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ME 536- Patient Care II > Older Adult > Flashcards

Older Adult Flashcards

1
Q

Older people have a higher rate of ______

A

chronic illnesses (often multiple)

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2
Q

Wide variation in _______ and ______ status

A

physical, functional

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3
Q

Individuals who do not have debilitating disease live healthy lives into their

A

80s and 90s

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4
Q

Assessing the older adult is not simple a

A

disease oriented approach

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5
Q

Focus is on healthy or ________ aging

A

successful

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6
Q

Lifespan wish for elder adult

A

simple happiness

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7
Q

Focus on older adult

A

understand supports
functional assessment
promote long term health and safety

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8
Q

Not just maximize life span, but maximize ______ span

A

health

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9
Q

Goals of care for older adult

A

maintain function
fulfilling, active lives
promote healthy aging

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10
Q

Primary aging

A

changes in physiologic reserve that occur over time

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11
Q

Primary aging is _________ of changes induced by _______

A

independent, disease

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12
Q

Changes in vital signs in older adults: BP

A

Systolic HTN with widened pulse pressure (vessels stiffen), auscultatory gap

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13
Q

Changes in vital signs in older adults: Heart Rate and Rhythm

A

decline in function of pacemaker cells, affects response to physiologic stress

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14
Q

Changes in vital signs in older adults: Respiratory rate

A

unchanged

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15
Q

Changes in vital signs in older adults: temperature

A

changes in temperature regulation leads to susceptibility to hypothermia/hyperthermia

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16
Q

Changes in physiology in older adults: skin

A

fragile, loose, transparent (esp hands/forearms) “onion skin”
actinic (solar or senile) purpura
Loss of subcutaneous fat/tissue

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17
Q

Changes in physiology in older adults: nails

A

lose luster, yellow, thicken, especially toenails

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18
Q

Changes in physiology in older adults: hair

A

loses pigment
hair recedes
loss of hair elsewhere (trunk, pubic, axilla, limbs)

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19
Q

Changes in physiology in older adults: Eyes

A

fat around eye atrophies
cornea lose luster
smaller pupils
dry eye common
presbyopia (age related vision loss)
increased risk glaucoma, macular degeneration, cataracts

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20
Q

Changes in physiology in older adults: Ears

A

deceased hearing (presbycusis)- lose higher tones
increased cerumen

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21
Q

Presbycusis

A

deceased hearing (especially lose higher tones)

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22
Q

Changes in physiology in older adults: mouth

A

decreased secretions
decreased sense of taste (d/t meds)

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23
Q

Changes in physiology in older adults: thorax and lungs

A

decrease in exercise capacity (d/t cardiac +- pulmonary)
increased work to move joints/contract muscles
chest wall stiffens (increased work of breathing)
kyphosis d/t OA

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24
Q

Changes in physiology in older adults: cardiovascular- VESSELS

A

Bruits (vessels in neck): partial material obstruction from atherosclerosis

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25
Q

Changes in physiology in older adults: Cardiovascular HEART

A

Extra heart sounds S3 after age 40 (suggests heart failure)
S4 (can he healthy but suggests decreased ventricular compliance/impaired filling)
Scarring in SA node

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26
Q

Changes in physiology in older adults: cardiovascular murmurs

A

systolic aortic murmurs are common
aortic stenosis (fibrosis and calcification)
Aortic stenosis (leaflets become calcified and immobile, impede outflow)

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27
Q

Aortic stenosis and aortic sclerosis increase risk of

A

cardiovascular morbidity and mortality

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28
Q

Changes in physiology in older adults: breasts

A

diminish in size (glandular tissue atrophies, replaced by fat)
ducts surrounding nipples become more palpable and firm/stringy strands (calcification deposits)

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29
Q

Changes in physiology in older adults: abdomen

A

fat accumulates in lower abdomen and near hips
signs of acute abdominal disease is blunted

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30
Q

Pair and fever in older adults

A

Pain is less severe
Fever is less pronounced

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31
Q

Changes in physiology in older adults: Male GU SEX

A

sexual interest intact
frequency declines
erection more dependent on tactile stimulation
ED in 1/2 of men

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32
Q

Changes in physiology in older adults: Male GU PROSTATE

A

Benign prostatic hyperplasia (BPH)
proliferation of prostate epithelial and stratal tissue
30s-70s
half of men with BPH have sx

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33
Q

Changes in physiology in older adults: female GU Menopause

A

Menopause usually around 48-55
Hot flashes up to 5 years (maybe longer)
vaginal dryness
urge incontinence
dyspareunia
Within 10 years ovaries are usually no longer palpable
Loss of estrogen tone

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34
Q

Changes in physiology in older adults: MSK

A

shortening (loss of height in trunk from thinning intervertebral discs, vertebral bodies shorten OA)
Skeletal muscle decrease in bulk/power
ROM diminishes from OA

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35
Q

Changes in physiology in older adults: Neurologic

A

difficult to distinguish changes of moral aging from disease
“benign forgetfulness” can occur at any age

