Lecture 6 Flashcards
Define multimorbidity and comorbidity.
- Multi = co-occurrence of 2+ chronic medical or psychiatric conditions that may or may not directly interact with each other.
- Comorbidity = condition or conditions that coexist in the context of a defined disease or condition.
Comorbidity would be like heart disease and hyperlipidemia.
What is a concern with geriatric patients and their multimorbidities?
They cannot participate in clinical trials.
What are the 3 AGS action steps for multimorbidity?
- Identify and comunicate priorities/trajectory
- Stop, start, or continue care based on priorities
- Align decisions and care among pts, caregivers, and other clinicians.
At what life expectancy should you follow chronic condition actions steps instead of disease-specific guidelines?
Life expectancy of 2-10yrs.
AGS Algorithim from UTD for eval and management of the older patient with multimorbidity
She said there will be an exam Q on this
What are the common chronic conditions in geriatric patients? (8)
- Urinary incontinence
- Constipation and fecal incontinence
- BPH
- Sleep disorders
- Sexual dysfunction
- Osteoporosis
- DM
- Weight Loss
What is urinary incontinence?
Involuntary loss of urine
What 3 bladder changes occur that lead to urinary incontinence?
- Decline in bladder capacity
- Increase in residual urine
- Increase in involuntary bladder contractions
In women:
Diminished estrogen + laxity of pelvic floor muscles
What are the 4 types of urinary incontinence?
- Overflow
- Stress
- Urge
- Functional
What is the mnemonic for reversible urinary incontinence condition?
- Delirium
- Restricted mobility, retention
- Infection, inflammation, impaction
- Polyuria, pharmaceuticals
DRIP
What are some behavioral modifications for urinary incontinence?
- Toileting after meals
- Scheduled voiding every 2 hours/prompted voiding
- Frequent inquiries about the need to pass urine.
What is 1st-line, 2nd, and 3rd for urinary incontinence?
- Exercise, lifestyle, behavior (conservative)
- Medications + 1st
- Noninvasive office-based acupuncture-like stimulation.
What medications help with urinary incontinence?
- Antimuscarinics: oxybutynin/tolterodine
- Beta-3 agonists: mirabegron, vibegron
Mainly know the drug classes and their MOA
Caution in glaucoma for antimuscarinics
How many bowel movements is considered normal?
At least 3 BMs a week.
What is the correct pooping position?
- Knees higher than hips
- Lean forward, elbows on knees
- Bulge out abdomen
- Straighten spine
What medications are used for BPH?
- Alpha-adrenergic blockers: doxazosin, tamsulosin, terazosin, etc
- 5-alpha reductase inhibitors: finasteride, dutasteride (use if pt has ED)
If BPH is persistent even with meds, what should we suggest?
Surgical intervention like a TURP.
What are the preferred meds for sleep disorders?
All the bolded ones
What lubricant types are recommended for hypoestrogenism after menopause?
Silicone or water-based only.
What deficiency results in osteoporosis usually?
Vit D deficiency
What is the difference between primary and secondary osteoporosis?
- Primary: Bone loss with normal aging
- Secondary: caused by Vit D deficiency usually
What T-score on a DEXA scan is bad?
Anything below -1.0 (aka -2.5) is generally poor.
Below -2.5 is osteoporosis
What is the gold standard test for osteoporosis?
DEXA Scan
T score -2.5 or lower is osteoporosis.
What assessment tool is recommended to screen for fractures?
FRAX
How do we manage osteoporosis?
- Antiresorptive meds: bisphosphonates, HRT, selective estrogen receptor modulators, denosuman, calcitonin
- Anabolic meds: Parathyroid hormone
Weight Loss Algorithm
SHE SAID TO STAR
What is failure to thrive an interaction between?
- Physical frailty
- Disability
- Impaired neuropsychiatric function
- Inability to obtain foodstuffs
What is optimal BMI in an older adult?
24-29
What are the aspects of frailty?
- Weight loss
- Exhaustion
- Weakness
- Slow gait
- Decreased physical activity
