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NRS 251 D: Emergency, Surgery, Geriatrics, Peds, OB > Geriatrics > Flashcards

Geriatrics Flashcards

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Royal College: Emergency Medicine 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
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2
Q

What percentage of older adults have type II DM?

A

about 25%

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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
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4
Q

Common geriatric Sxs of DM

A
  • urinary incontinence
  • falls
  • pain
  • cognitive impairment
  • depression
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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
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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
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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

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8
Q

How many years are required to see benefits from better control of BP and lipids?

A

2-3 years

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9
Q

For adults ≥ 65 yo, avoid using medications to achieve a hgb a1c < ____?

A

7.5%

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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%
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11
Q

T or F: Home monitoring of blood glucose has NOT been found to be cost effective

A

True

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12
Q

How to Dx HTN in Elderly

A

requires at least 3 BP readings taken on 2 separate visits

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13
Q

What is the benefits of HTN treatment?

A
  • reduces overall mortality, CVD events, HF, and stroke
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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
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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)
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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
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17
Q

Consider Stepping down HTN tx once patient has maintained target BP for how long?

A
  • > 1 year
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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
Q

Unusual sxs of PNA in LTC residents

A

loss of appetite, change in functional capacity

26
Q

Functional Independence Measure (FIM)

A
  • 18 items
  • rated on a 7-point ordinal scale
  • lowest = 18, highest level of function = 126
  • takes 30-45 min to administer
    *
27
Q

What do ADL and IADL stand for?

A
  • ADL: activities of daily living
  • IADL: Instrumental activities of daily living
28
Q

Katz ADL

A
  • 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
Q

Lawton-Brody IADL

A
  • 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
Q

When to use ADLs or IADL screening Tools? And how can administer/score them?

A
  • when?
    • potential admission to nursing home
    • after acute hospitalization
  • Who can admin?
    • MAs, LVNs, RNs
    • Home health nurses
    • community health workers if trained
31
Q

What is the FRAT?

A

Fall Risk Assessment Tool

  • Pros:
    • comprehensive
    • post-fall assessment
    • action plan
  • Cons:
    • LONG
32
Q

FRAT vs JHFRAT

A

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
Q

TUG Test

A

Timed Get Up & Go (TUG) Test

  • > 20 seconds = increased risk of falling
34
Q

Hendrich II Fall Risk Model

A
  • 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
Q

STRATIFY risk Assessment Tool

A
  • for hospitalized pts
  • Pros:
    • simple Y/N Format
  • Cons:
    • room for interpretation
36
Q

STEADI Algorithm

A
  • 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
Q

5 Domains of Cognition

A
  1. Orientation
  2. New Learning & Memory
  3. Language (Receptive & Expressive)
  4. Visual-Spatial Skills
  5. Simple Reasoning
38
Q

Do you want a family/caregiver present when doing a cognitive assessment?

A

generally no

39
Q

Clock Drawing Test

A

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
Q

Do the cognition assessments offer a formal dementia diagnosis?

A

Nope.

41
Q

Mini-Cog

A

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
Q

MOCA

A

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
Q

Self-Administered Gerocognitive Exam

A
  • Pros:
    • self administered exam
    • multiple versions in multiple language
  • Cons:
    • geriatric population only
    • examiner cannot give guidance
  • Scoring:
    • 0-22
    • >17 = normal cognition

NRS 251 D: Emergency, Surgery, Geriatrics, Peds, OB (9 decks)

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