Older adult starred slides

Question 2

List 6 barriers to good geriatric care

Answer 2

1) Communication
2) Underreporting symptoms.
3) Multiple complaints that may interact; “somatization” of emotions
4) Lack of time- be patient; probe relatives or other caregivers, screening tools
5) Measure function, be alert to change, esp. rapid change
6) Track data, treat diagnoses instead of sxs, have pt. familiarity, multiple visits instead of few marathons

Question 3

[barriers to good geriatric care]:
1) What type of change should you be particularly alert for?
2) What tools are important?
3) What may pts do to emotions?

Answer 3

1) Rapid change
2) Screening tools
3) somatization

Question 4

1) How often is breast cancer screening with Mammography recommended for 40-75 y/o?
2) What abt over 75?

Answer 4

1) Screen yearly or biennially
2) Shared decision-making process about whether to continue screening (dependent on health/life expectancy)

Question 5

1) What age range should be screened for cervical cancer?
2) What age range should be screened every 3 years with cervical cytology alone?
3) What age range should you screen every 3 years with cervical cytology alone, every 5 years with high-risk HPV testing alone, or every 5 years with both tests together (cotesting)?

Answer 5

1) Women aged 21-65 years
2) 21-29 yo
3) 30-65 yo

Question 6

How often should cervical cancer screening be done >65y/o?

Answer 6

If adequate recent screening with normal Pap smears, and not otherwise at high risk for cervical cancer, routine screening is not recommended

Question 7

1) What age should screening for colorectal cancer and premalignant polyps/lesions (USPSTF) for all adults of average risk? (both males and females).
2) When should this screening occur selectively?
3) What is the preferred test option and how often?

Answer 7

1) 45 y/o
2) In pts 76-85 years
3) Colonoscopy every 10 years (other testing options exist if pt is not amenable to colonoscopy)

Question 8

What condition relevant to older adults has screening recommendations that vary depending on source (American Urological Association, American Cancer Society, USPSTF, etc.) and are controversial?

Answer 8

Prostate cancer

Question 9

1) Screening for what condition may offer a small potential benefit, but have risks of harm (false positives, etc.)? What should you engage in bc of this?
2) When should discussion of screening for this condition begin for avg risk men? What abt higher risk?

Answer 9

1) Prostate cancer; shared decision making
2) 50 years; as early as age 40

Question 10

1) What is the prostate cancer screening method?
2) How often and up to what age? What do these vary depending on?

Answer 10

1) Prostate-specific Antigen (PSA) testing
2) Every 1-2 years up to age 69-75 depending on the source (UpToDate recommendations are given above)
-USPSTF: men aged 55-69, individual decision of whether to screen with PSA

Question 11

Who should be screened for lung cancer (USPSTF)?

Answer 11

Adults age 50-80 yo with:
1) 20 pack-year smoking history AND
2) Currently smoke or have quit within the past 15 years

Question 12

1) What is the lung cancer screening (USPSTF) recommendation for those who need them?
2) When should screening be discontinued?

Answer 12

1) Annual screening with low dose computed tomography (LDCT) of the chest.
2) Once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery

Question 13

What is the recommendation for skin cancer screening (USPSTF) for asymptom. adolescents and adults (do not have signs/ symptoms of skin cancer)?

Answer 13

“The current evidence is insufficient to assess the balance of benefits and harms of visual skin examination [whole-body screening skin exam] by a clinician to screen for skin cancer.”

Question 14

1) Osteoporosis screening to prevent osteoporotic fractures (USPSTF) is recommended in women >______.
2) How should you screen them? What does frequency of screening depend on?
3) Screening may begin earlier if woman is _______________ and at increased risk of osteoporosis

Answer 14

1) 65
2) Screen with bone measurement testing (e.g., DEXA scan to measure bone mineral density [BMD]); a number of factors
3) postmenopausal

Question 15

What is the current recommendation for osteoporosis screening to prevent osteoporotic fractures (USPSTF) in men?

Answer 15

“Insufficient evidence to assess the balance of benefits and harms of screening for osteoporosis to prevent osteoporotic fractures in men.”

Question 16

Define dementia

Answer 16

An acquired condition that is characterized by a decline in at least two cognitive domains:
1) Loss of memory
2) Attention
3) Language
4) Visuospatial
5) Executive functioning

Question 17

1) List types of dementia diagnoses
2) Which is most common?

Answer 17

1) Alzheimer disease (AD), vascular dementia, dementia with Lewy bodies, and Parkinson disease with dementia, and dementia of mixed etiology.
2) AD

Question 18

Define delirium

Answer 18

Serious disturbance in mental abilities that results in confused thinking and reduced awareness of surroundings

Question 19

What are 4 non-underlying disease related causes for delirium?

Answer 19

1) Intoxication
2) Sleep deprivation
3) Medications
4) Illegal drugs

Question 20

Elder abuse:
1) What should screening include looking for?
2) What is the prevalence of elder abuse? What group is it higher in?
3) Why may abuse not be detected?

Answer 20

1) Screening should include looking for abuse, neglect, exploitation, and abandonment.
2) Prevalence ranges from 5-10%
Higher in elders with dementia and depression
3) Elders less likely to report, therefore abuse may not be detected

Question 21

Why are elders less likely to report, therefore abuse may not be detected? (4 reasons)

Answer 21

1) Fear of retaliation
2) Physical or cognitive inability to report.
3) Unwillingness to expose the abuser
4) 90% are family members

Question 22

1) The great heterogeneity in older pts health contributes to the difficulty in distinguishing between __________ aging verses ____________ conditions.
2) This makes it harder to answer what question?

