Geriatrics Flashcards
Life expectancy in 2016
78.69 years
Baby boomers were born between…
1946-1964
AARP estimates ______ will be on Medicare by year ______.
80 million, 2030
WHO definition of of “young old”?
65-75 years old
WHO definition of “old”?
76-90 years old
WHO definition of “very old”?
91 years old
How much height is lost by age 80?
2 inches
5 main things that degenerate when we age
- height (decrease)
- weight (increase due to slowing metabolism)
- temperature (decrease)
- pulse (increase)
- blood pressure (increase)
Presbycusis is the _____ most common chronic disorder
3rd
Presbycusis causes _______ hearing loss first after the age of ____.
high frequency
55
When suspecting presbycusis, check for this first:
cerumen impaction
Two changes seen with aging that are BOTH related to dental hygiene
- tooth loss
2. gum recession
Is tooth loss normal?
NO
it’s a result of periodontal disease
What four people groups tend to have less teeth??
- Black seniors
- Current smokers
- Less money
- Less education
Is there a change in TLC with normal aging?
no, it’s only due to disease
Changes in the GI tract may affect _________.
absorption of nutrients and medications
What two medications are especially suseptible to changing absorption with an aging GI tract?
Those that are dependent on gastric pH for absorption:
- Ketoconazole
- Tetracycline
_______ hepatic drug metabolism is reduced with aging
phase 1
achlorhydria=
absence of hydrochloric acid in the gastric secretions
achlorhydria affects _____ of elders over _____ years old
20-25%
80
Renal blood flow decreases ____ with aging
50%
Greatest risks for prostate cancer (6)
- age >60
- race: AA
- family history (esp immediate family members)
- diet high in saturated fats
- high testosterone levels
- elevated PSA
Biggest reason for MSK decline in elderly?
disuse
Muscle mass decreases by _____ per decade starting in our ____
3-5%
30s
OA changes are visible on x-ray by age ____, most common in the _____ and ______
40
weight bearing joints, cervical spine
After age 75, elderly have difficulty with these three things:
stairs
walking 1/2 of a mile
assistance with walking at all
On a cellular level, MSK system exhibits changes in 2 things….
collagen, elastin
There is an increased risk of institutionalization with these 4 things:
- arthritis
- neurological deficits
- vascular disease
- trauma to hands!!!!!
Brain’s weight, size of nerve network, and blood flow diminish in the ____ decade of life
3rd
Are memory changes a normal part of the aging process?
YES
What can help keep memory sharp?
puzzles, Sudoko, crosswords, etc
Does insulin production increase or decrease with aging?
increase
Does NE increase or decrease with aging?
increase
Sexual hormones begin declining in what decade of life
4th or 5th
What percent of people have at least one chronic illness when >65 years old
85%
what percent of people have at least two chronic illnesses when >65 years old
60%
_______ may be the only symptom of medical illness in the elderly.
Functional decline
Goals of Comprehensive Geriatric Assessment (CGA) focus on ______ by attempting to reduce polypharmacy and address the multiple, complex, co-morbid medical and psychosocial problems of elderly patients.
FUNCTION
Who benefits from CGA?
frail elderly people elders with 1+ sensory impairments those with: - decreased functional status - change in mental status - multiple chronic medical problems - psychosocial issues - polypharmacy - incontinence - involuntary weight loss - frequent falls
Who benefits from CGA?
