Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Geriatrics 1 > Intro to Geriatrics > Flashcards

Intro to Geriatrics Flashcards

1
Q

At what age is someone considered elderly?

A

> 65 yo

- HOWEVER advances in medicine/prevention have caused dispute in this traditional labeling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Average life expectancy (2014)

A

78.6 yrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Life span definition

A

The number of years a species is expected to survive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Life expectancy definition

A

The average number of years of life remaining at a specific age
- Based on statistical probability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Chronological age definition

A

How many years a person has been alive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Biological age definition

A

The age that most people would be with a body & mind like theirs
- Based on health status

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How do we approach signs of “normal aging”

A

Treat as pathology until proven otherwise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Organ system decline

A

1% per year from 30 yo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Age-related changes: endocrine

A
  • Impaired glucose homeostasis (increase glucose w/ illness)
  • Decrease vit D absorption (osteopenia)
  • Decreased thyroxine clearance (decrease T4 dose)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Age-related changes: general

A
  • Decreased volume of TBW (decrease volume of distribution of water soluble drugs)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Age-related changes: respiratory

A
  • Decreased cough reflex (microaspiration)

- Decreased lung elasticity, increase chest wall stiffness, decreased diffusion capacity (decrease resting PO2)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Age-related changes: CV

A
  • Decreased B-receptor responsiveness (decrease CO & HR from stress)
  • Decreased baroreceptor sensitivity, decrease SA node automaticity (orthostatic HTN, volume depletion)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Age-related changes: GI

A
  • Decreased hepatic fcn (delayed hepatic clearing drug metabolism)
  • Decreased colonic motility, decreased anal/rectal fcn (constipation)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Age-related changes: GU

A
  • Vaginal/urethral atrophy (dyspareunia, bacteruria)

- Prostate enlargement (increase residual urine volume)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Age-related changes: MSK

A
  • Decreased muscle mass (falls)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Age-related changes: nervous system

A
  • Brain atrophy (benign senile forgetfulness)
  • Decreased “righting reflex” (body sway, unsteadiness)
  • Decreased stage 4 sleep (insomnia, early awakening)
  • Impaired thermal regulation (lower resting temp.)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Age-related changes: skin

A
  • Increased elasticity, thinning (wrinkles, sagging)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Age-related changes: eye

A
  • Presbyopia (decreased accommodation)

- Decreased visual acuity (need for increased lighting)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Consequences of normal aging can lead to…

A

Pathology unless recognized/addressed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Normal aging is a

A

Diagnosis of exlusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Most functional loss in older patients is r/t….

A

Disease and NOT aging itself

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Loss of organ function can be thought of as a

A

Threshold/”tipping point”

Ex) Renal decline -> decrease urination -> stress applied (UTI) -> diminished function/hospitalization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Hallmark of aging is

A

How well an organ adapts to external stress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Examples of preventative measures to target focal areas of diminished reserve

A
  • Exercise to prevent falls

- Vaccines to prevent pneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Consequences of diminished reserve

A
  • Atypical disease presentation (e.g. PNA: CC = acute confusion)
  • Law of diagnostic parsimony (e.g. common cold in young pt. vs elderly)
  • Weakened compensatory mechanisms (delayed manifestation of disease (e.g. fever), slow illness recovery
  • Increased risk for iatrogenesis (r/t interactions w/ healthcare system)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Law of diagnostic parsimony

A

Theory of one unifying diagnosis to explain presentation (aka can explain complaints with one single problem)
- Works better in young & middle-aged pt.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Neuropsychiatric changes (e.g. dementia, stroke) are ass. w/

A

Physical frailty, social isolation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Pt. >65 compose __% of all patients seen; in 40 years it is projected to be __%

A

33%; 50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Why is the geriatric population increasing?

A
  1. Advances in medicine keep people alive longer

2. Decreased birth rate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Those ages >65 (13% of the population account for __% of healthcare costs

A

33%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Robust: clinical condition

A

> 5 yr life expectancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Frail: clinical condition

A

<5 yr life expectancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Moderate dementia: clinical condition

A

2-10 yr life expectancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

End of life: clinical condition

A

<2 yr life expectancy

35
Q

How to determine if a pt. is considered “end of life”

A

If you’d be surprised if they were living in 1 yr.

36
Q

Screening for breast CA

A

Mammogram every 2 years for robust women until age 74

- Self exam or clinical exam NOT recommended (insufficient data) -> does NOT decrease morbidity & mortality

37
Q

Screening for colorectal CA

A

Screen average-risk individuals aged 50-75 years (no test type preference)
USPSTF recommends against screening those >75 and against ever screening those >85

38
Q

Screening for cervical CA

A

NOT recommended in women >65 (who have had adequate prior screening & are not high risk)
Do not screen women s/p hysterectomy

39
Q

Screening for prostate CA

A

NOT recommended in men >70

Screening in those aged 55-69 is an “individual choice”

40
Q

Screening for lung CA

A

Annual screening w/ low-dose CT in those 55-80 who have a 30 pack year hx AND currently smoke or have quit within the last 15 yrs
- D/C once a pt. has not smoked for 15 years OR if acquire a health problem that limits life expectancy

