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Patient Care II > Older Adult > Flashcards

Older Adult Flashcards

1
Q

What is the average life expectancy (2020 statistic)?

A

78.9 (compared to 47 in 1900)

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2
Q

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

A

80’s and 90’s

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3
Q

What is the focus on assessing the older adult?

A

Focus is on healthy or “successful” aging

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4
Q

What are the goals of care for the older adult?

A

No just maximize life span, but maximize health span

Maintain function
Fulfilling, active lives
Promote healthy aging

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5
Q

In older adults there is a decline in function of pacemaker cells, these affects are in response to what?

A

Response to physiologic stress

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6
Q

Will older adults have a widened ausculatory gap?

A

Yes, systolic HTN will cause widened pulse pressure due to vessels stiffening

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7
Q

Do older adults have different respiratory rate than normal?

A

No, stays unchanged

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8
Q

What is actinic (solar or senile) purpura due too?

A

Loss of subcutaneous tissue (esp. fat) with aging

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9
Q

What changes occur in older adults nails?

A

Loose luster, yellow, and thicken, especially toes (fungal infection?)

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10
Q

What is presbyopia?

A

Age related vision loss, need for reading glasses

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11
Q

What eye conditions are older adults at higher risk?

A

Glaucoma, macular degeneration, and cataracts (refractive and retinal errors)

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12
Q

What type of tone do older adults tend to loose most frequently?

A

Higher tones

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13
Q

Decreased salivary secretions and sense of taste in older adults tend to be due to what?

A

Medications

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14
Q

Increased work of breathing can be found in older adults due to what physiologic change?

A

Chest wall stiffening

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15
Q

An S3 heart sound after age 40 strongly suggests what?

A

Heart Failure

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16
Q

An S4 can be heard in healthy older adults, but usually suggests what finding?

A

Decreased ventricular compliance and impaired ventricular filling

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17
Q

Aortic sclerosis and aortic stenosis increase what risk?

A

Morbidity and mortality

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18
Q

As we age, does sexual interest remain intact?

A

Yes

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19
Q

Benign prostatic hyperplasia (BPH) typically begins in what decade of life?

A

Third decade

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20
Q

At what age does menstrual periods usually cease?

A

48-55

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21
Q

What are the top three geriatric syndromes?

A

Malnutrition, Sleep Disorders, and Depression

22
Q

What multidimensional problems exist in older adults?

A

Hearing
Vision
Polypharmacy
Morbidity

23
Q

How should you approach the visit with an older adult?

A

Well-lit, moderately warm room
Minimal background noise
Safe chairs
Face the patient and speak to them
Adjust the pace and content of the interview
Allow time for open-ended questions
Include family members and caregivers
Carefully assess symptoms
Ensure written communication

24
Q

You should allow for open-ended questions and for the patient to _______ during the visit?

A

Reminisce

25
Q

What functional status’ should be assessed at every visit of an older adult?

A

Activities of Daily Living (ADL’s)
Instrumental Activities of Daily Living (IADL’s)

26
Q

What are examples of Instrumental Activities of Daily Living (IADL’s)?

A

Food shopping, driving or using public transportation, using the phone, housework/home repair, making meals, laundry, taking meds, handling finances

27
Q

On average, how many prescriptions is a patient discharged to a skilled nursing facility prescribed?

A

14

28
Q

What is the phenomenon “Prescribing Cascade?”

A

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

29
Q

How should polypharmacy be avoided?

A

Start low and go slow in prescribing
Thorough medication history

30
Q

What criteria is used to assess inappropriate drug prescribing in older adults?

A

Beers Criteria

31
Q

What are the 5-categories of concern in the Beers Criteria?

A

Drugs that are potentially inappropriate

Drugs that should typically be avoided

Drugs to use with caution

Drug-drug interactions

Drug dose adjustment based on kidney function

32
Q

Falls are associated with what in older adults?

A

Decline in functional status
Increased chance of nursing home placement
Increased risk of death
Greater use of medical services

33
Q

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

A

Medications

34
Q

What are the key questions to ask when assessing fall risk?

A

Have you fallen in the past year?

Do you feel unsteady when standing or walking?

Are you worried about falling?

35
Q

If a patient answers yes to any of the fall risk screening assessment questions what physical exam components should be completed?

A

Gait evaluation
Strength
Balance

(Timed Up and Go)

36
Q

What is the best cognitive screening assessment in early decline, but isn’t good in late decline?

A

MOCA

37
Q

The mini-mental status exam is best used for monitoring what?

A

Cognitive decline

38
Q

Is depression a normal part of aging?

A

No depression is not normal, older adults have a high rate of successful suicide attempts

39
Q

What is a major cause of social and emotional distress in older adults?

A

Urinary incontinence

40
Q

What types of physical activity should be encouraged to promote a healthy lifestyle in older adults?

A

Aerobic
Muscle strengthening
Flexibility
Balance

41
Q

What two alcohol screeners should be provided to prevent unhealthy alcohol use in older adults?

A

AUDIT-C
CAGE (American Geriatric Society)

42
Q

What are the recommended vaccines in older adults?

A

Tetanus (every 10 years)
Annual influenza
Zoster starting at 50
Pneumococcal Vaccine

43
Q

What is the Pneumococal immunization recommendation for people age 65 or older (without previous vaccine or unknown vaccine status)?

A

1 dose of either PCV15 or PCV20

PPSV23 1 dose at least 1 year later if PCV15 used

44
Q

What are the ages colorectal screening are recommended by USPSTF?

A

45-75

45
Q

What are the ages breast screening are recommended by USPSTF?

A

biennial mammogram ages 50-74

46
Q

When do cervical cancer screens end?

A

Age 65

47
Q

What is the best test for colorectal cancer screeing?

A

The one the patient will do

48
Q

Advanced care planning should be done when?

A

At all ages, not just older adults

49
Q

What are the types of advanced directives?

A

Durable Power of Attorney for Healthcare

Living Will

Physician order for life-sustaining treatment (POSLT)

DNR/DNI

50
Q

When is the only time advanced directives should be acted upon?

A

When the patient loses the ability to make decisions for themselves

Patient Care II (11 decks)

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