frail elderly people elders with 1+ sensory impairments those with: - decreased functional status - change in mental status - multiple chronic medical problems - psychosocial issues - polypharmacy - incontinence - involuntary weight loss - frequent falls
when taking a history, some uncomfortable subjects won’t be brought up unless YOU broach the subject, such as:
- incontinence
- driving
- sexuality
- substance use
Activities of Daily Living (ADLs) acronym
DEATH:
Dressing Eating Ambulating Toileting Hygiene
Instrumental Activities of Daily Living (IADLs) acronym
SHAFT:
Shopping Housework Accounting Food preparation Transportation
Functional History includes documentation about:
ADLs IADLs use of assistive devices home environment home safety
Assistive devices are used for 5 different systems:
- eyes: glasses, contacts
- ears: hearing aids, pocket talker
- eating: dentures, weighted utensils
- ambulation: cane, walker, scooter
- transfers: hoyer lift, tub transfer, grab bars
Indications for EKG
smoking
HTN
bradycardia
arrhythmias
Indications for CXR
smoking SOB weight loss chronic cough chronic fever
Indications for CT brain
CVA
focal changes on exam
Basic health assessment with labs includes:
CBC full chemistry with liver and renal panels Lipoproteins (annually) albumin, pre-albumin Vit D drug levels B12/TSH/Folate PT/INR PSA (annually until age 75)
Delirium=
impaired attention
perceptual disturbances
cognitive impairment
Key Word: INATTENTIVENESS!!
Dementia=
global impairment cognitive function memory personality progresive interferes with normal social/occupational functioning
Key Word: SHORT TERM MEMORY LOSS
Category of drugs most often associated with cognitive S/E and cognitive decline with long-term use:
Benzodiazepenes
Dopamine agonists are used to treat
Parkinson’s
Restless Leg Syndrome
Examples of dopamine agonists
apomorphine HCL
Bromocriptine
Pramipexole (Mirapex)
Ropirinole (Requip)
Chemical agents that predispose to delerium
Illegal drugs/EtOH Digoxin dopamine agonists antipsychotics antidepressants anxiolytics sedatives anticonvulsants steroids
Main Tx for delirium
Treat the underlying cause!
Provide supporting, calming environment
_____ is the first most common cause of disability among those >65 years old, ______ is the second most common.
- arthritis
2. OA
_____ is the first most common cause of disability among those >65 years old, ______ is the second most common.
- arthritis
2. OA
Hypothetical course of an individual’s brain as it ages
- presymptomatic
- age associated memory impairment
- mild cognitive impairment
- cognitive disorder (NOS)
- Alzheimer’s Dz
Mild cognitive impairment is usually first noticed by
patient or those around them
____% of patients with mild cognitive impairment will develop Alzheimers within 3-4 years
50
Dementia= memory impairment plus one or more of the following:
aphasia (language disturbance)
apraxia (difficulty with motor activities)
agnosia (impaired recognition of familiar objects or persons or self)
executive function disturbance
A patient who has difficulty with the ability to keep appointments use the phone obtain a meal or snack travel alone
probably has an MMSE score of…..
25-20
= mild dementia
What is the first thing that’s lost in developing dementia?
orientation to time
How will loss of orientation to time manifest itself?
staying up late
sleeping during the day
waking up at 230am
T/F: a person with mild dementia may live alone
True
T/F: a person with mild dementia will still have good hygiene and relatively intact judgement
True
A patient who has lost the ability to use home appliances find belongings select clothing dress groom maintain hobbies
probably has an MMSE score of…
20-13
= moderate dementia
T/F: independent living is dangerous in moderate dementia and some supervision is necessary
True
T/F: onset of exaggerated mood/personality changes, poor impulse control, and lack of judgement occur in severe dementia
False. Occur in moderate dementia
Patient who has lost the ability to dispose of the trash clear the table walk eat
probably has an MMSE score of…..
12-7
= severe dementia
T/F: severe dementia marks the onset of impaired ADLs, poor personal hygiene, and need for continual supervision
True
At what stage of dementia does a patient need to be put in a nursing home?
Severe
what is a stronger predictor of mortality than heart disease or cancer in patients >75 years old
Alzheimer’s
Between ____ and _____, deaths from Alzheimer’s Dz as recorded on death certificates INCREASED ______%, while deaths from heart disease DECREASED ______%.
2000, 2015
123%
11%
7 warning signs of Alzheimer’s
- Asking same questions over and over
- Repeating the same stories
- Forgetting common tasks usually done with ease
- Losing the ability to pay bills or balance a checkbook
- Getting lost in familiar surroundings or misplacing household objects
- Neglecting to bathe, wearing same clothes day in and day out
- Relying on somebody else to make decisions or answer questions
What is most important when approaching the 7 warning signs of Alzheimer’s?
