Geriatrics Flashcards
Why do you want to be careful with sending older adults to the hospital?
- nosocomial infections
- delirium
- fall prevention
- mobility
- skin care/pressure sore development
- transitions of care can be challenging
What percentage of older adults have type II DM?
about 25%
Diabetes in older adults can lead to:
- 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
Common geriatric Sxs of DM
- urinary incontinence
- falls
- pain
- cognitive impairment
- depression
Hypoglycemia in elderly
- more likely in older patients
- reduced ability to sense warning signs
- shakiness
- irritability
- confusion
- tachycardia
- severe hypoglycemia
- LOC
- seizure
- coma
- death
Who benefits most from intensive glycemic control?
- older adults in good health
- those with microvascular complications
- frail elderly without microvascular complications will probably not live long enough to develop them
How many years required before benefits of glycemic control are reflected in reduced microvascular complications such a diabetic retinopathy or kidney disease?
8 years
How many years are required to see benefits from better control of BP and lipids?
2-3 years
For adults ≥ 65 yo, avoid using medications to achieve a hgb a1c < ____?
7.5%
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. 7-7.5%
- b. 7.5-8.0%
- c. 8.0-9.0%
T or F: Home monitoring of blood glucose has NOT been found to be cost effective
True
How to Dx HTN in Elderly
requires at least 3 BP readings taken on 2 separate visits
What is the benefits of HTN treatment?
- reduces overall mortality, CVD events, HF, and stroke
HTN Treatment Target
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
General Tx recommendations for HTN in geriatrics
- 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)
When BP has not be successfully reduced to target level, consider:
- 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
Consider Stepping down HTN tx once patient has maintained target BP for how long?
- > 1 year
4 groups of older adults most likely to benefit from statin therapy
- 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%
Afib in Elderly
- Prevalence: 10% in 80+ yos
- Risk factors:
- age, DM, HTN, Smoking, EtOH, OSA, Obesity
- Goal:
- rate control (beta-blockers)
- clot prevention (anticoags)
CHF in Elderly
- Beta blockers help function and survival in CHF
- Precipitants: (DAMN IT)
- Drugs, Arrhythmia, MI, Noncompliance, IV fluids (overload), Thyroid (hyper)
- Diuretics: Monitor potassium!
TIAs and Stroke in elderly
- 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
Thyroid Disorders in Elderly
- 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
When to bone scan for osteoporosis?
age 50+
Major SE of iron supplementation
constipation
Unusual sxs of PNA in LTC residents
loss of appetite, change in functional capacity
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
*
What do ADL and IADL stand for?
- ADL: activities of daily living
- IADL: Instrumental activities of daily living
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
Lawton-Brody IADL
- Tests independent living skills
- executive functions
- more complex than ADLs
- Good for:
- older adults
- not for “institutionalized” populations
- older adults
- 10-15 min
- Scores:
- Women 0-8
- 0 = low function
- 8 = high function
- Men: 0-5
- 0 = low function
- 5 = high function
- Women 0-8
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
What is the FRAT?
Fall Risk Assessment Tool
- Pros:
- comprehensive
- post-fall assessment
- action plan
- Cons:
- LONG
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
TUG Test
Timed Get Up & Go (TUG) Test
- > 20 seconds = increased risk of falling
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
STRATIFY risk Assessment Tool
- for hospitalized pts
- Pros:
- simple Y/N Format
- Cons:
- room for interpretation
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
5 Domains of Cognition
- Orientation
- New Learning & Memory
- Language (Receptive & Expressive)
- Visual-Spatial Skills
- Simple Reasoning
Do you want a family/caregiver present when doing a cognitive assessment?
generally no
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
Do the cognition assessments offer a formal dementia diagnosis?
Nope.
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
- only assesses memory + reasoning
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
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
