Older Adult Flashcards
what is 2x more likely in the elderly?
adverse drug reactions
evidenced-based list of potentially inappropriate meds for older adults >65
BEERS criteria
7 minute tool designed to assess cognitive literacy and pillbox skills in order to optimize medication safety
Medi-cog
assists with drug discontinuation in outpatient setting. asks prescriber to consider drug indication, dose, benefits
good palliative geriatric practice algorithm
wellness visit covered during first 12 months then yearly without charge- covered by original medicare (part B) and medicare advantage plans
Medicare 360
IPPE
individualized preventative physical exam
common eye changes in elderly?
d/t presbyopia, eye diseases present)
eye exam frequency
40-45 years→
55-64 (no RF) →
>65→
baseline eye exam (ophthalmologist) age 40 40-45 years→ every 2-4 years 55-64 (no RF) → every 1-3 years >65→ every 1-2 years Frequency increases as ages
tests to check elderly hearing
Whispered voice (behind patient): is the deficit volume or clarity related?
Finger rub near ear
Watch tick test (hold ticking watch near ear)
JNC 8 BP Recommendations:
> 60 years: LESS THAN 150/90 mmHg or less
Checked at every visit
Screen to check adult alcohol use
AUDIT
more detailed than cage, not as easy to interpret as Audit drinking tool
CARET
15 Q
Inpatient/ outpatient
Good for person with or without cognitive impairment
Many languages
Geriatric Depression Scale (GDS)
What test?
Have patient sit in chair, when I say go stand up and walk to line, turn around, walk (3m/10ft) back and sit back down → should be able to do in <12 secs
How well they stand, gait
TUG (Timed Up and Go)
if pt can hold 4 different positions for 10 seconds (eyes open or closed- your discretion)
Timed 4-Stage Balance Test:
Recommend to prevent falls, improve bone and muscle strength, and improve nerve health
Vitamin D
Pneumococcal Vaccine elderly considerations
Everyone 65 or older
get PPSV 23
Younger if immunocompromised (DM, lung disease, smoker, sickle cell)
If pt has previously had PPV13, must wait one year to receive PPSV23
Shingles Vaccine elderly
Shingrix → 2 dose series
2-6 months apart
Age 50 or older
If pt received Zostavax, revaccination with Shingrix is required
tetanus Vaccine elderly
every 10 years
Tdap if have new grandbabies (pertussis)
PODS
Plan for older drivers safety
SNAQ
what do the elderly need?
Simplified Nutritional assessment Questionnaire (SNAQ)
NEED:
K, Ca, Vit.D, B12, minerals, and dietary fiber
Exercise recommendations for elderly
2.5 hours per week of moderate aerobic exercise
Strengthening 2x/week
Activities to improve balance
Yoga, tai chi, standing on one foot and alternating
FRAT
fall risk assessment tools
IADL
instrument activities of daily living
More than 5 drugs per person (both prescription and nonprescription)
Higher risk of falls and changes in mental status
Polypharmacy
require 2 meds to cause interactions (erythromycin and theophylline used together are toxic)
SECONDARY ADE/adverse drug reaction
quitting meds cold turkey
Drug withdrawal syndrome
caused by benzos in older adults= higher incidence of falls
Tertiary ADE
chronic irreversible illness with gradual onset and steady decline in cognition
short -term memory loss (primary sx)
Disorientation
Disturbance in executive function (planning, organizing, abstract thinking)
Problems with ADLs
1 of 3: aphasia, apraxia, or agnosia
Day-night sleep cycles reversed
Irritability, withdrawal, and apathy in early stages
Alzheimers DIsease
acute onset with fluctuations in orientation and attention
Often seen in hospitalized older adults
Delirium
often accompanied by sodium imbalance
Thirst response is diminished
Decreased renal plasma flow= decline in ability to concentrate urine (prevents body from retaining enough fluid)
Vasopressin release (usually stimulated by low fluid volume) is diminished
s/s: confusion, lethargy, rapid weight loss, and functional decline.
dehydration in the elderly
labs/ tests to look for dehydration in elderly
BUN/creat: 25:1 or more
Na > 148
Hct elevated
PE: orthostatic bp and rise in pulse; elevated temperature
Resp and GU infections are common→ UA and CXR
Post-falls assessment: DDROPP
Post-falls assessment: DDROPP
diseases, drugs, recovery, onset, prodrome, and precipitants
STEADI
stopping elderly accidents, deaths, and injuries → CDC
proggressive loss of energy, strength, and stamina leading to decreased function and physical and cognitive deterioration unexplained weight loss of 10% or more of body weight in less than one year
failure to thrive
Physical signs of abuse, change in behavior or withdrawal from usual activities, checks signed by unauthorized persons, bedsores, poor hygiene or nutritional status.