Know the patient’s BASELINE and compare everything to that
Incidence of Alzheimer’s:
- ___ are 2x as likely to have it than Caucasians
- ___ are 1. 5x as likely to have it than Caucasians
- ___ (men or women) are more likely to have it
- Older AA
- Hispanics
- Women > Men
Alzheimer’s progresses to death in how many years?
6-10
Definite risk for Alzheimer’s (4)
age
family history
APOE-4 gene
Down Syndrome
What does autopsy show of Alzheimer’s?
senile plaques
&
neurofibrillary tangles
What type of dementia is Alzheimer’s?
cortical
Alzheimer’s patients look well and are alert, interactive. They have little insight and no complaints. However, they might have…
word finding difficulty
What is the most common type of subcortical dementia?
Vascular dementia!!
Subcortical dementia patients look like…
opposite of Alzheimer’s patients (cortical dementia)
- do not look well
- insights into deficits “painful awareness”
- depression
- pessimistic with lots of complaints
- non-fluent speech
- gaze paralysis
Name some examples of vascular dementia
major depression Creutzfeld-Jacob disease Parkinson's disease Huntington's disease HIV-related disorders most secondary dementias
Describe the onset of vascular dementia
RAPID
step-wise deterioration
focal neurological signs
High risk factors for vascular dementia
HTN
DM
strokes (even “silent” strokes)
Name some secondary dementias
hypothyroidism B12, folate deficiency depression normo-pressure hydrocephalus neurosyphilis
Dementia with Lewy bodies clinical picture
mix of Parkinson’s and Alzheimer’s, most often presents as dementia
What are Lewy bodies?
neuronal inclusions
2/3 of Dementia with Lewy Bodies patients have ___.
Hallucinations.
Usually of people, animals.
Patients are not afraid of them
MMSE score of ____ is suggestive of dementia.
MMSE score of ____ is definitive of dementia.
25
20
What’s important to remember about RPR and HIV testing? (ex: in the suspicion of neurosyphilis)
you must gain consent
What are you thinking about when asking about meds in the history for patients experiencing cognitive side effects?
Recent CHANGES in medication regiments
On the clock drawing test, patients get one point for… (5)
- clock circle
- all the numbers being in correct order
- 2 hands on the clock
- correct time
- all numbers being in proper place?
Normal score for the clock test
4-5
Most difficult behavioral symptoms to treat (4) and goal in Tx
agitation
agression
insomnia
anxiety
Goal: DECREASE difficult behavior, not eradicate
When dementia progresses, worsens, or is problematic for the patient/family/caretakers, the first step should be ….
meet as a group and discuss the options available for treatment
Is depression a normal part of aging?
NO
Who is most at risk for unrecognized depression in the US? (3)
Older men
Older AA
Hispanics
T/F: Depression that develops later in life tends to be under-diagnosed and inadequately treated
True
What’s the difference between depression and grief?
Grief is a normal response to life events (loss of income, retirement, loss of loved ones, transition to nursing home, etc)
Grief can move into depression. How long should grief last?
less than 1 year
Signs and Symptoms of depression acronym
SIGE CAPS
Sleep (insomnia, hypersomnia)
Interest (anhedonia)
Guilt (worthlessness, excessive daily guilt)
Energy (fatigue, loss of energy)
Concentration
Appetite (weight changes! plus or minus)
Psychomotor activity (agitation, retardation)
Suicidal ideation
Tool for depression screening
PHQ-2
What is a positive PHQ-2 score?
3 or more
> > move to PHQ-9 or geriatric depression scale
2 questions on the PHQ-2... over the last 2 weeks, how often have you been bothered by any of the following problems: Not at all Several days More than half the days Nearly everyday
- Little interest or pleasure in doing things
2. Feeling down, depressed, hopeless
RF for depression:
cognitive dysfunction multiple medical problems Parkinson's disease frequent hospitalizations weight loss chronic pain functional decline PMHx, FHx stroke anxiety unexplained physical Sx
Depression can cause pseudo-dementia, which is:
cognitive impairment and short-term memory loss
What should you suspect if there is a poor response to treatment, poor motivation to participate in treatment, or mood/somatic symptoms are out of proportion to diagnosis?
