Geriatrics Flashcards
Caveats in the evidence-based approach for geriatric patients
- Prognosis: Screening tests that are typically effective may not be useful in individuals who may not have long enough to act on the condition before it develops, or something else happens.
- Insufficient evidence for geriatric populations: Most of our evidence base is not for this population, and its applicability may be limited.
- Patient goals/preferences: Patients’ goals may relate to a functional or health state, symptom control, living situation, or survival. This is on many levels a personal choice.
In most medical visits, but especially in geriatric medical visits, the interview should always start with. . .
. . . an assessment of the patient’s agenda and issues, including immediate concerns and threats to quality of life.
The longer the range of projections, ___.
The longer the range of projections, the less can be said with certainty about his future health and social needs.
In geriatrics, you can gain much more information from the patient’s ___.
In geriatrics, you can gain much more information from the patient’s constitutional symptoms and gait.
Value of scheduled home habitus assessments
Home assessment and modifications can reduce falls by 41% among individuals with visual impairment and by 44% among those at high risk for falling
Value of vitamin D supplementation
Vitamin D supplementation can reduce falls by 22% and hip and nonvertebral fractures by 20% and 18%, respectively
Five M’s of Geriatrics
- Mind (maintain mental acuity and screen for depression)
- Mobility (maintain ability to walk and balance, prevent falls)
- Medications (reduce polypharmacy, de-prescribe unnecessary medications)
- Multi-complexity (help manage variety of conditions, including social determinants, home conditions important)
- Matters most (coordinating advance care, help manage goals of care, ensure values reflected in treatment)
When to consult a geriatrics specialist
- Significant physical impairment or frailty develop
- Family members and friends are under significant stress as caregivers
- Caregivers have trouble following complex treatments or managing relationships with many healthcare providers for multiple health conditions.
Functional status
How an older adult functions on a day to day basis. Includes:
- Basic Activities of Daily Living (ADLs): Bathing, Grooming, Dressing, Toilet use, Feeding, Transferring (bed to chair)
- Instrumental Activities of Daily Living (iADLs): Telephone use, Grocery shopping, Food preparation, Housekeeping/Laundry, Driving/Transportation, Managing Medications, Finances
Chair Stand
Ask the patient to rise from a chair without using their hands. Patient who have difficulty may be at higher risk for falls. This exercise also lowers fall risk
Gait Speed
How fast a patient walks may predict their risk for falls, hospitalization and even death. Less than 0.8 m/s means the patient is likely to be frail, and at higher risk for adverse outcomes.
Orthostatic hypotension
A decrease in systolic BP ≥ 20 mm Hg or diastolic BP of ≥ 10 mm Hg, or lightheadedness/ dizziness when going from lying or sitting to standing. Increase risk for falls.
Presbycusis
Age related hearing loss, starts with high pitched sounds. Use the Finger Rub Test and check for cerumen (wax) in the ears. Speak LOW (pitched voice), SLOW (enunciate) and face the patient.
Minicog
Brief cognitive assessment: ask the patient to repeat 3 words (banana, sunrise, chair), ask the patient to draw the face of a clock, put in all numbers, and set the time at ten past 11. Then ask the patient to repeat the 3 words. If abnormal, consider a MOCA or longer cognitive test.
Delirium
An acute change in mental status from baseline, resulting in confusion, inattention, and sometimes agitation (hyperactive delirium) or somnolence/sleepiness (hypoactive delirium). Common in hospitalized older patients; evaluated by the Confusion Assessment Method (CAM) which includes orientation questions and a test of attention (month of the year backwards)