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36
Q

Consider more than disease in elderly (4 others)

A

Functional
Economic
Psychosocial
Environmental

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37
Q

Geriatric syndromes

A

common health conditions in older adults
not distinct organ based category
multifactorial cause
functional decline and dependence

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38
Q

Examples of geriatric syndromes

A

cognitive impairment
incontinence
MALNUTRITION
Falls
SLEEP DISORDERS
sensory deficit
DEPRESSION

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39
Q

Aortic stenosis presents with

A

exertional fatigue

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40
Q

Risk factors in older adults

A

increased age
cognitive impairment
functional impairment
impaired mobility

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41
Q

Examples of multidimensional problems

A

hearing
vision
polypharmacy
mobility

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42
Q

Younger vs. older adults

A

younger adults (look for unifying diagnosis)
older adults (multifactorial, geriatric syndromes)

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43
Q

Approach to the patient: older adults

A

demeanor: respect, patience, cultural awareness
Pay close attention to: adjusting office environment, content and pace of visit

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44
Q

When an older adult spikes a fever you are concerned because

A

it is their bodies last resort

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45
Q

Approach to the patient: office modifications

A

well-lit, moderately warm room
minimal background noise
safe chairs
make sure glasses/HA/dentures in

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46
Q

Approach to the patient: older adults Interview

A

adjust pace, content
ALLOW TIME FOR OPEN ENDED QUESTIONS AND REMINISCING
Include family and caregivers
ensure written instructions are in large print and easy to read

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47
Q

Special areas to assess older adult

A

functional status
polypharmacy
fall risk
cognitive problems
mood/depression
nutrition
incontinence
vision/hearing
social supports
financial concerns
goals of care

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48
Q

Approach to the patient: older adults Functional status

A

absolutely vital to assess!!!
ADLs
IADL (instrumental activities of daily living)

49
Q

estrogen sets the _____

50
Q

Assessments to functional status in older adults

A

Katz Index of Independence in activities of daily living
Lawton-Brody IADL

51
Q

Content of Katz independence in activities of daily living questionnaire

A

bathing
dressing
toileting
transferring
continence
feeding

52
Q

Content of Lawton-Brody IADL questionnaire

A

ability to use telephone
shopping
laundry
mode of transportation
food preparation
responsibility of medications
housekeeping
ability to handle finances

53
Q

Polypharmacy definition

A

use of multiple medications

54
Q

Average amount of meds for a patient discharged to a skilled nursing facility

A

14 medications

55
Q

Risk of adverse reaction in older adults on multiple medications

A

increase with number of meds
13% 2 meds
58% 5 meds
82% 7 or more

56
Q

Risks with polypharmacy

A

drug-drug interactions
Independent risk factor for hip fractures (use of drugs affecting CNS)
Issues with med adherence
prescribing cascade

57
Q

Definition of prescribing cascade

A

adverse drug reaction is misinterpreted as a new medical condition, and so a new medication is prescribed

58
Q

How to avoid polypharmacy

A

Start low and go slow
Thorough medication history (all meds, including OTC, why are they taking it?)

59
Q

BEERS criteria

A

Used to assess inappropriate drug prescribing in older adults
List of medications considered potentially inappropriate for use in older patients, mostly due to high risk for adverse events

60
Q

5 categories of BEERs criteria

A

Drugs that are potentially inappropriate in older adults
Drugs that should be avoided in older adults with certain conditions
Drugs to use with caution
Drug-drug interactions
Drug dose adjustment based on renal function

61
Q

Falls are associated with

A

decline in functional status
increased chance of nursing home placement
increased risk of death
greater use of medical services

MEDICATION USE

62
Q

What is the most modifiable risk factor for falls in older adults

A

medication use

63
Q

Biological factors in falls in older adults

A

leg weakness
mobility problems
problems with balance
poor vision

64
Q

Behavioral factors in falls in older adults

A

psychoactive meds
4+ medications
risky behavior
inactivity

65
Q

Environmental factors in falls in older adults

A

clutter/tripping hazards
no stair railings or grab bars
poor lighting

66
Q

Fall screening/risk assessment older adults

A

have you fallen in the last year? (# times, injury)
do you feel unsteady when standing/walking?
are you worried about falling?

67
Q

If an elder adult answers yes to a fall screening question you should

A

evaluate gait, strength and balance
Timed Get up and go trial

68
Q

How to do a Timed Up and Go (TUG)

A

Patients wear regular footwear and can use a waling aid
Sit in a standard aim chair and identify a line 3 meters/10 feet away

  1. stand up from chair
  2. walk to the line on the floor at your normal place
  3. turn
  4. walk back to the chair at your normal pace
  5. sit down again
69
Q

Cognitive issues in older adults SCREENING TOOLS

A

assess memory complaints from patient or concerns from caregivers

MOCA
MMSE
Mini-Cog

70
Q

When do you use a MOCA with an older adult

A

best in early decline, not effective late

71
Q

When do you use MMSE in older adults

A

used for monitoring
screening NOT status exam

72
Q

When do you use Mini-Cog in older adults

A

Yes/no for further screening or suspected dementia

73
Q

Is depression a normal part of aging?

