Geriatrics Flashcards
Lab findings commonly found in elder mistreatment
Hypernatremia
elevated BUN/Cr
elevated uric acid
low serum albumin
low cholesterol
low total lymphocyte count (sign of malnutrition)
elevated creatinine kinase
think: dehydration, poor nutrition
How to evaluate a geriatric patient for functional decline
Multistep holistic approach
-Identify and characterize the disability
-Identify previous health conditions that may contribute to the disability
-Identify functional impairments (e.g. cognitive, pain, nutritional status, medication side effects
Contextualize these factors to the patient’s socioeconomic status
Use a multidisciplinary team to address ways of increasing the patient’s capacity and reducing task demand
When to start screening for osteoporosis
Women >65
At-risk women >50
Risk factors for osteoporosis
low body weight
previous fracture
Family Hx of osteoporosis with fracture
Hx of falls, physical inactivity
low vitamin D or calcium intake
use of certain meds (e.g. corticosteroids)
bone measurement tests most used to screen for osteoporosis
DEXA of hip and lumbar spine
Quantitative ultrasound of the calcaneus – less expensive, more portable
Are gait changes in older adults an inevitable consequence of aging?
no, Monica.
mild to moderate Alzheimer’s disease: treatment
Cholinesterase inhibitors
- donepezil (Aricept)
- rivastigmine (Exelon
- galantamine (Reminyl)
- tacrine (Cognex)
moderate to severe Alzheimer’s disease: treatment
NMDA-receptor antagonist
- memantine
Routine evaluation of a patient with dementia
CBC
BMP: electrolytes, BUN/Cr, glucose
Thyroid function testing
Serum B12
LFTs
syphilis serology
Functional Reach test
A patient is expected to reach further than 6 inches with fist extending while bending forward but standing at one place
Normal changes to pulmonary functions in older adults
residual volume increases
functional residual capacity increases d/t increased residual volume
vital capacity decreases
Most common type of urinary incontinence in older adults
urge incontinence
urge incontinence: evaluation
History & physical
UA
Voiding diary
cotton-swab test
cough stress test
measurement of PVR
cystoscopy
urodynamic studies
urge incontinence: treatment
changes in diet
behavioral modification
pelvic floor exercises
surgical intervention
medications: anticholinergics, antispasmodics, TCAs
USPSTF Final Recommendation Statement: risk factors for falls
Hx of falls
Hx of mobility problems
Poor performance on the timed “Get Up and Go” test
USPSTF Final Recommendation Statement: interventions to prevent falls
Exercise, PT
150 minutes/week of moderate intensity activity or 75 minutes/week of vigorous intensity aerobic activity
Muscle-strengthening activity 2x/week
Common vitamin deficiency in older adults who do not consume a nutritious diet
Vitamin C
Can lead to scurvy
treatment for asymptomatic UTI in elderly patients
no treatment for asymptomatic UTI
mixed incontinence: management
Behavioral therapies including pelvic floor exercise, pelvic floor stimulation, and biofeedback are more effective than placebo or bladder muscle relaxants
The USPSTF recommends vitamin D for what population?
exercise or PT and vitamin D for community-dwelling adults >65 who are at increased risk for falls
