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Geriatrics Final > Intro/Geriatric Assessment/Resources > Flashcards

Intro/Geriatric Assessment/Resources Flashcards

1
Q

What are the demographic trends of the aging population?

A
  1. People > 65 is increasing (70 million by 2030)=1/5 of Americans
  2. Women live longer than men (d/t estrogen, less smoking, more likely to seek medical attention and less hazardous jobs)
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2
Q

What are the myths about the elderly? (6)

A
  1. Majority of elderly are alone or isolated
  2. Majority have bad health
  3. Tend to be more religious
  4. Don’t engage in sex (truth: >65=highest growing rate of HIV)
  5. Majority live in nursing homes or other facilities
  6. Majority are poor
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3
Q

What are the top 3 causes of mortality?

A
  1. Heart disease
  2. Malignancy
  3. Stroke
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4
Q

What are the top 3 causes of morbidity?

A
  1. Arthritis
  2. HTN
  3. Hearing impairment
    (Tend to have more co-morbidities–> biopsychosocial approach is required)
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5
Q

What are the 4 “geriatric giants” (disabilities representing to common final pathway of many chronic diseases)?

A
  1. Incontinence
  2. Immobility
  3. Instability (–> falls)
  4. Intellectual impairment
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6
Q

What are the 3 different types of living arrangements available to seniors?

A
  1. Independent living (at home)
  2. Assisted living
  3. Nursing home (aka skilled nursing facility (SNF))
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7
Q

Describe independent living.

A

Completely independent OR
With family or caregiver OR
W/ or w/o adult daycare (bus comes to pick them up for social activities or some type of therapy.

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8
Q

Which living situation is “Most ideal as long as it’s safe”?

A

Independent Living

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9
Q

Describe assisted living.

A

Between independent living and nursing homes.
Not able to live by themselves but don’t need constant care (help w/ making meals, housekeeping, etc.) – but NO MEDICAL CARE.
Aka = residential care, board and care, domiciliary care, supported care, adult homes, sheltered housing, retirement residences.

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10
Q

Describe Nursing home.

A

***Contains RNs who provide 24 hour care and a doctor who supervises.
Skilled medical care includes services of trained professionals that are needed for a limited period of time following an injury or illness (nurse, physical, speech or occupational therapists).
Custodial or personal care = help w/ bathing, dressing, eating, grooming, getting up, toileting.
Can be temporary (after surgery, etc.) or long-term (people who are losing their function).

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11
Q

What is the difference between skilled nursing care and custodial care?

A

Who provides the care and who pays differs.

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12
Q

***Which living situation is the “fastest growing trend”?

A

Assisted living.

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13
Q

***What is the #1 reason a senior is put in a home (institutionalized)?

A

caregiver burnout (also predicts risk of elder abuse)

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14
Q

What does Medicare Part A pay for? Who qualifies? What facilities does it cover?

A
  • Pays for care in specified facilities if they are medically necessary based on Medicare requirements.
  • ***Free if you worked and payed social security taxes for 10 years (40 calendar quarters. If not, pay premium).
  • Covers: Inpatient care in hospitals (including critical access hospitals), Skilled nursing facilities (SNFs), Long Term Care Hospital (LTCH) , Inpatient Rehabilitation Facility (IRF), Hospice care, Home health care, Inpatient Mental health/psychiatric care.
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15
Q

What does Medicare Part B cover? Is it free?

A
  • Covers most medically necessary doctors’ services, preventive care, durable medical equipment, hospital outpatient services (physical, speech and occupational therapy), laboratory tests, x-rays, drugs, mental health care, and some home health and ambulance services.
  • ***NO!!! There is a monthly premium for this coverage.
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16
Q

What does Medicare Part D cover? Who provides this coverage? Is it free?

A
  • Covers prescription drugs.
  • Provided only thru private insurance companies that have contracts w/ the government – never provided directly by the government.
  • ***Optional = extra cost
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17
Q

What is Medicaid (aka MediCal in California)?

A
  • Funded by state and federal
  • Eligibility based on income
  • Some states provide dental, vision, hearing, and community based serves (IHSS).
18
Q

What does Medi-Medi mean?

