Geriatrics- Lecture Notes Flashcards
Although people are living longer, they often struggle with multiple chronic diseases and geriatric syndromes that diminish quality of life for both themselves and their families.
Creating care plans specific to older adults enables the primary care provider to improve the quality of life and longevity of older adults and aids families caring for their older loved ones.
The older adult may present vague (nonspecific) symptoms and history; certain serious and treatable conditions may be missed because they are considered by the person or family to be a normal part of aging; or they may be reluctant to report certain issues as they do not want further tests or hospitalization.
Additionally, and commonly, older adults frequently present with altered (atypical) presentation, meaning “no signs and symptoms, unrelated to or even the opposite of what is usually expected”.
- Vague symptoms could be serious and they need more consideration
Health-promotion activities should be incorporated into every patient encounter.
Access to care- hearing deficits, vision, mobility, transportation to and from appointments.
What are the Geriatric Syndrome Markers? SPICES LIST
S – sleep disturbances
P- problems with eating or feeding
I- Incontinence
C- confusion
E- evidence for falls
S – skin breakdown
**any of these complaints they need to be evaluated- what is the cause of these symptoms
Cognition- list of things to cause cognitive changes within the pt.
Not acting right or thinking clearly
DELIRIUM LIST?
D – drugs
E – electrolyte imbalance
L – lack of drugs (withdrawal, uncontrolled pain)
I – infection
R- reduced sensory input (vision or hearing loss)
I – intracranial (cerebral vascular accident or sudural hematoma
U- urinary retention or retention of stool
M – myocardial/pulmonary
Falls?
Falls:
Risk factors for falls include previous falls, increasing age, medications- HTN that can cause hypostatic hypotension, sedative, and cognitive deficits.
Falls among older adults constitute the most common cause of traumatic injury
Fall risk assessment can reduce the risks of falls, decrease the morbidity and mortality associated with falls in older adults, and improve the quality of life for both the patient and loved ones.
What are the 3 questions that are used to identify adults who are at risk for falls?
Three questions are used to identify older adults who are at risk for falls: Red flags to ask the pt. every time you see them
- Have you fallen in the past year?
2. Do you feel unsteady when standing or walking?
3. Do you worry about falling?
Ritual – tool that you can use to screen for falls?
R- Review self-assessment from older adults
I- Identify risk factors (e.g., scatter rugs in the home, lack of grab bars in bathrooms, stairs, and poor home lighting or poor vision).
T- Test gait and balance (recommendation of programs such as yoga, tai chi, Zumba, and other programs for older adults to improve strength, gait, and balance).
U- Undertake multifactorial assessment
A- Apply interventions (e.g., order appropriate fall prevention devices such as canes, walkers, and bathroom grab bars).
L – later follow- up
What is the history to apply to Geriatric syndromes?
Optimizing communication- can they hear you, do they have an assisted device do they need a translator
-Speak directly to your patient unless directed toward their surrogate.- what is the pts perception of what is going on. Do not be negative, may need to interview patient and caregiver separately.
-Assess and manage emotionally charged interactions. Refrain from taking negative energy personally.
- Assess patient and caregiver health literacy and adjust explanations accordingly.
-Gauge the degree of social and financial support- access to water etc.
-Establish patient’s values, preferences, and goals of care.
What physical signs should you look for during a physical exam?
- Orthostatic hypotension: contributes to poor energy, diminished functional status, increased risk of falls, and decline in renal function due to ineffective organ perfusion- significant- dizziness & falls
- Hypothermia/hyperthermia: increased susceptibility in the elderly; less likely to mount a fever in the setting of infection; consider thyroid derangement. Not able to manage temperature.
- Weight loss: Assess access to food; may be presenting feature in mood disorder, thyroid derangement, dementia, malignancy- access to food, depressed, cancer, thyroid problem, dementia forgetting to eat
- Hearing: Check for cerumen impaction- check ears for cerumen impaction most common cause for hearing loss.
-Gait, balance, and proximal muscle strength: assessed via Timed Get up and Go Test, functional reach test, and Tinetti balance assessment tool
Geriatric Syndromes: What are some differential dx?
- Coronary artery disease: Elderly patients with coronary heart disease often present with atypical symptoms, including exertional dyspnea. Silent myocardial ischemia is also common.
2. Constipation: In older adults, constipation due to slow transit is very common and may be associated with fecal impaction and overflow fecal incontinence.
3. Delirium: Nearly 30% of older patients experience delirium at some time during hospitalization.
4. Urinary tract infection (UTI): UTI is the most common infectious illness in adults aged ≥65 years, but diagnosis of UTI is fraught with difficulty because of the high prevalence of asymptomatic bacteriuria and pyuria, neither of which should be treated unless symptomatic. Asymptomatic bacteriuria is a marker for debility, but treatment does not improve outcomes and may cause harm.
5. Depression: It is more common in elderly females. If left untreated, it is often the precursor of overt dementia.
6. Insomnia: Late-life insomnia is often persistent and may prompt self-medication with over-the-counter sleep aids or alcohol.
7. Hearing difficulties: Some studies showed increased incidence of dementia in patient with hearing difficulties.
8. Visual Impairment: Macular degeneration, glaucoma, and cataracts are the most commonly encountered causes, and a yearly eye exam is important
Sudden change in behaviors- constipation and UTI- number 1 cause for incontinence. If their bowels are full of stool this can press on bladder. Impacted- overflow fecal incontinence.
Diagnostic Procedures/Other: Geriatric Syndromes?
- Avoid unnecessary patient/caregiver burden if results will not significantly enhance the plan of care.
- Consider risks/harms, cost, time, travel, pain/discomfort, anxiety, and recovery time for all testing under consideration.
- Take into consideration renal function for imaging (with contrast) studies involving contrast.
- Many lab results require comparison with age-specific reference values (e.g., thyroid-stimulating hormone, A1c, prostate-specific antigen, D-dimer).
What are some General Treatment Measures- for Geriatric Syndromes?
. Optimize nonpharmacologic options first.
2. Align with patients’ goals of care.- to make sure careplan aligns.
Ex. Lesion on skin does not want chemo because of age. Etc.
3. Feasibility for patient and caregivers: Assess cost, availability, travel burden, and adherence to treatment plan.
4. Compliance
Medications - @ risk for adverse drug reactions-
- At greater risk of ADR (adeverse drug reactions) from medications due to?
age-related changes in the?
- Absorption
- Distribution
- Metabolism
- elimination of medications.
. Polypharmacy is defined as?
The practice of administering many different medications concurrently for a single disease or to treat coexisting conditions, a practice that increases the risk of adverse drug reactions.
**Giving different meds at the same time to treat different conditions- leads to adverse drug reactions.
How many drugs is considered polypharmacy?
- 5 or More = polypharmacy