Intro to geriatrics Flashcards
what is old age
-the golden years have come at last
-i cant see, i cant pee
-i cant chew, i cant tie my shoe
-muscles lost their flex, i cant have sex
-memory shrinks, hearing stinks
-no sense of smell, i look like hell
-body drooping, trouble pooping
Aging
-physiological changes
-pathophysiological changes- cataracts, hearing loss
-successful aging- this is our goal
-absence of pathology; decline in function
-preventative medicine
-tx- may not treat as aggressively bc of side effects; ex. diabetes management, HTN
-polypharmacy- 5 or more meds
-quality of life and functional ability
changing dynamics
-Americans are aging
-Baby Boomers have arrived!! -> Between 1946 and 1964
-1998: Age 65+ numbered 34 million
-2050: Age 65+ will number 80 million
-Largest increases in people age 85
-Older population more ethnically diverse
-Life span:
-females – 81
-males – 76
challenges of geriatrics in primary care
-short visit times- 15mins is not enough
-low reimbursement rates- they need more time
-multiple co-morbidities
-needs of caregiver and pt
-ever expanding dx and therapeutic options
-cross cultural communication
-reasons why elderly visit are longer:
-they chat
-polypharmacy
-questions
-co-morbidities
importance of assessment
-eval how pts problems and living environment leads to functional disability and diminished quality of life - @ every visit!
-loss of spouse, surgery, etc.
-disability and dependence often increases with age
-40% lifetime risk of nursing home placement
-many elders spend some time dependent prior to death
-majority live independently
-interdisciplinary team approach- usually PCP
-eval different domains: medical, cognitive, psychological, social (living situation), physical
-expands scope of interest to include caregiver and environment
-emphasis on optimization of function
-increase in active life expectancy! -> do as much as they possibly can
mores form??
-goes into specifics
-specifies daily things that pt wants or doesnt want
-IV fluids
-IV antibiotics
-planning death and disability is hard
assessment of function
-loss of function or disturbances
-First indication or presentation of medical conditions- maybe something new is happening
-Highly impacts quality of life
-Further disability and institutionalization
-Impacts pt and caregiver
basis for assessment: Activities of Daily Living (ADLs)
-need to be able to do these to live independently
-Bathing
-Dressing
-Toileting
-Transfers
-Continence
-Feeding- use utensils to feed themselves
basis for assessment: instrumental Activities of Daily Living (IADLs)
-if you cant do these it doesnt mean you cant live independently
-Using telephone
-Shopping
-Food preparation
-Housekeeping
-Laundry
-Transportation
-Medications- can be delivered
-Managing money
use of functional level
-Use functional status as baseline
-Guides recommendations for exercises, PT, adaptive devices for impairments -> sitting down exercise, balance
-Consider home evaluation for impaired
-Potential marker of caregiver stress
-Useful for evaluating risk of & need for placement
underreporting of complaints
-Underreporting of symptoms common
-afraid to tell or they will take away independence
-attribute treatable symptoms to “aging” and stated “nothing can be done about it anyway”
-Attitudes ; misconceptions
-1/2-1/3 of symptoms may go unreported to physicians
-It is important to do a “Geriatric ROS”
-changing these things increase quality of life
-ex. incontinence, using hearing aids
review of systems
-General: fevers, chills, malaise, fatiguability, night sweats, weight changes
-Neurologic: syncope, seizures, weakness, paralysis, abnormal sensation/coordination, tremors, memory loss
-Psychiatric: depression, mood changes, difficulty concentrating, nervousness, tension, suicidal ideation, irritability, sleep disturbances
-Sensory Functions: visual changes, hearing changes, neuropathy, balance/coordination
-Motor Functions: gait, falls, ATAXIA
-Diet: preferences, restrictions (religious, allergic, disease), vitamins/supplements, caffeine, food/liquid intake diary, “look in fridge test”, who prepares/obtains food
-Skin: rash/eruption, itching, pigmentation, excessive sweating, nail/hair abnormalities
-Head: Headaches, dizziness, syncope, severe head injuries, loss of consciousness
-Eye: visual changes, blurring, diplopia, photophobia, pain, eye medication use, eye trauma, FH of eye disease
-Ears: hearing loss, pain, discharge, tinnitus, vertigo
