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Clinical Disciplines > Geriatrics > Flashcards

Geriatrics Flashcards

1
Q

Life Expectancy Estimates

A

At 65 you have 15 years, 75 you have 10, 85 you have 5, 95 you have 2-3

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2
Q

Vitals to check at each visit

A 
Weight, temp, pulse, BP, respiratory rate
Height yearly (for osteoporosis)
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3
Q

Normal skin/nail changes

A

Wrinkles, loss of turgor, decreased vascularity (pale), thinning, fragility, plaques and purpura
yellow, brittle nails

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4
Q

Hair changes

A

Hairline recession at temples and vertex
thinning on scalp and body
women have thickened facial hair

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5
Q

When does visual acuity start to diminish?

A

AKA presbyopia
50, more rapidly after 70
Cataracts start in 60s

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6
Q

What order does hearing diminish?

A

AKA presbycusis

starts with high pitched, then midland low pitches

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7
Q

Mouth Changes

A

Darkened teeth, fissures in tongue , tongue sticking to buccal mucosa (xerostomia)
enlarged tongue in pts without teeth
angular cheilitis

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8
Q

What does back and abdominal pain raise concern for?

A

AAA, esp male smokers

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9
Q

Urinary changes

A

denervation and contractility of detrusor, loss of bladder capacity, inability to inhibit voiding

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10
Q

What is normal gait velocity?

A

> 0.8 meters/s or <5 seconds on a 4 meter walkway

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11
Q

What makes up health status of older adults?

A

Chronic diseases and number

  • physiologic changes
  • susceptibility to acute illness/injury
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12
Q

Diseases that are major causes of mortality?

A

Heart disease, cancer (esp lung, colorectal, breast), lung disease, cerebrovascular disease/stroke
-Acutely: pneumonia and influenza

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13
Q

What % of older adults have difficulty with activities of daily living?

A

40% (1/2 occur chronically/progressively, the other 1/2 catastrophically like hip fracture/stroke)

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14
Q

Precursors to disability

A

difficulty walking, cognitive impairment, visual impairment

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15
Q

How can we modify consequences of disease?

A

Health habits (diet, alcohol, smoking), screening, immunizations (flu, pneumonia, zoster), education, access to healthcare, community service support

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16
Q

Primary Prevention

A

Prevent disease or injury to occur

vaccines, exercise, diets, BP monitoring, safety eval, etc

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17
Q

Secondary Prevention

A

Intervention for pts with condition to prevent progression to complication (stop smoking with CV disease)
-Screenings!

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18
Q

Tertiary Prevention

A

Effort to improve care to avoid further complications (rehab to optimize function)
-foot/dental care, geriatric assessment, etc

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19
Q

Principles ofPrevention

A

Prevalence of the problem and likelihood of effective intervention

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20
Q

What is the main syndromes we want to prevent?

A

Falls, dizziness, functional decline (these increase risk for disability)

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21
Q

Screening Recommendations

A
  • ACP/AISM: ADL screening, cognitive screening, health status eval
  • USPTF: welcome to medicare visit, periodic screening, counseling and immunizations (>65)
22
Q

Screening for psychosocial problems

A

PHQ-9, Beck depression Inventory, geriatric depression scale

23
Q

Recommended Physical Activity

A

Total of 150 minutes of moderate intensity activity weekly

-helps balance/fall prevention, stamina, CV conditioning, strength/tone/mass, flexibility, osteoporosis prevention

24
Q

Nutrition Recommendations

A
  • Nutritional requirements stay the same but calorie needs decline
  • low body mass index (weight loss of >10lbs in 6 months could be poor nutrition/cancer)
  • Mini nutritional assessment
25
Q

Prevention of osteoporosis

A
  • exercise (weight bearing) and diet for bone health

- walking increases skeletal load-low benefit, strength training is better

26
Q

Calcium and Vitamin D supplementation

A

1500 mg calcium citrate daily (500 mg doses), no more than 1000 units vitaminD/day

27
Q

What is the most preventable problem in an older adult?