41
Q

Screening for osteoporosis

A

Recommended in women <65 who are @ increased risk (determined by clinical assessment tool)
- RF: age, low body mass, excessive ETOH, current smoker, long-term corticosteroid use, h/o fx, h/o falls in past yr

Conflicting evidence for screening in men

42
Q

Screening for TSH

A

Consider every 2-5 yrs (insufficient evidence)

43
Q

Screening for BP

A

Each visit

44
Q

Screening for weight

A

Each visit

45
Q

Screening for BG

A

Up to age 70 in overweight/obese pt., q3 years if normal

46
Q

Screening for cholesterol

A

Consider for age 65-79 with additional RF

47
Q

Screening for AAA

A

Once for men 65-75 with additional RF

48
Q

Screening for height

A

Annually

49
Q

Older adults should be counseled at least once annually about….

A
  • Physical activity
  • Alcohol misuse (screening at least once using CAGE)
  • Smoking cessation
  • Sexual dysfcn & STI (screen only high risk for STI & HIV)
50
Q

Screening for falls

A

Annual (recommend exercise interventions to those at risk)

51
Q

Screening for incontinence

A

Annually

52
Q

Screening for cognitive status

A

If symptomatic

53
Q

Screening for depression

A

Annually

54
Q

Screening for vision

A

Annually

55
Q

Screening for hearing

A

Annually

56
Q

Screening for nutrition

A

Obtain wt. @ each visit, height annually -> calculate BMI

57
Q

Screening for mistreatment

A

Question w/ clinical suspicion

58
Q

Screening for safety & preventing injury

A
  • Smoke, CO detectors
  • Water heater temperature
  • Sun protection
  • Test driving skills
  • Use of seat belts
  • Advanced directive
  • Healthcare proxy
59
Q

Influenza vaccine recommendations

A

Annually (high dose)

60
Q

Pneumococcal vaccine recommendations

A

After 65

61
Q

Tetanus-diphtheria vaccine recommendations

A

Every 10 years

62
Q

Herpes zoster vaccine recommendations

A

Once after age 60

63
Q

Aspirin recommendations

A

Individualized in those >60 w/ an ASCVD score of 10% or greater
- Add a PPI if ASA is used in those >60

64
Q

Calcium recommendations

A

Food: should be primary source (~1,200mg target)
Supplementation: 500mg or less at one time, best taken w/ meals and in divided doses

65
Q

Vitamin D

A

800 IU daily

66
Q

Multivitamin

A

Consider if potentially deficient

Can reduce prevalence of suboptimal vitamin status if formulated @ 100% recommended daily value

67
Q

Hormone therapy

A

NOT recommended

68
Q

What is a problem list?

A

A problem oriented medical record

69
Q

What does a problem list include?

A

All past & current problems (medical & social/psychiatric)
Ideally each entry includes:
- A diagnosis
- A physiologic finding
- A symptom, abnl physical finding, abnl test result

70
Q

Who should maintain the problem list in the medical record?

A

PCP (however, others can add to it)

71
Q

PROBLEM LISTS ARE

A

DYNAMIC

72
Q

Why is the problem list important?

A

“Old” diagnoses might still hold value (e.g. DVT in 1990, presents today w/ CP & SOB)

73
Q

Who is eligible for an IPPE (initial preventative physical exam)?

A

Pt. who are within the first 12 months from their effective date of medicare B coverage
- IT IS A ONE TIME BENEFIT

74
Q

Focus of IPPE

A
  • Modifiable risk factors
  • Education
  • Counseling
  • Referral
  • all r/t covered Medicare benefit services
75
Q

Required elements of IPPE

A

Review…

  • Comprehensive PMH & SH
  • RF for depression
  • Functional ability & level of safety
  • Focused PE (must include BMI, BP, visual acuity)
  • +/- EKG (no longer required)
  • Brief education, counseling, & referral
  • End of life planning upon consent
76
Q

What does Medicare NOT cover?

A

Routine PE

77
Q

Who can perform IPPE?

A

MD, CNS, NP, PA

78
Q

When can someone get a Medicare annual wellness visit (AWV)

A

12 months AFTER effective date of medicare part B coverage period
- CANNOT have received IPPE or AWV in the past 12 months

79
Q

Who can perform AWV?

A

MD, CNS, NP, PA, health educator, RD, nutritionist*

*working in a team under the direct supervision of a physician

80
Q

Components of an AWV

A
  • Health-risk assessment (HRA) - self-reported!
  • PMH, SH, hospital stays, meds, allergies
  • List of current problems & suppliers involved in care (e.g. pharmacist)
  • Ht., wt., BMI, BP
  • Assessment of cognitive impairment (by provider or family, friends etc.)
  • Review RF for depression, functional ability
  • Screening recommendations
  • Establish a list of RF for which preventative measures are underway
  • Referrals to other HCP
  • Voluntary Advanced Care Planning (verbal or written)
81
Q

When are HRAs implemented?

A

At initial & subsequent AWV (before or during appt)

82
Q

AWV must be at least ___ months apart

A

12

83
Q

AWV does NOT include

A

A physical exam

84
Q

Both IPPE and AWV are

A

FREE w/ Medicare

Geriatrics 1 (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions