Geriatrics Flashcards
Geriatric clinical approach includes ? three domains that affect ? and ?
What are the 3 main outcome of the assessment for this population
Older PTs care about what 3 results of a prognosis?
Function, Social, Psych
Well being/Quality of life
Prognosis
Patient goals
Functional status
Function Independence Dementia
What are the Activities of Daily Living
What are the instrumental activities of daily living?
Continence Feed Toilet
Transfer Bathe Dress
Drive Meds Telephone Shop
Misenplace Clean Laundry Finance
How is a Functional Evaluation conducted
What is the leading cause of non-fatal injuries and death in older PTs?
How often is this leading cause assessed?
Time to get up from chair
Walk 10ft, return to chair
>30sec= impaired mobility
Falls, Gait
Incidence and Frequency annually
How is gait assessed?
What are the 4 parts of the PTs gait that are assessed?
Can PT rise from chair w/out hands- quad strength
Symmetry Length Height
Width
What are the intrinsic RFs for a fall?
What are the secondary RFs
How can their near/far vision and hearing be tested?
Meds Vision PHOTN
Atrophy Vit D- 800IU/day
Light Footwear Trip hazard Safety
Near- Jaeger
Far- Snellen
Hearing- whisper test
Define the mini cognition test
What is the next step if they fail this test?
How is depression screened for?
3 item recall, clock drawing- 2min
Both norm- dementia unlikely
Mini mental exam- 10min
MOCA, specific- 30min
PHQ 2: two questions, one pos warrants investigation
What are the two questions asked during the PHQ 2 and what are they assessing?
Past 2 wks, felt down, depressed, hopeless- depressive mood
Past 2 wks, felt little interest or pleasure doing things- anhedonia
How does the eye and vision change due to increased age?
These changes lead to ? condition
Why do PTs have difficulties w/ reading in dim light
Lens becomes less flexible, less accommodation
Presbyopia
Dec light to retina
? is the leading cause of vision impairment in the US/world
What are the typical Sxs of this MC
What will be seen on PE
Cataracts
Blurred yellow vision w/ increase sensitivity to glare
Central opacity
Dec red reflex
What is the leading cause of irreversible vision loss in PTs >65y/o
What are the two types and characteristics of each
Age related macular degeneration
Non-neovascular, dry (MC):
Gradual central blurring
Difficult reading fine print/street signs, facial recognition
Rx: antioxidants and Zinc
Neovascular, wet:
Rapid central vision loss
Refer for Tx w/ anti-VEGF
How does Diabetic Retinopathy present
How is it managed
What exam is needed annually
Blurred vision
Field constriction
Scotoma
Observe w/ referral
Dilated funduscopic exam
What are 4 types of eye complaints that require immediate referral?
Cerumen impaction will present w/ ? PE findings
What age related deterioration is overlooked but a contributor to morbidity
Rapid Painful Monocular
Vision loss
Weber to L
Rinne BC>AC on L
Hearing loss
Hearing loss is independently associated w/ ? issues in PTs
What is the MC type of hearing loss
What causes conductive hearing loss in these PTs
Incident dementia Accelerated cognitive decline Poor neurocognitive function Increase falls Gait disturbance
Sensorineural HL- presbycusis
Perfs Impaction Effusions
What are the Aminoglycoside antibiotics associated w/ hearing loss?
What is the criteria for OHOTN
Gentamicin Amikacin Vancomycin Erythromycin Neomycin Streptomycin
SBP dec 20mm
DBP dec 10mm <3min of Sxs
How is cognitive impairment different from normal aging to concerning?
Define Mild Cognitive Impairement
Normal aging- PT remembers later w/ intact learning and subtle deficits in memory function w/out functional impairment
Cognitive function below normal for age/education but severe enough for dementia
MCI is characterized by what 3 parameters
Subjective complaints validated by second person
Evidence of objective cognitive impairment in one of more domain
Intact functional status
If PT presents w/ memory loss and draws all numbers on one side of a clock, ? is Dx
When does the Dx of Dementia begin and how quickly does the risk increase?
Vascular dementia
Starts at 60
Doublex every 5yrs
What are the 5 types of dementia in order of frequency and RFs for each
Alzheimer-
RF: Age FamHx
Lewy Body- Parkinsonism Visual hallucinations Cognitive fluctuant
Vascular-
RF: DM Age Smoking HTN Lipidemia
Frontotemporal- Personality/Social behavior changes Nonfluent speech
Neurodegenerative-
Huntingtons Metabolic abnormalities
What are the key features of Dementia
What is focused on during PE
PTs present w/ memory loss, temper change worse at end of day and disagrees w/ caregiver, what assessment is done
Gradual, stable onset
ADL interference
Inattention on gradient
Non-reversible cognitive decline
Functional assessment w/ ADL/IADLs
Neuro exam
Mini Mental state exam- 3 item recall, clock test
Both norm= r/o dementia
When/what PT would be considered high risk for dementia
How often are Mini Mental State Exams repeated?
What does this test indicate or suggest for Dx
> 80y/o
q6-12mon
Cognitive decline, suggests Dx of MCI, dementia
MOCA test is more influenced by ? and is more ? than MMSE
What general labs are ordered for a Dementia work up
What specific labs would be ordered?
Education
Sensitive, particularly for detecting MCI
CBC Chem-18 (Kidney E+ Glucose Liver)
BETCH CDR
B12 ETOH TFTs Ca HIV
CSF Drug/Tox screen RPR
What other Dx co-exists w/ dementia in half of PTs
Why is identifying this co-existing Dx important
How would this underlying issue be suspected
Depression
Can be cause of cognitive defecits
Must be ID’d/r/o prior to Dx of dementia
Memory complaints OOP to deficits
Define Delirium
What is the classic triad for Alzeimers
Sensory deficit Other psych d/0 Delerium Depression Alcohol abuse Meds- BEERS LIST
Memory impairment
Visuospatial problems
Language impairment
Alzheimer
Early: retain social function, fail complex tasks
Disorientation:
Time Place Person
Languae:
Anomic Fluent Mutism
Lost in familiar places
Behavior changes common