Hospitalized Elderly

Question 1

What does Primum No Nocere mean?

Answer 1

“First do no harm”

Question 2

What is the life expectancy for:
Women ____
Men ____
Average overall ____

Answer 2

Women: 81 y/o
Men: 76 y/o
Average overall: 78.6 y/o

Question 3

___-___ is considered “middle-aged”

Answer 3

45 - 65 y/o

Question 4

By 2030, ___ (fraction) of the US population will be elderly

Answer 4

1/5

Question 5

Age (IS/IS NOT) an independent RF for morbidity and mortality to surgery

Answer 5

IS NOT!

Question 6

What are the 3 factors that should be taken into account when caring for an elderly pt

Answer 6

1. Prognosis
2. Values and preferences (keep the pt empowered)
3. Independent functioning

Question 7

If expected lifespan is ___ years, tx the pt’s condition as you would any pt

If expected lifespan ___ years (esp. considerably less), consider if the tx is giving QOL w/o bringing undue discomfort or harm

Answer 7

> 10 yrs

<10 yrs

Question 8

If a pt’s clinical condition worsens from a single dz, what happens to the prognosis?

Answer 8

Prognosis worsens w/ that dz

worse dz –> worse prognosis

Question 9

If one single dz does not predominate, prognosis may be predicted from what 3 things?

Answer 9

Age
Gender
General health

Question 10

What factors are included to determine the prognosis for pts at home?

Answer 10

Age
Gender
Co-morbidities
Functional status

Question 11

What should be considered prior to making major decisions in the care of a geriatric pt?

Answer 11

Hospitalization
Testing
Tx (surgery)
Disposition (home resources)

Question 12

Pt preference changes w/ ___ and ____

Answer 12

Time

Changing medical status

Question 13

____ is a key determinant for prognosis, pt’s needs and potential effects of tx

Answer 13

Functional Status (ADLs and IADLs)

Question 14

____% of pts >65 y/o and ____% of pts >85 y/o have issues w/ ADLs and IADLs.

Answer 14

25% of pts >65 y/o and 50% of pts >85 y/o have issues w/ ADLs and IADLs

Question 15

If only (IADL/ADL) help required, living independently is okay

Pts w/ (IADL/ADL) impairment may live at home w/ assistance or a caregiver

Answer 15

IADL

ADL

Question 16

What are significant issues that play a part in the management and disposition of and elderly pt in the hospital?

Answer 16

Dementia
Depression
Disposition
Home/social situation 
Immobility
Polypharmacy 
Sensory impairment (vision/hearing) 
(DDDHIPS)

Question 17

What adverse situations occur w/ an immobile elderly pt in the hospital? (x2)

Answer 17

Pressure ulcers

Deconditioning

Question 18

What physiologic changes can occur in a pt who is immobile? (x8)

Answer 18

CV decline
Fluid shifts
↓ O2 uptake
Muscle strength loss
Pressure ulcers
↑ risk for DVT / PE
Postural hypotension
↑ fall risk

Question 19

What are factors that contribute to disposition (debilitation) in the elderly? (x4)

Answer 19

Weight loss
Frailty
Gait
Balance

Question 20

If immobility is inevitable, what can be done to manage adverse outcomes?

Answer 20

PT/OT
Reposition pt every 2 hrs
Active ROM

Question 21

Rules of Polypharmacy….

1. If a patient experiences delirium, check the ____
2. keep the regimen ____
3. If you cannot figure out why a patient is on a medicine, the patient doesn’t know why and doesn’t need it, you should ___
4. Start __, go ____

Answer 21

1. Med list
2. Simple
3. Get rid of it!
4. “Start low, go slow”

Question 22

What are the options for sending a geriatric pt home after hospitalization?

Answer 22

1. Home independently
2. Home w/ family/caregiver
3. Home w/ home health resources
4. Rehab hospital
5. Skilled nursing Facility

Question 23

T/F: Once Advanced Care planning is put into place by a pt, the decision is final and can only be changed w/ legal involvement

Answer 23

F: they are fluid and pt can change their ADC whenever