A

Dual eligible (medicare + mediCal)

19
Q

What makes a geriatric assessment different from a standard medical assessment?

A
  • Includes nonmedical domains (caregiver, insurance, mobility)
  • Emphasizes functional capacity and quality of life
  • Incorporates a multidisciplinary team
20
Q

***Vaccinations: When should you administer the influenza vaccine? Can you give intranasal? What allergies should you ask about?

A

October (takes 2 weeks to activate).
No!
Allergies: chicken eggs, prior flu shot.

21
Q

***Vaccinations: When should you administer the Shingles vaccine? What allergies should you ask about?

A

CDC recommends >60yo; FDA says >50yo is ok.
Allergies: gelatin.
*Don’t give to immunocompromised b/c live vaccine.

22
Q

***Vaccinations: When should you administer the Pneumococcal vaccine?

A

> 65yo (Give 13 and 23 valent)

23
Q

ROS is important in the assessment of the elderly. What are the two main components?

A
  1. Basic Activities of Daily Living (Basic ADLs)– Katz Scale
  2. Instrumental Activities of Daily Living (IADLs)
24
Q

What are the Basic Activities of Daily Living (Basic ADLs)– Katz Scale (6)?

A
  1. Bathing (no assistance or assistance bathing only one part of body)
  2. dressing (no assistance except w/ shoe tying)
  3. toileting (no assistance but may use: cane/walker for support, bedpan/urinal at night, catheterize self intermittently)
  4. continence (complete control w/ no accidents)
  5. transferring (get out of bed/chair w/o assistance; may use: cane/walker, electric lift chair)
  6. feeding (gets food to mouth w/o assistance; food prep may be done by someone else)
25
Q

What are Instrumental Activities of Daily Living (IADLs)?

A
  1. Prepares meals
  2. manages money
  3. shopping
  4. housework
  5. uses a phone
  6. takes own meds
  7. uses transportation
26
Q

General?

A

Nutrition
Appetite
Sleep patterns
Falls

27
Q

Head and Neck?

A

Visual changes

Hearing loss

28
Q

GI?

A

Constipation

Diarrhea

29
Q

***GU?

A 
Incontinence
Sexual function
(Very important b/c embarrassed/resigned to think it is normal)
30
Q

Neuro?

A

Gait
Parasthesias
Tremors

31
Q

Psych?

A

Memory loss

Depression

32
Q

PE: What is great to monitor nutrition, fluid status and osteoporosis?

A

Height and Weight

33
Q

PE: What is a good monitor for orthostatic changes?

A

Vitals

34
Q

PE: Eyes, ears, mouth, thyroid. What should you remove before exam? What can account for up to 30% of conductive hearing loss?

A
  • Dentures.

- Wax.

35
Q

PE: Abd- What should you look for?

A

urinary retention, AAA, hernias, rectal and prostate

36
Q

PE: Pelvic- What should you look for?

A

cystocele, rectocele, atrophic vaginitis

37
Q

PE: Skin- What should you look for?

A

rashes, sores, ulcers, edema

38
Q

PE: Neuro- What should you look for?

A

gait, balance, transfer, position, vibration, reflexes

39
Q

How often should you perform a mental status exam? What are the components?

A
  • General MSE: Appearance, dress, thought pattern, speech pattern, body language
  • MMSE (if consistently < 24 consider progressive cognitive impairment)
  • Recall clock-drawing
  • Geriatric Depression screen
40
Q

PE: What is the functional assessment? Why is this important?

A
  • Ability to dress/undress, transfer to bed, ambulate
  • Check out his/her home
  • Fall risk assessment
  • Important b/c illness often presents atypically as a change in function. Function prioritizes approach and signifies effectiveness of treatment.
41
Q

***What high yield labs should you perform on the first visit at a geriatrics clinic?

A

CBC, Chem-7 (BMP), ESR, Vitamin B12, TSH

42
Q

***What 2 things are “vital in geriatric medical care”?

A
  1. Biopsychosocial model

2. Team approach

Geriatrics Final (10 decks)

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