Depression
Who is at the highest risk for suicide?
Elderly white men who live alone!!!
What do we focus on in PE and lab eval for depression?
signs of systemic disease, cognitive function, fall risk
Is there indication for neuro-imaging in depression workup?
NO
Labs for depression workup (8)
CBC: anemia >> anorexia, weight loss electrolytes calcium: energy LFTs: increased ALT >> fatigue, weight loss B12 free testosterone TSH: thyroid disease>> hypo= fatigue, weight gain, sleep. hyper= weight loss, burn out, fatigue UA: UTI!!
For outpatient mental health services, Medicare reimburses ____ of allowable charges
50%
In managing depression, combination of ___ and ___ is most effective.
psychotherapy, pharmacotherapy
Pharmacology selection should be guided by ____
side-effect profiles
Early, mild stages of Alzheimer’s benefit from ___.
Life reminiscing
Principles for Pharmacotherapy:
- Always check ____.
- Medicines typically take _____ or longer to show effect.
- ____ is preferred because it _____.
- Start low, go slow!!
- Beer’s list (list of meds that are risky to use in elderly patients)
- 4-6 weeks
- Monotherapy, minimize S/E and drug interactions
First line med for depression
SSRI
Important to do this when prescribing an SSRI!!!!!
get an EKG!!!
because they can cause QT prolongation
Second line med for depression
SNRI
What med do you use with patients who would otherwise say NO to antidepressants?
Duloxetine (Cymbalta)
Serotonin Syndrome=
condition that occurs when there’s too much serotonin in the body
Occurs with SSRIs, SNRIs, or abrupt discontinuation of these agents
Sx of serotonin syndrome
AMS monoclonus tremors hyper-reflexia fever
T/F: Studies of RF for serotonin syndrome are needed
True
This med is useful for Tx depression in patients with lethargy, daytime sedation, fatigue
Bupropion (Wellbutrin)
This med is only an antidepressant at HIGH doses and used for insomnia at LOW doses. Useful for sundowning patients (agitation with dementia)
Trazodone (Desyrel)
S/E of TCAs that make them not first line anymore
Orthostatic hypotension
falls
constipation
worsening confusion in Alzheimer’s
T/F: when considering TCAs you should consult with psychiatry.
True.
due to S/E
TCAs should be used with caution in:
cardiac abnormalities arrhythmias glaucoma urinary retention BPH
T/F: baseline EKG is not required before prescribing TCAs
False.
EKG is required
Caution with TCAs for ___ toxicity
SSRI
What med could be used for depressed patients with severe psychomotor retardation? Dose?
Methylphenidate (Ritalin)
5-10mg BID depending on response
Ritalin is CI in …
confusion
CV disease
arrhythmias
What can you move to for depression Tx when adequate meds have not produced a response?
Electroconvulsive Therapy
6-12 treatment
Biggest reason for NH placement.
_____ is a major problem that families often cannot deal with.
caregiver burden
incontinence
3 precipitates of NH placement requests
- crisis
- loss of function (incontinence)
- family’s inability to compensate for #2
Is underweight or overweight more concerning in the elderly?
Underweight
____ are needed for a great majority of the elderly population, ____ becomes more common.
Glasses, legal blindness
Goal of NH, care is to ____, not ____. So, it is critical to know ____.
maintain or improve function
encourage dependance
ADLs, IADLs
Important to know what about socioeconomic status when placing in a NH
- nature of family relationships
- relevant financial info: who’s paying for this?
