Geriatrics Flashcards
When should we screen for depression?
Sleep issues Decrees interest Energy Concentration Appetite Somatic symptoms, cognitive impairment, psychosis
When should we do head imaging due to cognition?
If age greater than 60 Rapid unexpected decline in function Short duration dementia Recent and significant head trauma History of cancer Use of anticoagulants Unexplained neuro findings New localizing signs
When should you screen for osteoporosis?
If less than 65 and risk factors
Or everyone over 65
Initial screen for weight loss in acute setting
CBC with differential Urinalysis Hemoglobin A1C Creatinine and electrolytes Liver panel Calcium CRP TSH FIT
CAM criteria
- Acute onset and fluctuating course
- Inattention
- Disorganized thinking
- Altered LOC
Need 1+2 and either 3/4
Risk factors for delirium on admission
- Sensory impairment
- Severe illness
- Cognitive impairment
- Dehydration
Risk factors for delirium in hospital
- Malnutrition
- Physical restraints
- Catheters
- Polypharmacy
Risk factors for delirium pre-op
- Age >70
- EtOH abuse
- Poor cognitive function
- Poor functional status
- Abnormal Na, K, Glucose
- AA surgery
Management of delirium
- Meds: avoid benzos, merperidine, anticholinergics
- Regular tylenol to reducse opiod dose for pain
- Avoid catheters, physical restraints, do regular toileting and comfort rounds
- Manage fluids and electrolyres
- Feed appropriately
- Use glasses, hearing aids etc
What are some major physiological changes that occur with age?
- Cardiac: stiffer vessels, higher BP, less response to beta stimulation
- Resp: Decrease elasticity, decreased strength of diaphragm
- MSK: decreased muscle bass, loss of calcium from bone
Which drugs may increase the risk of falling?
Sedatives antidepressants -ssris antipsychotics anti hypertensives diurectives NSAIDS anticholinergics alchohol
What has the best evidence for fall intervention?
Exercise program
How is driving assessed?
Safety record Attention skills Family Report Ethanol Drugs Reaction time Intellectual impairment Vision/visuospatial function Executive function
Is dementia a contraindication to driving?
- Only if moderate to severe
2. If mild reassess every 6-12 months
How does age affect drug pharmacology?
- Absorption may be slower but not sig. changed
- Distribution: larger in fat, less in water
- Metabolism: decreased first pass metabolism s higher serum drug concentrations
- Distribution: decreased renal function so decreased excretion
Adverse drug reaction
Noxious/unintended result of a drug, elderly at much higher risk. See Beers list.
Which medications interact significantly with warfarin
- Antibiotics
- Antifungals
- Antidepressants
- Antiplatelet agents
- Amiodarone
- Anti-inflammatories
- Acetaminophen
- Alternative drugs (herbals
What are the types of elder abuse?
Physical Psychological Material/financial exploitation Neglect Violation of rights
Personal directive:
Written before loss of capacity
Covers non-financial decisions
Power of attorney
makes financial decisions
What changes in sexuality occur with aging?
Men: decreased libido, erections take longer to achieve and are more difficult to maintain, decreased intensity of orgasm
Women: vulvovaginal atrophy, decreased lubrication
what counts as a fever in the elderly?
> 37.2 C oral
Frailty
An increased state of vulnerability to external stressors
Phenotype: slow gait, weight loss, decreased strength, decreased activity, exhaustion
Risks of prolonged bedrest
- Loss of muscle mass, strength, aerobic capacity
- Loss of plasma volume- orthostatic hypoT
- Reduced ventilation
- Accelerated vertebral bone loss
- Functional incontinence
- Pressure sores
- Malnutrition and dehydration
- Change in quality of life
What are the medical indications for a urinary catheter/
- Urinary retention unmanageable
- Monitoring urinary output
- Bladder hemorrhage
- Surgery
- Palliation
- Bad sacral ulcers
What are the common causes of transient urinary incontinence?
- Thin, dry vagina/atrophy
- Obstruction (stool)
- Infection
- Limited mobility
- Emotional disorder
- Therapeutic meds (diuretics)
- Endocrine/excess output
- Delirium/confusion **
What characterizes the causes of chronic urinary incontinence?
- Urge-large volumes +urgency
- Stress-loss on exertion but small vol.
- Overflow-urge but only small vol. passed
- Functional- cognitive, physical, environmental barriers
- Mixed - stress + urge
What are treatments for causes of chronic urinary incontinence?
- Urge-bladder training, scheduling toilets, anti-cholinergic
- Stress-kegels
- Overflow-intermittant catheterization
- Functional- tx underlying cause
- Mixed - anticholinergic
Red flags for urinary incontinence?
- Organ prolapse
- Hematuria
- Palpable bladder after voiding
- Suspected pelvic mass
Most common cause of fecal incontinence?
Fecal impaction
pharmacological treatment for chronic constipation?
Osmotic laxatives (PEG, lactulose)** safe chronic*
Stimulant laxatives, bulk forming (Biscodyl, senna) not safe chronically
Suppositories
Risk factors for chronic constipation?
- Endocrine (hypokalemia, hypothyroid, diabetes, hypoMg, hyperparathyroid)
- Meds- opiods, anticholinergics, antacids, iron, levadopa/carbidopa
- Dehydration
- Neuro changes
Well elderly- obesity
Measure height, weight, BMI
-behavioural interventions in those that are obese
Well elderly- prostate
Do not do regular PSA
Well elderly-Colorectal cancer
- FIT for patients 50-74, q 1-2 years
2. Colonoscopy if FIT positive
Well elderly-depression
Screen if clinical clues
Well elderly- cervical cancer
- Screen q 3 years until 69
2. Don’t screen over 70 if 3 good tests
Well elderly-breast cancer
Mammography q 2-3 years 50-74
Well elderly-HTN
screen bp every visit
Well elderly-DM
screen HBA1C q 3-5 years in high risk
Well elderly-Vaccinationes
pneumococcal (routine if >65) herpes zoster (optional)
