Geriatrics & Interview Challenges: LGBTQ

Question 1

Indications for geriatric assessment

Answer 1

Age — along with any of the following:

Chronic comorbid conditions, comorbid psychosocial illness (anxiety, depression, etc), cognitive changes, high health care utilization, change in living situation, risk of fall or functional status change, polypharmacy, change in health (i.e., weight loss)

Question 2

What are some strategies for assessing the medications a geriatric pt is taking?

Answer 2

Have pt bring in all meds and supplements to their visit

Ask about ALL meds including Rx, OTC, vitamins, herbs, and supplements

Use Beer’s criteria or other clinical tools to reduce or avoid prescribing medications that may lead to adverse events

Close follow up after starting new meds

[meds to watch out for: opioids, benzodiazepines, antidepressants, hypnotics, antipsychotics, antihistamines, glaucoma agents, NSAIDs, muscle relaxants]

Question 3

Most commonly used criteria for prescribing medications to geriatric pts

Answer 3

Beers criteria

Question 4

What are the 3 categories of beer’s criteria?

Answer 4

Medications to always avoid for older pts

Medications that are potentially inappropriate for older pts with certain medical conditions

Medications used with caution

Question 5

What are the STOPP and START criteria?

Answer 5

STOPP (Screening tool of older person’s prescriptions) — similar to Beers criteria but also includes drug-drug interactions and duplication of drugs within class

START (Screening tool to alert doctors to the right treatment) — consists of 22 evidence-based prescribing indicators in older persons

Question 6

Methods for assessing functional ability of geriatric patients (ADLs)

Answer 6

Katz index of independence in activities of daily living

Lawton instrumental activities of daily living scale

Question 7

Assessment strategies for fall risk

Answer 7

Tinetti Balance and Gait Evaluation

‘Get up and go’ test

Question 8

Recommendations to reduce risk of falls

Answer 8

Exercise
Physical therapy
Assess home for fall-hazards
Review meds
Assess vision
Perform neurologic exam

Question 9

Vision conditions that increase in incidence with age

Answer 9

Glaucoma
Cataracts
Macular degeneration
Vision clarity peripheral vision loss
Neglect changes d/t CVA
DM retinopathy
Poor night vision

Question 10

There is no specific recommendation for vision assessment, even through USPSTF. Periodic assessment with Snellen eye chart is usually done by primary care provider. What are 2 situations in which ophthalmologist referral is recommended?

Answer 10

Monitor diabetics pts for diabetic retinopathy

Pts at increased risk for glaucoma (family hx, etc.)

Question 11

2 options for cognition screening that both address level of arousal, attention and concentration, memory, language, visuospatial perception, calculations, executive functioning, mood and thought content

Answer 11

Mini mental status exam

Montreal Cognition Assessment (MOCA)

[CN exam can also be done to assess neurologic function as well as vision screen]

Question 12

Two-question method that screens for depression and next step if positive

Answer 12

“During the past month, have you been bothered by feeling down, depressed, or hopeless?”

“During the past month, have you been bothered by little interest or pleasure in doing things?”

— answering yes to either of the above prompts a more detailed questionnaire called PHQ-9

Question 13

Which vaccines are recommended in geriatric patients (pts age 65+)?

Answer 13

Tetanus or TdAP

Influenza vaccine

Pneumococcal vaccine

Herpes zoster vaccine

Question 14

Name the aspects that compose a complete geriatric pt assessment

Answer 14

Medications
Functional ability
Fall risks
Vision
Cognitive and mental health
Vaccinations needed
Social support

Question 15

Office environment considerations that can put LGBTQ patients at ease with a healthcare facility

Answer 15

At least 1 unisex restroom

LGBT-specific media, including local or national magazines or newsletters about and for LGBT individuals

Visible non-discrimination statement stating that equal care will be providd to all pts regardless of age, race, ethnicity, physical ability and attributes, religion, sexual identity, and gender identity

Posters showing racially and ethnically diverse same-sex couples, or posters from non-profit HIV/AIDS or LGBT organizations

Brochures (multilingual when possible and appropriate) about LGBT health concerns

Question 16

Language and behavior of providers that can put LGBTQ pts at ease

Answer 16

Perusing intake form and asking what their indicated gender identity/sexual orientation means to them (even if left blank)

Introduction - establish appropriate pronouns and use patient’s language

Rainbow pin on white coat

Self-disclosure if appropriate