Vets who are ___% service connected or those going into NH on hospice are paid for by the VA
70%
2 steps of advanced directives
- establish medical power of attorney
- create a living will
*** try to have these convos with family members present!!!
Physicians in the NH
Medical Director must be an MD
MD must do the initial eval and then visit the patient once every 30 days
____ have close oversight. You must be able to justify the decision to use these and document convos about the risks, benefits, and convos with proxy decision makers
Psychotropic meds
One of the most common problems diagnosed in NH is ____.
Polypharmacy
We often prescribe a med for every problem, even the S/E of other meds!!
___% of NH residents have incontinence
50%
RF for incontinence
Women
Age
Causes of transient urinary incontinence acronym
DIAPPERS
Delirium Infection Atrophic vaginitis/urethritis Pharmaceuticals Psychological problems Excessive urine output Restricted mobility Stool impaction
Consider ____ in incontinence evaluation in clinic. RNs can do this and so can you with minimal training
Post Void Risidual (PVR) ultrasound
PVR value indicating adequate emptying
<50mL
PVR value indicating inadequate emptying
What could it be due to?
<200mL
Detrusor weakness or obstruction
If concerned about hydronephrosis, you should perform a ____.
Renal US
4 types of urinary incontinence
Stress
Urge
Overflow
Functional
MC type of incontinence in younger women
stress incontinence
____= leakage of urine with increased intraabdominal pressure: exertion, laughing, coughing, sneezing
stress incontinence
2 mechanisms of stress incontinence
Weak pelvic floor muscles from childbirth, obesity, surgery, etc
Intrinsic sphincter deficiency… multiple surgeries lead to neuromuscular damage
Stress incontinence Tx
Conservative first: Kagels, fluid restriction, pelvic floor PT
Pharmacologic: Vaginal estrogen
Surgical
____= leakage of urine along with or before urge to void
Urge incontinence
MC type of incontinence in older women
Urge incontinence
“overactive bladder”
Urge incontinence Tx
Conservative first: fluid restriction, timed voiding, Kegels
Pharmacologic:
- Antimuscarinics (Oxybutinin)
- Alpha blocker
- Beta agonist
Surgical
____= continuous leakage of urine, dribbling, incomplete emptying, “bedwetting”
Overflow incontinence
MC type of incontinence in men
Overflow incontinence
2 mechanisms of overflow incontinence
- detrusor underactivity (DM!!)
- bladder outlet obstruction (BPH!!)
anticholinergic meds
Overflow incontinence Tx
Acute: foley catheter
Treat BPH
If elevated Cr»_space;> renal US (to r/o hydronephrosis)
If DM or neuro illness is causing retention:
- chronic intermittent catheterization
- foley
____= functionally unable to toilet themselves in a timely manner despite intact storage and emptying function
Functional incontinence
MC type of incontinence in frail elderly
Functional Incontinence
How to deal with functional incontinence
Things like: provide closer toilet proximity use pads/special undergarments clean floors grab bars timed, prompted voiding
____= a localized area of tissue damage that tends to occur when soft tissue is compressed between a bony prominence and an external surface for a prolonged period of time
pressure ulcer
Pathophysiology of pressure ulcers
compression of soft tissue»_space; microvascular occlusion»_space; ischemia, hypoxemia
moisture causes skin breakdown
develops within 3-4 hours
Braden Scale for pressure ulcer risk has 6 categories:
- sensory perception
- moisture
- activity
- mobility
- nutrition
- friction and shear
How does the Braden scale work?
Each category is rated 1-4.
- 1= most extreme
- 4= least extreme
Risk for pressure sore increases as the score decreases
- 15-16= mild
- 12-14= moderate
- <12 = serious
4 changes in elderly skin that make them more prone to pressure ulcers
- decreased blood flow
- decreased elastin
- loss of subcutaneous fat
- decreased dermal-epidermal turnover
Most common areas for pressure ulcers (3)
sacrum
heel
coccyx
Classifications of pressure ulcers (4)
Stage 1: CLOSED!! nonblanchable erythema of intact skin
Stage 2: partial thickness skin loss involving epidermis, dermis, or both. NO SUBCUTANEOUS TISSUE EXPOSED
Stage 3: full thickness skin loss INVOLVING SUBCUTANEOUS TISSUE, no fascia, muscle, tendon, ligament, or bone is exposed
Stage 4: full thickness skin loss with extensive destruction, tissue necrosis, or damage to the muscle, bone or supporting structure
Can you backstage a pressure ulcer?
