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IC 1.0 > Geriatrics 2 > Flashcards

Geriatrics 2 Flashcards

1
Q

What is the best indicator of morbidity?

A

age

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2
Q

What are the two leading causes of death in older adults?

A

1) heart disease

2) cancer

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3
Q

When should elderly patients stop getting the flu vaccine?

A

never, it should be continued annually through the end of life

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4
Q

Which cohort of older adults is expanding the fastest?

A

those over 85, and in particular, those between 90-95

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5
Q

What is the “oldest continent”? Youngest?

A

Europe has the highest percentage of geriatrics while Africa has the lowest

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6
Q

What is the life expectancy for a male in the US? How does this change with age?

A
  • life expectancy is 78 years at 65

- at 75, it becomes 84

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7
Q

What is the life expectancy for a female in the US? How does this change with age?

A
  • life expectancy is 86 years at 65

- at 75, it becomes 87

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8
Q

Overall, women live how much longer than men?

A

about eight years

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9
Q

Why is it clinically important that women live longer than men?

A

because older women are more likely to be single, poor, living alone and to enter nursing homes

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10
Q

Which race is projected to become the second largest geriatric population behind whites?

A

Hispanics

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11
Q

What do part A, B, and D medicare cover?

A
  • A: in-hospital expenses
  • B: out-patient expenses
  • C: drugs
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12
Q

What two financial sources pay for nursing home care?

A
  • out of pocket

- medicaid

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13
Q

What is required to qualify for full medicare benefits?

A

having paid into the system for 40 quarters (10 years)

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14
Q

What out of pocket costs are associated with part A, B, and D medicare?

A
  • A: 1,200 dollars for 60 days of in hospital care
  • B: 20% copay
  • D: more complicated and varies by plan
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15
Q

What is important to remember about Part D medicare and less so for the other parts?

A

patients are penalized by 1% for every quarter they delay picking a part D plan

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16
Q

Who is eligible for medicare?

A
  • those over 65
  • those who have been disabled for over 24 months
  • those with end-stage renal disease
  • those with ALS
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17
Q

Generally speaking, all patient populations recall about what percentage of information provided by their physician?

A

only 50%, less for geriatric patients

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18
Q

What is the prevalence of low health literacy in geriatric patients?

A

over 80%

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19
Q

Why is assessing a review of functions so important in the geriatric population?

A
  • predicts outcomes
  • allows for monitoring response to treatment
  • helps in making diagnoses
  • helps determine level of care needed
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20
Q

What do ADL and IADL stand for?

A
  • ADL: activities of daily living

- IADL: instrumental activities of daily living

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21
Q

What are the ADLs?

A

DEATH

  • dressing
  • eating
  • ambulating
  • toileting
  • hygiene
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22
Q

What are the IADLs?

A

SHAFTT

  • Shopping
  • Housekeeping
  • Accounting
  • Food Prep
  • Telephone
  • Transportation
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23
Q

For which diseases, is medication underuse a common problem in geriatrics?

A
  • psych disorders
  • asthma/COPD
  • heart failure
  • hyperlipidemia
  • hypertension
  • diabetes
  • osteoarthritis
  • cancer
  • pain
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24
Q

What are the ten most common potentially inappropriate drugs used in geriatrics?

A 
inappropriate:
- propoxyphene
- diphenhydramine
- hydroxyzine
- oxybutynin
- amitriptyline
- cyproheptadine
excess: 
- iron supplements > 325 mg daily
- ranitidine longer than 12 weeks
drug-disease interactions:
- COPD and sedatives/hypnotics
- constipation and strong anticholinergics
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25
Q

How do we define malnutrition?

A
  • weight loss of more than 10% in sixth months or more than 5% in one month
  • or prealbumin < 19 mg/dL
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26
Q

What is the best way to help geriatric patients gain weight?

A

ensure and protein shakes; there are no safe pills

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27
Q

What is a significant indicator of malnutrition in geriatric patients that is easily recognizable upon observation?

A

temporal wasting

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28
Q

How many additional calories are needed to help a patient gain one pound per week?

A

500 calories a day

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29
Q

When should restrictive, therapeutic diets be used in geriatric patients? When should they not?

A
  • they should be avoided unless their clinical value is certain
  • this is because these sorts of diets often have reduced taste and geriatric patients may become malnourished
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30
Q

What are some ways to prevent undernutrition in geriatric patients?

A
  • enhance the social aspect
  • provide adequate time
  • enhance comfort, taste, and appearance of food
  • address dental complaints
  • cater to patient’s food preferences
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31
Q

What is functional incontinence?

