Old People Suck Flashcards
Falls
May or may not be associated with syncope
Associated with decline in functional status, nursing home placement, increase use of medical services, fear of falling
Multiple causation-meds, hazards, position change
RF: older age, cognitive impairment, female, history of fall, leg weakness or gait, foot disorder, balance problems, low vitamin D, pain, PD, CVA, arthritis
Meds- benzos, sedatives, antidepressants, antipsychotic, cardiac meds, hypoglycemia agents
Frailty
More likely to have delayed recovery, greater functional impairment, including disability and dependence, hospitalization with worse outcomes, death
High rates of mortality in 6-12 months
Primary assisted with age process
Secondary due to chronic disease end stage
Weight loss greater than 10lbs, exhaustion, slowness, low activity level, weakness
Prevent immobility
Dizziness
Acute or chronic
Vertigo, pre syncope, disequilibrium, other, mixed
Caused by vertigo, Ménière’s disease, ototoxic medications, neuroma, neuro disease, psychiatric
Meds that can increase-anxiety meds, orthostatic and CNS effect meds, CV drugs and anti hypertension, aminoglycosides, NSAIDs, antihistamines, anticholinergics
a 74 year old women with recurrent falls is seen in your clinic with her daughter she has a history of mild dementia; CHF, CAD, HTN. She takes furosemide, lisinopril, ASA, metoprolol, olazapine, simvastatin. She lives by herself in an apartment she has lived in for 40 years and has housekeeping come once a week; her physical examination is remarkable for decreased proximal lower extremity muscle strength
Which of the following is NOT an evidence based intervention for decreased her risk of falling
Initiating donepezil treatment
Malnutrition
Protein 0.8 g/kg/day
Fat 20-35%
Carbs 45-65%
Fiber 30 grams per day
Less than 3.5 albumin is a probable marker for disease, injury, inflammation
Pre albumin better reflects short term changes
Les than 160 total cholesterol can indicate CA
Dehydration
Fluids 30 ml/kg/day
Obesity
Greater than 30 BMI
Vitamin D deficiency
Up to 4000 IU are consider safe
Drugs for under nutrition
Mirtazapine
Cyprohepatadine
Megestrol
Dronabinol
Growth hormone
Steroids
Which one of the following would be most helpful for assessing the adequacy of patients nutrient intake
Complete calorie count for 3 days
Which of the following micronutrient supplements increases healing of pressure ulcers in older adults
No supplement is necessary if vitamin deficiency is not present
An 87 year old women comes to your primary care clinic with a complaint of shoulder pain. She says she fell three days ago at home while walking out of her bathroom. She landed on her right shoulder and did not hit her head. Your patients says she may have slipped on the rug but doesn’t remember. She had a history of DM, neuropathy, HTN, OA. She takes glipizide, lisinopril, amitriptyline, Tylenol as needed. On exam her postural vital signs are normal: an evaluation of her hair shows her to have some mild swaying on ambulation only which of the following would you do first to decrease risk of repeat fall
Start an exercise program directed by PT
Potential prevention of fragility can be accomplished by
Preventing or minimizing immobility
Maintaining physical activity and exercise
What is the most common fluid or electrolyte disturbance in older adults
Dehydration
Which of the following is true about albumin
It is a risk indicator for M/M
You cannot be obese and malnourished
False
In a nursing home resident, recognizing and managing weight loss is an important quality indicator what would be a significant weight loss according to minimum data set
10% in 6 months
For frail, obese older adults NP should emphasize
Preservation of strength and flexibility
When evaluating a geriatric patient for dizziness the diagnostic testing should always include
Cardiac exam; orthostatic BP; balance and gait difficulties
What drugs contribute to dizziness in geriatric patients?
NSAIDs, anticholinergics, diuretics