A

Iatrogenesis (problems brought forth by health care workers)

28
Q

Common iatrogenic problems

A
  • under/over diagnosing
  • Bedrest
  • over sedation/delirium
  • enforced/learned dependency
  • transfer trauma
  • over treatment/antibx
  • polypharmacy
29
Q

Risks of hospitals

A

Iatrogenic events, cognition changes, testing (can cause more harm than good), central lines, catheters, changing treatments, unfamiliarity with patient, caregivers not informed on treatment/testing

30
Q

Complications of bedrest

A

Pressure ulcers, bone resorption, hypercalcemia, postural hypotension, atelectasis/pneumonia, thrombophlebitis, incontinence, fecal impaction, decreased muscle mass/strength, decreased cardiac output, depression, sensory deprivation

31
Q

What is the leading iatrogenic event in long term care facilities?

A

Learned dependence

32
Q

How to prevent iatrogenic events

A
  • Only prescribe new meds if necessary

- maintain philosophy of care focusing on optimizing function and physical activity

33
Q

What is the major cause of morbidity/mortality in geriatrics?

A

Falls! (1/3 living at home fall each year, 1/2 in LTC facilities)

34
Q

Complications of falls

A

Injury/fracture, subdural hematoma, hospitalization/iatrogenic, disability

35
Q

Management of fall risk patients

A

PT and OT, gait training, muscle strengthening, assistive devices, hip protectors if high risk in LTC facility

36
Q

Palliative Care

A

Approach that improves quality of life of patients and their families facing life threatening illness

37
Q

Four Trajectories of functional decline

A
  • Short period decline before death
  • Chronic illness with exacerbations and sudden death
  • Progressive deterioration
  • Sudden, severe neurological injury
38
Q

Trajectory 1: short period of decline before death

A

Cancer, stroke, MI

-they’re healthy then something happens that dramatically drops their health quickly

39
Q

Trajectory 2: Chronic illness with exacerbations and sudden death

A

COPD, CHF, end stage liver disease, AIDS
-they have a chronic illness with constant decline, but periods that are worse and get better, but when they get better its not to baseline

40
Q

Trajectory 3: Progressive deterioration

A

Neurodegenerative diseases like dementia, Parkinson’s, MS

-constant slow decline

41
Q

Trajectory 4: Sudden, severe neurologic injury

A

Sudden severe neuro impairment like stroke, traumatic brain injury, hypoxic ischemic encephalopathy
Get REALLY bad, then a little better and drop off again

42
Q

Hospice vs Palliative Care

A
  • Hospice: prognosis of <6 months, certified by doc, focus is on comfort not cure, medicare covers it, volunteers provide care, families offered grief counseling for a year after
  • Palliative: any time during illness, can try curative treatment, provided by healthcare professionals, medicare covers part of service
43
Q

Advanced Care Planning

A

Process for identifying and communicating values and preferences regarding future healthcare

44
Q

Advance directive

A

Document that chooses a person to make medical decisions for you

45
Q

Living will

A

Expresses your wishes about medical treatment in a terminal condition

46
Q

POLST

A

Physician Orders for Life-Sustaining Treatment

-requires valid clinician signature, allows doc to make decisions for you

47
Q

Medical Surrogate options if patient doesn’t have POA

A

First is spouse unless they’re legally separated

  • then an adult child of patient
  • parent
  • domestic partner if unmarried
  • sibling
  • close friend
  • if none available, physician can make decisions or court appointed person
48
Q

Five Wishes Program

A

Provides online forms for patients to express their wishes if they don’t have someone to be MPOA

49
Q

Primary goals of care

A
  • Curative: restore health
  • Palliative: promote comfort by receiving pain and suffering
  • Combination
50
Q

SPIKES Protocol

A

Guide to communicate important info with patient and families

  • Setting
  • Perception-what does pt know?
  • Invitation-how much do they want to know?
  • Knowledge
  • Emotion
  • Subsequent

Clinical Disciplines (4 decks)

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