A

Depression is NOT a normal part of aging

74
Q

Older adults attempt suicide less but are

A

more successful in completion

75
Q

Most older adults who complete suicide

A

were in their first episode of depression and had seen a physician in the last month of life

76
Q

Screening tools for mood/depression in older adults

A

PQI2
1. In the past month have you been bothered by feeling down, depressed or homeless?
2. During the past month, have you been bothered by little interest or pleasure in doing things?

77
Q

Nutrition in older adults

A

Malnutrition associated with increased mortality

78
Q

Weight loss in the elderly can predict

79
Q

Hospitalized older patients are at higher risk for

A

nutritional risk or are malnourished

80
Q

Nutrition screening for older adults

A

serial measurement of body weight

81
Q

Urinary incontinence for older adults

A

major cause of social and emotional distress (can place a role in nursing home placement)

82
Q

causes for urinary incontinence in older adults

A

increased risk in diabetes, usually multifactorial

83
Q

Is incontinence more common in older men or women

84
Q

Fecal incontinence in older adults more common in men or women

A

slightly more in women

85
Q

What is the cause of fecal incontinence in older adults

A

multifactorial
decreased strength of external sphincter
increased rectal compliance
medications
lactose intolerance
poor mobility

86
Q

Prevention in older adults

A

physical activity
tobacco cessation
alcohol screening
ASA to prevent CV disease

87
Q

What screening tool does American Geriatric Society suggest for alcohol screening

88
Q

Immunizations in older adults

A

TD Q 10 (1 dose TDAP if never received)
annual flu shot
Zoster (age 50)
Pneumococcal

89
Q

A lot of polypharmacy comes from

A

specialty care

90
Q

Zoster immunizations in older adults

A

Start at age 50

91
Q

Shingrix is a

A

recombinant vaccine for zoster

92
Q

Zostavax is a

A

live attenuated zoster vaccine

93
Q

What are the three different vaccines for pneumococcal

A

PCV15 (1 dose)
PCV20 (1 dose PPSV23 1 year later)
PPSV23

94
Q

What are do people get pneumococcal vaccine

A

65 or older

95
Q

What are the current recommendations for pneumococcal vaccine in older adults

A

PCV20
OR
PCV15 and PPSV23 1 dose 1 year later

96
Q

Why would a younger person get pneumococcal vaccine

A

certain underlying medical conditions or risk factors (heart, lung, liver, diabetes, ETOH, smoker)

97
Q

Older adult: What age does USPSTF suggest to screen for colorectal cancer

98
Q

Older adult: What age does USPSTF suggest to screen for breast cancer

A

biennial mammography age 50-74

99
Q

Older adult: What age does USPSTF suggest to screen for lung cancer

A

55-80, 30 pack years, current smoker or quit in past 15 years

100
Q

Older adult: What age does USPSTF suggest to screen for prostate cancer

A

individual discussion with patient

101
Q

Older adult: What age does USPSTF suggest to screen for cervical cancer

A

can stop at age 65 if previous screening was adequate and negative

102
Q

Older adult blood pressure screening

103
Q

Older adult statin screening ages

104
Q

Older adult diabetes screening

A

40-70 with increased BMI

105
Q

Older adult osteoporosis screenings

A

postmenopausal women <65 higher risk
all women age 65 and older

106
Q

Older adult elder abuse screening

A

ask patients, direct, specific questions

107
Q

Older adult AAA screening

A

men 65-75 who have ever smoked

108
Q

Older adult colorectal screening tests

A

gFOBT: guaiac fecal occult blood (3 specimens, 2 samples/specimen)
FIT: fecal immunochemical test for hemoglobin
FIT-DNA: cologuard
Flexible sigmoidoscopy: Flex-sig (goes to splenic flexure)
Colonoscopy
CT colonography

109
Q

What colon cancer screenings are stool based

A

FOBT (yearly)
FIT (yearly)
FIT-DNA (1-3 years)

110
Q

What are the benefits of stool based colon cancer screenings?

A

No bowel prep

111
Q

What are visual based colon cancer screenings

A

Colonoscopy (Q10)
CT colonography (Q5)
Sigmoidoscopy (Q5)

112
Q

What is the best test for colorectal cancer screening?

A

The one that the patient will do

113
Q

When should advanced care planning be done?

A

all ages, not just older adults

114
Q

What is the importance of advanced care planning

A

ensure the patients get care that is consistent with their own goals, values, preferences

115
Q

What are the benefits of advanced care planning

A

provider/family will comply with patient’s wishes
deceased hospitalization at end of life
increased use of hospice
higher satisfaction with quality of care

116
Q

Advance directives are done:

A

when a patient can still make decisions

117
Q

When are advanced directives acted on?

A

ONLY if the patient loses the ability to make decisions for themselves

118
Q

What are the main types of advance directives?

A

DPOA
Living will
POLST
DNR/DNI

ME 536- Patient Care II (8 decks)

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