Geriatrics 2.0 Flashcards
Clinical approach to the geriatric assessment/Dx includes ? three domains
What are the three main outcomes of the assessment
Functional
Social
Psychological
Prognosis
Goals
Functional status
? determines what interventions and likely to be beneficial or burdenson to TP
The above answer worsens above ? age and with age related conditions such as ?
Prognosis
> 90y/o
Dementia
Malnutrition
Functional status
When life expectancy is more than ?yrs, same tests and Txs are offered to geriatrics as younger populations
When does this change?
10yrs
<12mon- palliative care
<6mon- hospice
What would be an example of a single Dz process that would have a prognosis better calculated by a Dz-specific instrument
What are 4 examples of advanced directives
Lung Ca metatestases to brain
Medical POA
Out of Hospital DNR
Declaration Mental Health Tx
Directive to Dr and Surrogate
_____ can be viewed as a summary of the overall impact of health conditions on a PT
What are the ADLs
What are the IDLs
Functional status
Continence Feeding Transfer
Toilet Bathe Dress
Driving Money Telephone Shopping Housekeeping Laundry Food prep Taking meds
When does Functional Status need to be assessed
Falls and Gait are the leading cause of injuries and death in older adults and are screened when/how?
How is a PTs gait assessed
Loss of spouse/caregiver
After hospitalization
Severe illness
Annually for incidence/frequency
Time Up and Go- time to get up, walk 3meters and return
Abnormal >15sec
What PTs are at increased risk for falls?
What meds are particularly known for causing them?
Single fall w/ injury
One or more fall past year
Gait/balance issues
Psychotropic drugs
What are the three best efficacious prevention for falls?
In PTs w/ cardioinhibitory carotid sinus hypersensitivity who experience recurrent falls, what is the best suggested Tx
After d/c of predisposing medications, if PT still has PHOTN, then ? medication is recommended?
Medical reduction
Physical therapy
Home safety mods
Dual chamber pacemaker
Fludrocortisone
Intrinsic RFs for falls
Secondary RFs
How much exercise is recommended
Meds Vision PHOTN Atrophy Vit D
Lighting Footwear Tripping hazard Safety measures
150min/wk
Normal vision is ?
Impaired is ?
Legally blind is ?
> 20/40
20/40-200
<20/200 or
Total visual field <20*
Cognitive impairment is an impairment in at least two of what domains?
What test can be done in the office to screen for dementia
Function Language Visuospacial function Memory Personality/Behavior
Mini Cog- three item recall and clock drawing in 2min; both normal, dementia unlikely
What is the next step for PTs that fail a Mini-Cog in office?
What is the in office depression screening tool?
Mini Mental Status Exam, 10min
MOCA- specific, 30min
PHQ 2-
Have you been feeling depressed?
Have you been experiencing anhedonia
DIAPPERS Acronym
Deliriium Infection Atrophic urethritis Pharm Psych Excessive excretion Restricted mobility Stool impaction
When does unintentional weight loss need to be investigated?
What are the six types of elder abuse?
What are the RFs associated w/ abuse
5% <1mon
10% <6mon
Sexual Abandon Finance Emotion Physical Neglect
Institution Caregiver Elder Environment
What are clues abuse may be occurring
How do retinal detachments present?
What type of age related process do PTs complain of
Behavior changes
Lack of clothing/hygiene
Unfilled Rx
Delayed injury presentation
Painless photophobia, floaters and visual field defect
Presbyopia- loss of lens flexibility/curvature, difficulty reading in low light
Nearly half of older adults have vision worse than 20/40 because ?
What step can PTs do to compensate for normal age related loss of vision
Problem w/ glasses
Bright, indirect light
What eye condition is the leading cause of vision impairment in the world
What would be seen on PE?
What is the only Tx
Cataracts- blurred yellow vision w/ increased sensitivity to glare (stain on shirt w/ otherwise appropriate dress)
White haze- mod/worse case
Dec red reflex
Surgery when <20/40
Inhibits daily living
What is the leading cause of irreversible vision in PTs >65
What are the two types
ARMD- impaired central vision
Non-neovascular/Dry, MC:
Gradual blurring of central vision w/ dec reading fine print/facial recognition
PE: Drusen lesions
Tx: Anti-Oxidants, Zinc
Neovascular/Wet:
Metamorphopsia- distorted images
Rapid loss of central vision
Tx w/ refer and anti-VEGF (Bevacizumab)
What are the RFs for AMD
What are two protective factors?
Smoking Age White FamHx
Eating green veggies/fish
How does Diabetic Retinopathy present
What exam is needed annually
What two protective steps can prevent Dz progression
Blurred vision w/ scomatoma and field constriction
Dilated, funduscopic exam
Glucose/HTN control
What is the early stage of Diabetic Retinopathy called?
What occurs during this early stage
What happens if this stage continues to develop
Non-proliferative/background retinopathy
Pericyte/endothelium damage leds to inc permeability
Retinal hypoxia increases GF leading to proliferative diabetic retinopathy
Define Glaucoma
When does USPTF recommend screenings
How does this condition present w/ vision changes
2nd MC cause of blindness:
Progressive optic neuropathy where IOP leads to atrophy of optic nerve
No screening
Loss of peripheral vision
Glaucoma affects ? race the most in the US
How is IOP measured
What is used to determine if angle is open or closed?
AfAm around 45y/o
By 80y/o, Hispanic/Latino dominant
Tonometry
Gonioscopy
What is normal IOP ranges
What are 3 types of vision Sxs/Changes that need ASAP referrals
10-21mm
Dec central vision
Ocular pain
Loss of peripheral vision