Geriatrics Transitions & Miscellaneous Flashcards
What professional organizations offer recommendations for cancer screening?
USPSTF
ACS (american cancer society)
ACP (american college of physicians)
ACOG (american college of obstetricians and gynecologists)
ACCP (american college of chest physicians)
AUA (american urologic association)
when does colon cancer screening start
45 (or 50)
up to age 75-85
what are the colon cancer screens available
FIT- annual
Sigmoidoscopy - every 5 years
colonoscopy - every 10 years
when does breast cancer screening begin?
40 (or 50) up to age 75
mammogram every 1-2 years
when are cervical cancer screenings begun
start at age 21
up to age 65
what are the cervical cancer screenings available and how often?
Pap - every 3 years
HPV + Pap every 5 years
when do lung cancer screenings begin
age 50 in current and former smokes with 20+ pack years
screen up to 75-80
low dose CT scan yearly
when does prostate cancer screening begin?
age 50 (to 55)
up to age 70
what does a AAA repaire decrease
mrotality in men 65- 75 years of age
for men >75, mortality exceeds benefits
what are the recommendations for AAA screening?
one-time screening with ultrasound in men 65-75 who have ever smoked
when should be screen for hyperlipidemia
if patient have additional risk factors for heart disease and are aged 65-75
how often should fasting glucose be tested in patients with symptoms of diabetes and those at risk of diabetes
symptoms of diabetes: every year
risk factors: every 3 years
what screening is recommended for ALL adults
hypertension screening
who are at an increased risk of chlamydia/gonorrhea
all sexually active women > 25 at increased risk
when do we screen for Hep C
adults 18-79
when is it recommended for women to be screened for osteoporosis
women 65 years or older
or sooner if RF such as daily steroids, decreased estrogen exposure or infrequent meses
what are the potential harms of screenings?
worry/anxiety
cost and use of resources
additional procedure/risk of infection
exposure to raditation
complication of sedation/anesthesia
injury
aggressive treatment to slow growing tumors
what is the pneumococcal recommendations
all adults over 65 should get PCV13 followed 6-12 months later by PPSV23
also recommended for smokers, diabetics, chronic liund disease
what are the influenza vaccine recommendations
recommended annually for all people over 6 months of age.
high dose vaccine may be more effective in adults over 65.
what is the Tdap vaccine recommendation
Td or Tdap every 10 years for all adults.
OR Td every 10 years and a one time booster of pertussis vaccine over age 65
what is the zoster vaccine recommendation
RZV (2 dose recombinant zoster vaccine) recommended for adults >50 yo
what is the most common neurologic complication in geriatric patients
delirium
what is the most common type of complication in the geriatric surgical population
neurologic complication
what are the most important risk factors associated with post-operative delirium
advanced age and dementia
what is often associated with post-operative delirium
abnormal pre-operative lab values (electroyltes, glucose, low hemoglobin levels)
what are iatrogenic risk factors for delirium in ICU patients
sedative medications
and possibly use of opioids
what are lung expansion modalities to decrease complications in the elderly
chest physiotherapy
deep breathing exercises
incentive spirometry and OPEP
continuous positive airway pressure (CPAP)
what is the goal of lung expansion modalities
increase post-operative functional residual capacity and expand partially or completely collapsed alveoli
when are preoperative ECGs indicated
in patient with cardiac risk facotrs and active disease undergoing at least intermediate surgery
what are the post operative adverse events associated with perioperative hypothermia
poor wound healing, suscptibility to infections, shivering, discomfrot and increased cardiovascular stress and subsequent complications
when should the BEERS criteria be consulted
medication management in older population - polypharmacy
what are contributing factors to delirium
infection, medications, electroylte abnormalitites, ETOH/drug withdrawal, pain/fear
why might providers be reluctant to address the issue of an older persons driving capabilities
lack of training in injury prevention or rehabilitation
fear of losing a patient
legal concerns
what medications are associated with increased driving risk/impaired skills
opioids
benzos
antidepressants
hypnotics
antipsychotics
antihistamines
glaucoma agents
NSAIDs (pain not becasue of impairment)
Muscle relaxants
what are medical illnesses that impair driving
celiac disease
DM
pulmonary disease
alcoholism
dementia
cerebrovascular disease
parkinsons
arthritis
visual/hearing impairment
sleep apena
seizure d/o
various neuromuscular disorders
how can we assess safety for an older patients driving abilities
visual acuity, visual fields, hearing, cognition
MSK function
alcohol use
attention and judgement
visual spatial skills (clock-drawing)
medication review
what is PGD
prolonged grief disorder
perisistant and impairing form of grief that occurs when there are impediments to adaption
what are indicators of PGD
pervasice intense yearing or longing
peristent preoccupaton with the decreases (persists at least 6 months)
emotional pain, sadness, guilt, anger, denial, blame, anhedonia, emotional numbness
dx made when emotion impairs functioning
What are the risk factors for prolonged grieving
maladaptive grief-related emotions, cognitions or behaviors
psychiatric dz hx
lower SES
hx of childhood attachment difficulties
current physical illness or pronounced psychological stress
older adults (male, less educated, “oldest old”, poor cognitive performance, hx of depression)
what are four identifiable forms of grief
pre-death, acute, integrated, prolonged/complicated