NO.
They can get WORSE, but regardless of healing, that wound will always be at it’s highest stage. It does not get called a lesser stage as it heals.
What’s an unstageable ulcer?
When debris/eschar covers the pressure ulcer and you’re unable to assess depth
Should you debride stable lesions?
NO
Ulcer documentation: 5 steps
- Ulcer measured head to toe in cm: length x width x depth
- Assess periwound tissues, wound bed, level, type of exudate
- Note odor (after dressing is removed and the wound is cleaned)
- Eval for tunneling (vertical) or undermining (parallel)
- Do not back stage
When do you need systemic Abx therapy for an infected pressure ulcer?
MRSA
Pseudomonas
Anaerobes
Mechanical debridement=
apply wet dressing, it becomes dry, you will remove tissue when you remove the dry dressing (it’s stuck to it)
Sharp debridement=
a surgical procedure. Scalpel used to remove necrotic tissue and expose clean tissue
Enzymatic debridement=
topical agent liquifies the necrotic tissue
Tx for pressure ulcers that good for superficial wounds with minimal drainage. It’s thin, transparent, semipermeable, and nonabsorbent
films
Tx for pressure ulcers that’s good for wounds with low to moderate drainage. It’s adherent, opaque, gas impermeable, and absorbent. Not good for infected wounds, can cause hyperpigmentation
hydrocolloid
Tx for pressure ulcers that is semitransparent, absorbent an nonadhesive. Soothing, but can cause maceration of surrounding tissues. Not good for wounds with heavy drainage
Hydrogel
Tx for pressure ulcers that’s IDEAL FOR DRAINING WOUNDS. Biodegradable dressings derived from seaweed.
Alginates
Tx for pressure ulcers that’s polyurethane dressing, highly comfortable, and permeable
foams
_____% of people over _____ years old have Alzheimer’s
10, 65
_____ Americans living with Alzheimers in 2018
5.7
What type of group meets to solve a problem, then disbands?
Ad hoc
What type of group may be one discipline or multidisciplinary, but is short lived and has little interactive problem solving?
Formal Work Group
What are the four phases of team development?
- Forming
- Storming
- Norming
- Performing
What happens in the Forming phase of team development?
It’s the creation stage.
Members size each other up.
Members are categorized based on their professional role or status.
Conflict is not usually discussed.
What happens in the Storming phase of team development?
Conflicts can't be avoided. Some new members withdraw. Functional leaders emerge. Realize each member has power for leadership and decision making. Team updates goals and roles.
What happens during the Norming phase of team development?
Attempt to establish common team goals.
Begin to see overlap of roles.
Know conflicts are present but may choose to ignore them.
Members may start to show up late or skip
What happens during the Performing phase of team development?
Members encourage and help each other.
Team grows strong.
Members meet regularly and on time
Emphasize productivity and problem solving
5 principles for team members
- control yourself- you can’t control others
- conceptualize- don’t personalize
- listen- make sure you are heard
- explore- dont’ explode
- feedback- don’t stab in the back
How is the skill of redirection helpful in team practice?
changes the focus of the team
How is the skill of conceptualization helpful in team practice?
restates the issue
How is the skill of listening helpful in team practice?
allows team members to be heard. paraphrase, repetition
How is the skill of exploring helpful in team practice?
helps members ID issues, express ideas, and begin to focus on solutions
How is the skill of feedback helpful in team practice?
direct, supportive info that facilitates discussion
What are the Kubler-Ross Stages of Grief?
- Denial
- Anger
- Bargaining
- Depression
- Acceptance (does not mean they’re ok with what’s happening though)
Patients with _____ are at risk for suboptimal palliative care
dementia
5 major concerns at the end of life
- Nutrition
- Pain
- Non-pain Sx
- Spirituality
- Purpose
T/F: terminally ill patients may lose weight and appetite without discomfort
True
T/F: it is probably best to not force a patient to eat at the end of life because it only causes added discomfort
True
T/F: Artificial feeding has been shown to extend life expectancy and improve quality of life
False. No evidence for this.