In home setting report to state adult protective services; police, ombudsman
Elder abuse
major physical and physiological changes that occur with aging
Reduction in lean body mass, increase in body fat
Decreased blood flow to liver and kidneys
Abnormalities in cardiac conduction system
Decreased gastric acid production
Decreased total body water
Increased volume distribution for fat soluble drugs, decreased distribution for water soluble drugs
Decreased vit d absorption and activation
Major causes of elder death
heart disease, CVA, falls, sepsis from UTIs, HTN leading to renal failure or stroke, diabetes. Hearing and vision impairment affecting mobility.
What is important to know about incontinence in women?
Not normal at any age
non-pharma plans for urge incontinence
pharma
PT, OT, decrease fluids, weight loss, management of constipation
Anticholinergic meds (avoid in elderly), B-adrenergic agonists, intravaginal estrogen, Botox
when to refer urge incontinence to urology
Failure or intolerance of non-surgical treatments
Surgical: sacral nerve stimulator
when to refer Stress incontinence to urology
Failure or intolerance of non-surgical treatments. Suprapubic catheter
when to refer overflow incontinence to urology
Failure or intolerance of non-surgical treatments. Suprapubic cath
non-pharma plans for stress incontinence
pharma
Smoking cessation, weight loss, decrease fluids, PT, OT, pessary, urethral plugs
A-adrenergic agonists
Duloxetine
non-pharma plans for mixed incontinence
pharma
Treat using combo of treatments for urge/ stress w/ focus on most dominant symptom
non-pharma plans for mixed incontinence
pharma
identify and relieve obstruction. Self or assisted intermittent cath, indwelling cath
a-adrenergic antagonists or blockers
what kind of incontinence to refer to urology
incontinence that is associated with hematuria or an infection that is not responsive to treatment
what is urinary incontinence in men usually due to
BPH
what is urinary incontinence in men usually due to
decreased activity, medications (pain, depression, etc), diabetic neuropathy, etc.
clasts break down the bone (bone resorption>bone formation)
osteoporosis
BMD higher than 1 SD below the young adult mean
Normal BMD
BMD between 1 and 2.5 SD below the young adult mean
Osteopenia (or low bone mass)
BMD lower than 2.5 SD below the young adult mean
Osteoporosis
(WHO p1002):
BMD lower than 2.5 SD below young adult mean and the presence of one for more fragility fractures
Established (or severe) osteoporosis
USPSTF osteoporosis screening recommendations for women > 65
B
USPSTF osteoporosis screening recommendations for postmenopausal women younger than 65 at increased risk
B
USPSTF osteoporosis screening recommendations for men
I
only FDA approved for prevention of osteoporosis
Hormone Therapy
Osteoporosis risk factors
Advanced age
Female gender- post menopause ( decreased estrogen)
Prior osteoporotic fracture
Femoral neck BMD
Low BMI
Oral glucocorticoid use (5mg prednisone/day for 3 or more months-ever)
rheumatoid arthritis
Secondary osteoporosis- glucocorticoid treatments most common cause of 2ndary
Parental hx of hip fracture
Current smoking
More than 3 alcoholic drinks/day
foods high in calcium
Broccoli, green leafy vegetables
osteoporosis lifestyle modifications
Nutritional supplements, increase physical activity, stop smoking, limit alcohol and caffeine. Calcium and Vitamin D supplements
meds used to tx osteoporosis
Bisphosphonates
RANKL Ab, estrogen replacement, SERMs
vision changes associated with aging
Decreased visual acuity (presbyopia).
Structural changes within the eyes,
floaters, reduced peripheral vision
vision changes associated with pathology
Cataracts,
Glaucoma,
Macular degeneration,
Retinopathy
elderly hearing changes
Presbycusis (age related hearing loss), tinnitus, ear wax (produce more as you age)
elderly touch/ pain changes
Diminished ability to feel injury, pressure. Clumsiness, difficulty with tasks
(reduced brain weight,
decreased conduction speed along nerves related to loss of myelin sheath, decreased circulation, and slowed waste removal)
elderly proprioception changes
Decreased conduction speed along nerves related to loss of myelin sheath -> Difficulty with balance, falls, decreased willingness to leave
familiar surroundings
elderly smell changes
Decreased number of nerve endings and mucus production in the nose -> Decreased enjoyment of pleasant smells & taste, decreased ability to smell dangerous odors such as gas or smoke
elderly taste changes
Decline in the number of taste buds, & Remaining taste buds shrink. Taste sensitivity declines. Decreased saliva production
risk factors include age, diabetes, smoking, alcohol use, UV light exposure Symptoms: cloudy/blurry vision Faded colors Glare, possibly halo around lights Decreased night vision Double vision or multiple images in one eye Frequent prescription changes
cataracts
Presentation of Infections in the Elderly
Absence of fever Sepsis without usual leukocytosis and fever Falls Decreased appetite or fluid intake Confusion Change in functional status
cognitive screenings for elderly
Mocha, MiniCog
Erikson stage for elderly
Integrity vs. despair
Reflection on life, did they accomplish what they wanted, was life what they thought it would be? Was life productive and happy (Integrity( or not? (despair/depression).
what can happen with continuous wearing of dentures-
oral stomatitis
