Intro to Gero: Veterans, Cognitive Copetence Flashcards by Abigail Interrante

What health considerations should you take into a account when caring for a veteran?

At risk for:

Persistant Pain
PTSD
Depression
Severe anxiety
Increase risk of substance use disorder
Homeless

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Why is substance use disorder common among veterans?

coping mechanism for loss or trauma

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What substances are commonly involved in substance use disorder in older adults?

Alcohol
Illicit drugs

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What are some health risks of substance use disorder in older adults?

Impaired mood and cognition
Increased risk for falls
Chronic conditions (diabetes, heart disease, HTN)
Psycosocial consequences: isollation, depression, delirium

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Why should older adults avoid or limit alcohol use?

more sensitive to its effects with age

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When is cannabis use considered appropriate for older adults?

Only when used for therapeutic purposes

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What is the SMAST-G and what does it assess?

A 10 yes-or-no questionnaire (can be self-administered or by a clinician)
2+ points indicate a potential alcohol problem

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What does the CAGE questionnaire assess?

Assess pt drinking using 4 questions:

Have you ever tried to cut down on your drinking?
Have people annoyed you by criticizing your drinking?
Have you ever felt guilty about your drinking?
Have you ever had a drink first thing in the morning (eye-opener)?

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What are the 4 tools used for assessing alcohol risk (or substnace use disorder) in older adults?

SMAST-G
CAGE Questionare
ARPS
Short ARPS (shARPS)

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When is a person considered legally competent?

18 years or older
pregnant or married minor
Legally emancipated
Not declared incompetent by a court of law

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What happens if someone is declared legally incompetent?

A court-appointed guardian makes healthcare decisions for them

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What is clinical competence?

Person who is legally competent and can make appropriate dcisions

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Decisional capacity is met if a person is able to:

Identify the problem
Recognize options
Make decisions
Provide rationale supporting decisions

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What are strategies to help prevent cognitive impairment?

Cognitive training (learning new skills)
Physical/mental activity
Social engagement
Proper nutrition

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What is depression in older adults?

Mood disorder with cognitive, affective, and physical manifestations.

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What are the two types of depression in older adults?

Primary: physical (lack NT - norepi and seratonin)
Secondary: situational (loss/chronic illness)

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What are risk factors for depression in older adults?

Hospital/nursing home admission
Chronic pain (veterans)
-> high-dose opioid users
Isolation
Homelessness

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What are symptoms of depression in older adults?

Early morning insomnia
Excessive daytime sleeping
Lack of energy
Increased pain/disability

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What tool is commonly used to screen for depression in older adults?

Geriatric Depression Scale – Short Form (GDS-SF)
-> 15 yes-or-no questions

What do scores on the GDS-SF indicate?

5+ suggests depression
-> → follow-up with comprehensive assessment
10+ = DX depression

What is the first-line drug therapy for depression in older adults?

Selective Serotonin Reuptake Inhibitors (SSRIs)

What are non-pharmacological therapies for depression?

Reminiscence therapy
Music therapy
Managing underlying causes

Why should tricyclic antidepressants be avoided in older adults?

anticholinergic properties can cause:

Acute confusion
Constipation
Urinary retention
Incontinence

Depression is a ____ mental health problem among older adults

common

What are the three types of delirium?

- Hyperactive - Hypoactive (often undiagnosed) - Mixed

What drug therapies increase the risk of delirium?

- Anticholinergics - Opioids - Psychoactive drugs (ex: antipsychotics)

What are non-medication-related risk factors for delirium?

- Fluid/electrolyte imbalance - Infections (e.g., UTI, pneumonia, sepsis) - Fecal impaction, severe diarrhea - Metabolic syndrome (Hypoglycemia) - Surgery (especially older adults) - Neurologic disorders (tumors, ciculatory, renal, pulmonary -> hypoxemia) - Hypoxemia (↓ O₂) - Nutritional deficiencies - Relocation (critical care) - Major losses - Old-old - Alcoholism - Major organ disorders

What are common cognitive symptoms of delirium?

**I MAD AF** - Inattentiveness - May become Psychotic - Acute confusion - Disorganized thinking - Altered LOC - Fluctuating onset

What are two other manifestations of delirium besides cognitive changes?

- Physical manifestations - Emotional manifestations

What is the primary assessment tool for delirium?

Confusion Assessment Method (CAM)

What are the CAM diagnostic criteria for delirium?

Presence of: - Acue onset + fluctuating course - Inattention - Disorganized thinking - Altered LOC

What are 4 tools used to screen for delirium?

- CAM - Delirium Index (DI) - NEECHAM Confusion Scale - Mini-Cog

Is it certain that a patient with delirium will return to their previous level of functioning?

- NO, recovery is uncertain

What are key interventions for delirium?

- Remove/treat causes -> give O₂, treat UTI - calm voice to reorient the patient - soothing music - Provide doll/stuffed animals -> prevent pt from line pulling - Keep familiar items nearby - Avoid multiple drugs - Promote adequate sleep

What is dementia?

- global impairment of intellectual fxn (chronic, progressive)

What is the most common type of dementia?

- Alzheimer's dz

What is the second most common type of dementia?

- Multi-infarct dementia

What are common risk factors for dementia?

- Female gender - Age 65+ - Down syndrome - Traumatic brain injury

What are behavioral symptoms of dementia?

- Aggressiveness -> verbal & physical - Rapid mood swings - Increased confusion at night (sundowning) - Fatigue - Wandering - Hoarding/hiding objects - Paranoia, delusions, depression

What are physical symptoms of dementia?

- Incontinence - ↓ Appetite or ability to eat -> forget how to chew or swallow - Sexual disinhibition

What does the **Folsteins Mini-Mental State Examination**(**MMSE**) assess and how is it scored?

**Assess for Dementia:** O SCARR - Orientation - Registration - Attention - Calculation - Recall - Speech-language - scored out of 30 -> ↓ score = ↑ severity of dementia

What does the Montral Cognitive Assessment Test (MoCA) assess and how is it scored?

**Assess for Dementia:** - Tests 10 items in 4 categories (fruit, animal, color, towns) - Max score = 40 - Score ≥ 25 = no dementia

What is the purpose of the Clock Drawing Test in dementia screening?

- assess cognitive and spatial awareness deficits

What are key interventions for patients with dementia?

- safety measures to pvt falls, wandering, injury - Cholinesterase inhibitors (donepezil) - Behavior management - ADLs/mobility assistance PRN

Is dementia a normal part of aging?

* No, dememntia is not a normal sign of aging

What is another term often used for dementia?

Chronic confusion