:
* additional risk assessment comes later in algorithm
37
5 Domains of Cognition
1. Orientation
2. New Learning & Memory
3. Language (Receptive & Expressive)
4. Visual-Spatial Skills
5. Simple Reasoning
38
Do you want a family/caregiver present when doing a cognitive assessment?
generally no
39
Clock Drawing Test
Assesses Cognition
* Pros:
* Very fast
* good for diverse groups
* can indicate severity of impairment
* Cons:
* does not assess all domains of cognition
* Scoring:
* 0-10
* \< 5= impaired
40
Do the cognition assessments offer a formal dementia diagnosis?
Nope.
41
Mini-Cog
Assesses Cognition
* Score:
* 0-5
* +1 per word recalled (3)
* +2 for normal clock drawing
* Score of 3 = validated dementia screening
* Score of 4 = needs further eval
* Pros:
* widely used in clinics
* very fast
* less affected by language, ethnicity, level of education
* Cons:
* only assesses memory + reasoning
* can be impaired and do well
42
MOCA
Montreal Cognitive Assessment
* Pros:
* specific for MCI
* good domain balance
* multiple versions of form
* Excellent at **detecting early cog changes**
* Cons:
* takes time 10-15 min
* must complete training which costs $$$
* Scoring:
* 0-30
* 18-25: MCI
* 10-17: mod Cog impairment
* \< 10: severe cog impairment
43
Self-Administered Gerocognitive Exam
* Pros:
* self administered exam
* multiple versions in multiple language
* Cons:
* geriatric population only
* examiner cannot give guidance
* Scoring:
* 0-22
* \>17 = normal cognition