Strongly recommended to not use percutaneous feeding tubes in patients with ____.
advanced dementia
Case-based reports, retrospective series, and testimony from hospice professional support that _____ in terminally ill patients is associated with ____ of symptoms.
dehydration, amelioration
T/F: it is legally, ethically, and professionally acceptable to discontinue nutritional support in the terminally ill
True. Agreed upon by the AMA, ANA, ADA
Guidelines for pain control (3)
- Acetaminophen/NSAIDs for mild pain
- # 1 plus a weak or moderate opioid for moderate pain (Tramadol, Hydrocodone)
- # 1 plus a strong opiate for severe pain (Morphine, Fentanyl)
Starting point for Morphine Rx
5mg PO
Qualifications for home health care
1 comorbidity + 2 ADLs
or
3 ADLs
S/E of Morphine
constipation sweating dry mouth urinary retention respiratory depression
Definition of dyspnea
subjective breathlessness
Dyspnea is not associated with respiratory rates, pulmonary congestion, hypoxia, or hypercarbia, so we should limit use of O2 to those who are…
dyspneic AND hypoxemic
Opioids like morphine may work by decreasing both _____ and _____.
respiratory drive, sensation of breathlessness
If patient is already on opioids, how much do you increase the dose for pain control?
25-50%
Delerium precautions:
open blinds clocks calendars phone numbers decreased noise
_____ may cause paradoxical agitation
Benzos
Best treatment for delirium at the end of life
1-2mg of Haloperidol PO
or
2nd generation antipsychotic LOW dose
___% of people >65 years old will fall/have fallen
33%
___% of people >85 years old will fall/have fallen
40%
T/F: falling is more common in males
False, but the severity is often worse in males when they do fall
___% of falls lead to fracture
5%
Falls are the ____ leading cause of death in the elderly
5th
Fall–related injuries are ___% of all medical expenditures
6%
There’s an increased risk of ____ and decreased ____ with falls
hospitalization, NH placement, death
independence, self-imposed restriction of activities
A patient needs a fall evaluation when they’ve had ____ falls in _____.
2, 6 months
History of falls acronym
CATASTROPHE
Caregiver/housing Alcohol Treatment (meds and compliance) Affect Syncope Teetering/dizziness Recent illness Ocular problems Pain with mobility Hearing Environmental hazards
Falling physical exam acronym
I HATE FALLING
Inflammation/deformity of the bones
Hypotension (orthostatic)
Auditory and visual abnormalities
Tremor
Equilibrium/balance
Foot problems Arrhythmia/valvular Dz Leg-length discrepancy Lack of conditioning/generalized weakness Illness Nutritional status Gait disturbance
What gait assessment test identifies ataxia, stride variability, gait instability, LE weakness?
Get up and go test
What gait assessment test is a quantitative measure of static balance?
Progressive Romberg
T/F: hip protectors are no longer considered to be the standard of care
True.
Studies have suggested an increased risk of hip fracture
What is a contraindication to ECT?
a space occupying lesion
Antidepressants take ____ to become effective
2-6 weeks
If prescribing a narcotic, also prescribe a ____.
laxative/stool softener
Quality of life may improve with ____.
increased mobility
What is the one question care plan?
“Given your current capabilities, what is the best way you can imagine spending the rest of your time?”
T/F: Palliative care can be offered during the course of any life-threatening illness.
True
Hospice care is a comprehensive care system for patients expected to live ____.
<6 months
Hospice became a Medicare benefit in ____.
1982
Those entering hospice care must sign a ______.
Certificate of Terminal Illness
3 most common Sx near end of life:
- decreased appetite
- dyspnea
- pain
Goal of palliative care:
interdisciplinary care for the patient and family to reduce both physical and emotional suffering