A

a form of incontinence in which there is no physiologic problem with urination but there is a problem with ambulation that prevents the patient from reaching the bathroom in time

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32
Q

What is overflow incontinence?

A

incontinence that arises due to an obstruction and increasing amounts of residual volume after voiding

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33
Q

At what age do women and men become equally affected by urinary incontinence?

A

age 80

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34
Q

What other illnesses does urinary incontinence increase the risk for?

A
  • cellulitis, pressure ulcers, and UTIs from being wet often
  • sleep deprivation and falls with fractions as incontinence makes patients get up in the middle of the night
  • sexual dysfunction
  • depression and social withdrawal
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35
Q

What are some age-related physiologic changes that increase the likelihood of urinary incontinence in geriatric populations?

A
  • detrusor overactivity and decreased contractility
  • BPH
  • more urine output during the night
  • atrophic vaginitis and urethritis
  • decreased ability to postpone voiding
  • decreased bladder capacity
36
Q

What is the most common type of urinary incontinence?

A

stress incontinence

37
Q

What cause stress incontinence?

A

sphincter dysfunction due to a weakened pelvic floor

38
Q

How is stress urinary incontinence treated?

A
  • kegel exercises
  • pessary (small foam block)
  • surgical correction
39
Q

How is functional urinary incontinence best treated?

A

environmental modification

40
Q

How is urge urinary incontinence treated?

A
  • first with behavior modification including fewer drinks before bedtime, caffeine avoidance, and bladder training
  • then with anticholinergics if necessary
41
Q

What sort of urinary incontinence is treated with an anticholinergic?

A

urge urinary incontinence

42
Q

How is overflow urinary incontinence treated?

A
  • correction of the outlet obstruction (BPH with an alpha blocker)
  • catheterization
43
Q

Which urinary incontinence is treated with an alpha-adrenergic inhibitor?

A

BPH-mediated overflow incontinence

44
Q

What can happen if you give a patient with overflow incontinence an anticholinergic?

A

you may cause an acute urinary retention

45
Q

Why does osteoporosis occur?

A

because the balance between bone formation and resorption begins to favor resorption

46
Q

What is osteopenia?

A

a milder, precursor to osteoporosis

47
Q

How do we define osteopenia and osteoporosis?

A
  • osteopenia: bone mineral density between 2.5 and 1 standard deviations below standard
  • osteoporosis: bone mineral density more than 2.5 standard deviations below standard
48
Q

How does hip fracture affect quality of life and mortality?

A
  • 50% don’t recover prior function after fracture

- there is 20% excess mortality in the year after hip fractures

49
Q

What endocrine changes can contribute to osteoporosis?

A
  • estrogen deficiency
  • androgen deficiency
  • hyperparathyroidism
50
Q

What is the number one secondary cause for bone loss?

A

Cushing’s disease

51
Q

What are risk factors for osteoporosis?

A
  • early menopause
  • being White or Asian
  • having a sedentary lifestyle
  • smoking/alcohol abuse
  • low body weight
52
Q

What is delirium?

A

an acute, potentially reversible change in mental status, usually caused by an inciting condition

53
Q

Delirium carries with it what risk for mortality?

A

increased risk of mortality for up to two years following discharge

54
Q

What criteria are used to diagnose delirium?

A

the confusion assessment method (CAM)

55
Q

What are the diagnostic criteria for delirium?

A
  • acute change in mental status and fluctuating course
  • inattention
  • and disorganized thinking or altered level of consciousness
56
Q

What factors are predispose one to an episode of delirium?

A
  • advanced age
  • dementia
  • functional impairment of ADLs
  • medical comorbidity
  • male gender
  • sensory impairment
57
Q

How should delirium be approached from a treatment standard?

A
  • identify the underlying disease and address contributing factors
  • avoid complications by removing indwelling devices, prevent or treat constipation or urinary retention, and encourage proper sleep hygiene
  • review and optimize drug list
  • offer orienting stimuli and adequate socialization
  • mobilize the patient as soon as possible
  • ensure proper nutrition
58
Q

What are social restraints?

A

things like a “sitter” or family member in the room with a patient 24/7 rather than physical bindings or pharmaceuticals

59
Q

What kind of restraints should be used on patients with delirium if needed?

A

social restraints

60
Q

How does dementia differ from delirium?

A
  • the course of delirium is more fluctuating and acute than is seen in dementia
  • furthermore, a diagnosis of dementia requires both memory and functional impairment
61
Q

What is the most common form of dementia?

A

Alzheimer’s disease

62
Q

What tests are available to screen for dementia?

A
  • MMSE (easiest)
  • SLUMS
  • MoCA (hardest)
63
Q

Before diagnosing dementia you must also do what?