-Nose: sense of smell, obstruction, epistaxis, postnasal drip, sinus pain, rhinorrhea
-Oral: hoarseness, sore throat, gum bleeding/soreness, tooth abscess/extraction, ulcers, taste changes
-Cardiac/Peripheral Vascular: Chest pain, palpitations, dyspnea, orthopnea, edema, claudication, HTN, previous MI, exercise tolerance, previous cardiac studies
-Pulmonary: pleuritic pain, dypsnea, cyanosis, wheezing, cough/sputum, hemoptysis, TB exposure, previous CXR’s
-Renal/Urinary:dysuria, flank/suprapubic pain, urgency, frequency, nocturia, hematuria, polyuria, hesitancy, dribbling, force of stream changes, STD’s
-Hematologic: anemia (dizziness/fatigue/dyspnea), easy bruising/bleeding, blood cell abnormalities, transfusions
-Lymphatic: lymph node enlargement/tenderness
-Endocrine/Metabolic: thyroid enlargement/pain, heat/cold intolerance, unexplained weight change, diabetes, polydipsia, polyuria, facial/body hair changes, increased hat/glove size, striae
-Musculoskeletal: joint stiffness, pain, limited ROM, swelling, redness, heat, bone deformity
-Gastrointestinal: appetite, digestion, dysphagia, heartburn, nausea, vomiting, hematemesis, diarrhea, constipation, stool changes, flatulence, hemorrhoids, hepatitis, jaundice, dark urine, history of ulcers/gallstones/polyps/tumors, previous X-rays
-Sexual: libido, intercourse frequency, sexual difficulties, impotence
-Gynecologic: itching, last Pap smear, menopause age
-Breasts: pain, tenderness, discharge, lumps, mammograms, self-breast exams
geriatric syndromes
-Cognitive and Behavioral Disorders:
-Confusion
-Dementia
-Delirium
-Depression
-Frailty
-Falls & Gait disorders- every visit! -> beginning of the end
-Urinary incontinence
-Medication management- polypharmacy
geriatrics in primary care
-focus on function
-review of meds
-screen for geriatric syndromes
-consider caregivers and abuse
-advanced directives
-use more detailed tests only when indicated
-use team approach
improve efficiency of visit
-discuss- pt goals early
-focus- visit on pts goals and priorities
-realize- pts goals and priorities may change over time
-train- nursing and ancillary staff to perform screening tests
team involvement
-involve- social worker and other team members early
-consider:
-home nursing visits
-referral to team geriatric program
-other community referrals (case management programs etc.)
life expectancy
-has gone down
geriatric medicine
-demographic shift worldwide
-Help everyone age well, preserving independence, dignity, and purpose.
-Maximize their health and well being; their functional ability.
-Preventative medicine
-best practices in managing geriatric syndromes, managing transitions across health systemsa
acute care for elders- ACE
-specific area in hospital made for elderly
-design- non slip, lighting, etc
-goals- mobility, cognitive
-stakeholders- pt, family, provider, hospital
-impact- lower readmission, shorter stay
-how it works:
-prepared environment
-interdisciplinary team
3 guiding principles
-Complexity, Multimorbidity, and Physiologic Reserve
The Importance of Cognition & Function
Increase risk for medical errors, functional decline & environmental hazards
The Role of Goals & Prognosis in Clinical Decision Making
geriatric assessment
-H&P, functional, psychological, social domains
-prognosis- can affect screenings
vision, hearing, leg (TUG), urinary incontinence, nutrition, memory, depression, physical disability
> 20/40!
-TUG- risk for falls, balance
common change with age: cardio, neuro, respiratory, integumentary
-reflex to catch themself from falls
-respiratory- last to be affected, reserved
-aspiration- from decrease respiratory muscle strength
-decrease temperature regulation -> high risk hypothermia, no shiver, no sweating
common change with age: gastro, urinary, reproductive
-gastroparesis
-pay attention to drug doses- altered drug clearance
common change with age: MSK, vision, hearing, sensory, endo
-weight gain also -> decrease mobility
screenings
dementia
Prevention
Clinical findings
Alzheimer’s disease
Dementia with Lewy bodies
Vascular dementia
Frontotemporal dementia
Other dementias
Advanced & end-stage disease
-Medication & sensory deficits
Alcohol abuse
Other Psychiatric Conditions
documentation of cognitive status
delirium
-Acute, transient, usually reversible, fluctuating disturbance in attention, cognition, and consciousness level.
-Precipitating factors:
-Any disorder or drug.
-Clinical diagnosis with laboratory and imaging
-Treatment
-Underlying cause
-Supportive measures
