Geriatrics

Question 1

what causes involuntary weight loss in elderly?

Answer 1

social causes (difficulty shopping, meal prep), malignancy, depression, GI (malabsorption, swallowing difficulties, poor dentition), endocrine (hyperthyroid, DM2, adrenal insufficiency), advanced heart and lung dx, nutritional deficits, chronic infection (HIV), medication side effects and unknown.

Question 2

How to establish involuntary weight loss?

Answer 2

clothing size changes or objective weight measurement

Question 3

what are common causes for falls in elderly?

Answer 3

impaired vision and decreased proprioception.

Question 4

what are the reversible causes of falls in elderly

Answer 4

vision, postural blood pressure, medication use, balance and gait, targeted cardiovascular and neurological examination, home hazard evaluation

Question 5

How to treat vision impairment in elderly?

Answer 5

correction if visual acuity is <20/60
cataract removal
ample lighting without glare

Question 6

How to treat postural blood pressure changes in elderly?

Answer 6

remove offending medication
modification of salt and fluid intake
behavioral changes (slow change in position)
compression stockings

Question 7

How to treat the risk of falls from medication use?

Answer 7

removal of offending medications (benzos, neuroleptics, sleep aides)
reduce polypharmacy

Question 8

How to treat balance and gait?

Answer 8

Do a get up and go test
environmental modifications
PT/OT for gait and balance training
Assessment of assistive device
exercise program

Question 9

Targeted cardiovascular musculoskeletal or neurological examination

Answer 9

diagnose and treat underlying cause if identified

Question 10

home hazard evaluation

Answer 10

environmental modifications (adjust poor lighting and remove loose rugs, place non slip bathmats and rails.

Question 11

what is an independent predictor of functional decline and death in elderly when adjusting for depression and medical illness?

Answer 11

loneliness. If not addressed social isolation can lead to increased rates of anxiety, depression and suicide.

Question 12

how to combat loneliness in elderly?

Answer 12

for pts who admit they are feeling lonely, drs need to help quality of life with interventions that decrease social isolation like social services agencies, senior center activities, volunteer work.

Question 13

advanced dementia is defined by

Answer 13

profound memory deficits, total functional dependence, no knowledge of recent or past events, little to no verbal communication and limited ability to ambulate.

Question 14

how does hospice care help pts who have advanced dementia?

Answer 14

they help improve quality of life experiences for patients with dementia, lower rates of hospitalization, increase likelihood of appropriate pain management and provide bereavement services to care givers.

Question 15

does megestrol help with lack of appetite in dementia pts?

Answer 15

no

Question 16

side effects of donepezil?

Answer 16

bradycardia, diarrhea, and nausea and vivid dreams

Question 17

does artificial nutrition help with advanced dementia pts?

Answer 17

no it doesn’t help prevent malnutrition,

same risk for aspiration pneumonia and doesn’t improve wound healing for sacral decubitis ulcers.

Question 18

Side effects of commonly used drugs in elderly:

digoxin

Answer 18

nausea, vomiting, cognitive impairment heart block

Question 19

Side effects of commonly used drugs in elderly:

benzos

Answer 19

falls

Question 20

Side effects of commonly used drugs in elderly:
anticholinergic medications
(including first generation antihistamines)

Answer 20

cognitive decline, confusion, hallucinations
dizziness, falls
urinary retention and constipation

Question 21

Side effects of commonly used drugs in elderly:

opioid analgesics

Answer 21

constipation, sedation and confusion

Question 22

Side effects of commonly used drugs in elderly:

antipsychotics:

Answer 22

increased mortality in pts who have dementia

community acquired pneumonia

Question 23

Side effects of commonly used drugs in elderly: insulin and sulfonylureas

Answer 23

episodes of hypoglycemia

Question 24

Side effects of commonly used drugs in elderly: fluoroquinolones

Answer 24

tendon inflammation and rupture

hypoglycemia

Question 25

polypharmacy is defined as

Answer 25

> 5-10 medications and OTC supplements.

seen in older indivuals and can cause adverse drug reactions, drug drug interactions, prescribing cascades, non adherence

Question 26

anti cholingergic drugs are:

Answer 26

amitriptyline
diphenydramine
meclizine
oxybutynin
zofran

Question 27

anticholinergic side effects:

Answer 27

memory impairment, hallucinations, confusion, blurred vision, dry mouth, constipation, and urinary retention.

Question 28

quality of life screening

Answer 28

screen for depression, falls, elder abuse, advanced directive
driving safety, financial security
cognitive impairment
malnutrition
hearing and vision loss
bowel and bladder incontinence
functional decline

Question 29

screening exams for someone who’s life expectancy is >5-10 years (80 yrs)

Answer 29

balancing harms and benefits is a risk

Question 30

Risk factors for increased driving risk in medical history:

Answer 30

• history of falls in the past 1-2 years
• recent accidents
• sedating medications (TCAs, anticholinergics)
• history of TIA, syncope, seizures, unstable ischemic heart dx, sleep disorders
• ETOH use
• inability to perform activities of daily living
• anxiety with driving

Question 31

physical exam findings that put someone at increased risk for driving:

Answer 31

visual impairment >20/40 acuity in at least one eye, 120 of peripheral horizontal vision

• cognitive impairment MMSE<24/30
• decreased mobility of the head and neck
• hearing deficits
• get up and go test >15 seconds.