A

rule out other causes of cognitive decline such as medications, infection, depression, etc.

64
Q

Are ADLs or IADLs first to be lost during early dementia?

A

IADLs

65
Q

What is most often the first ADL lost in the course of dementia?

A

hygiene

66
Q

Which ADL is the most likely to initially warrant a home health aide?

A

bathing

67
Q

What MMSE score indicates moderate dementia?

A

10-19

68
Q

In what order are basic functions lost during dementia?

A
  • IADLs before ADLs
  • hygiene before other ADLs
  • generally speaking: first learned as a child are the last to be lost
69
Q

How is dementia treated pharmacologically?

A
  • primarily with cholinesterase inhibitors (donepezil, rivastigmine, galantine) in the mild to moderate stages
  • NMDA receptor antagonist (memantine) for moderate to severe
70
Q

How does depression differ from delirium and dementia?

A

depression manifests with more somatic complaints than memory and function complaints

71
Q

What treatment options are available for geriatric patients with depression?

A
  • psychotherapy (CBT, interpersonal or problem-solving)
  • SSRIs are preferred drug
  • ECT is available for major depression, those with a suicide risk or mania
72
Q

Under what circumstances is ECT indicated for depression in the elderly? What are the contraindications?

A
  • indicated for major depression, cases with a risk of suicide or instances of mania
  • contraindicated in those with increased ICP, pheochromocytoma, intracerebal hemorrhage, recent MI, etc.
73
Q

What is the response rate for geriatric patients with depression receiving mono therapy?

A
  • 40% improve within 6 weeks and another 15-25 after an additional 6 weeks
  • overall, a relatively strong resposne
74
Q

What is the most common prescribing error when it comes to depression?

A

failure to increase the dose to the recommended level within the first two weeks of treatment

75
Q

When you’re treating a geriatric patient with depression and mono therapy fails, what other options should you consider?

A
  • consider switching to a different drug class
  • add psychotherapy
  • consult a geriatric psychiatrist
76
Q

Why do geriatric patients have a higher risk of pressure ulcer?

A
  • local blood supply to skin decreases
  • epithelial layers flatten and thin with age
  • there is decreased amounts of subq fat
  • collagen fibers lose their elasticity
  • tolerance to hypoxia decreases
77
Q

What are the four stages of pressure ulcers?

A

1) persistent erythema of intact skin, won’t blanch
2) partial-thickness skin loss involving epidermis, dermis, or both
3) full-thickness skin loss involving damage or necrosis of subq tissue
4) full-thickness skin loss with extensive destruction to muscle, bone, or supporting structures

78
Q

What is a deep tissue injury?

A
  • an area of tissue that painful, firm, mushy, boggy, or warmer/cooler than adjacent tissue
  • little or no ulceration and no way to detect how deep it’s going
  • the wound is typically dark
79
Q

What is an unstageable pressure ulcer?

A
  • one for which the depth of injury cannot be assessed due to the presence of a hard eschar or significant slough
  • stable (dry, adherent, intact, and without erythema) eschars should not be removed
80
Q

What are the four major complications of pressure ulcers?

A
  • sepsis
    localized infection, cellulitis, osteomyelitis
  • pain
  • depression
81
Q

What is the mortality rate of those who develop a pressure ulcer?

A

60% in older persons within one year of hospital discharge

82
Q

What are the intrinsic risk factors for developing a pressure ulcer?

A
  • age
  • nutritional status
  • arteriolar blood pressure
83
Q

What are extrinsic risk factors for developing a pressure ulcer?

A
  • pressure, friction, or shear

- moisture (urinary or fecal incontinence)

84
Q

What steps related to skin care should be taken to avoid pressure ulcers?

A
  • daily systematic skin inspection and cleansing
  • reducing factors that promote dryness (increase humidity, apply moisturizer, reduce exposure to cold)
  • avoid massaging over bony prominences
  • reduce moisture from incontinence, perspiration, etc.
  • minimize friction and shear using proper repositioning, turning, etc.
85
Q

What mechanical loading steps should be taken to avoid pressure ulcers?

A
  • reposition at least every two hours
  • keep head of the bed at lowest elevation possible
  • use lifting devices to decrease friction and shear
  • remind patients in chairs to shift weight every 15 minutes
  • do not use doughnut seat cushions
86
Q

Under what circumstances should doughnut seat cushions be used to prevent pressure ulcers?

A

they shouldn’t; they’re contraindicated because they may cause such ulcers

87
Q

Where are most pressure ulcers found?

A

on the heels

IC 1.0 (24 decks)

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