Answer 22

1) intrinsic; pathologic
2) “When to treat?”

Question 23

1) If undecided on whether to treat, then evaluate what abt a pt’s function?
2) What should determine your decision after that?

Answer 23

1) Whether function is sufficiently impaired
2) If so, then treat; if not very impaired, then watch, wait, reevaluate

Question 24

List 6 ADLs (activities of daily living)

Answer 24

Bathing
Dressing
Toileting
Transferring
Continence
Feeding

Question 25

1) What main thing should you ask abt ADLs?
2) In general, what are ADLs?
3) What 3 questions should you ask to help answer the main question?

Answer 25

1) Ask how well the patient performs the ADLs
2) Basic self-care abilities
3) -Can the patient perform these activities independently?
-Does the patient need help?
-Is the patient completely dependent on others for ADLs?

Question 26

1) What main thing should you ask abt Instrumental Activities of Daily Living (IADLs)?
2) In general, what are IADLs?
3) What 3 questions should you ask to help answer the main question?

Answer 26

1) Ask how well the patient performs the IADLs
2) Activities which are higher level functions
3) -Can the patient perform these activities independently?
-Does the patient need help?
-Is the patient completely dependent on others for IADLs?

Question 27

Blood pressure:
1) With aging, ______ and __________________ increase, whereas __________ decreases (widening pulse pressure)
2) Isolated systolic hypertension (SBP ≥140 mmHg with DBP <90 mmHg) after age 50 and widened pulse pressure >60 increases risk for what 3 things?

Answer 27

1) SBP and peripheral vascular resistance; DBP
2) Stroke, renal failure, and heart disease

Question 28

1) Define orthostatic hypotension
2) What % of older adults does it occur in?
3) List 4 symptoms

Answer 28

1) Drop in SBP of >20 mmHg or DBP of >10 mm Hg, increase of HR of 20 BPM, or dizziness within 3 minutes of standing
2) 20%
3) Lightheadedness, weakness, unsteadiness, and visual blurring

Question 29

Heart rate and rhythm:
1) Resting HR is unchanged, but ___________________ declines, affecting response to exercise and physiologic stress.
2) Why?
3) What abt heart rhythm can change w age?

Answer 29

1) maximal heart rate
-Due to slowing of pacemaker cells in SA node and blunted β-adrenergic response (Beta blockers may also do this)
3) More likely to have abnormal heart rhythms

Question 30

1) Does RR change w age?
2) What do age-related changes in temp. regulation lead to?

Answer 30

1) No; respiratory rate unchanged
2) Susceptibility to hypothermia

Question 31

What is the “5th vital sign” in older adults?

Answer 31

Functional Status

Question 32

1) Assessment of older adults places special emphasis on maintaining what 2 things?
2) Maintaining what is the primary focus?

Answer 32

1) Independence and optimal level of function
2) Functional status

Question 33

1) A number of performance-based assessment instruments for functional status are available, such as what? What does this screening assess?
2) Patients should also undergo risk factor assessment for _______

Answer 33

1) 10-Minute Geriatric Screen; physical, cognitive, and psychosocial factors
2) falls

Question 34

List the 2 types of macular degeneration.
Which is more common and less severe? Which is neovascular?

Answer 34

Two types:
1) Dry atrophic: more common, less severe
2) Wet exudative: neovascular

Question 35

List 2 symptoms of macular degeneration

Answer 35

1) Poor central vision
2) Blindness

Question 36

What is the leading cause of visual impairment?

Answer 36

Cataracts

Question 37

List some of the multiple risk factors for cataracts

Answer 37

1) Cigarette smoking
2) High alcohol intake
3) Diabetes mellitus (DM)
4) Medications (e.g., steroids)
5) Trauma

Question 38

1) Define glaucoma
2) What does it lead to?

Answer 38

1) Increased intraocular pressure
2) Optic nerve damage

Question 39

In older adults:
1) Systolic bruits heard in middle or upper portions of carotid arteries suggest what? From what?
2) What does having an S3 strongly suggest after age 40?

Answer 39

1) Partial arterial obstruction; atherosclerosis
2) Heart failure and dilatation of the left ventricle from CHF

Question 40

1) S4 can be heard in healthy older people, but often suggests decreased ____________ and impaired _______________.
2) What may occur as a result?

Answer 40

1) ventricular compliance and impaired ventricular filling
2) LVH (left ventricular hypertrophy)

Question 41

1) Menstrual periods typically cease between what ages? What is the median?
2) Women often experience hot flashes for up to how many years? What are 3 other symptoms they may have?
3) Within how long are the ovaries usually no longer palpable?

Answer 41

1) 48-55; median 51 years
2) Five year; vaginal dryness, urge incontinence, or dyspareunia
3) 10 years

Question 42

1) Proliferation of prostate epithelial and stromal tissue (aka benign prostatic hyperplasia (BPH)) begins in what decade?
2) What decade does it continue to and what happens then?
3) How many men w BPH have symptoms?

Answer 42

1) Third decade
2) Until the seventh, then plateaus
3) Only half

Question 43

True or false: Signs and symptoms of alcohol abuse/ use disorder may be subtler in older adults

Answer 43

True

Question 44

True or false: Signs and symptoms of alcohol abuse/ use disorder may be more obvious in older adults

Answer 44

False; may be more subtle

Question 45

List the 4 CAGE questions

Answer 45

1) Have you ever felt you should cut down on your drinking?
2) Have people annoyed you by criticizing your drinking?
3) Have you ever felt bad or guiltyabout your drinking?
4) Have you ever taken a drink first thing in the morning (eye-opener) to steady your nerves or get rid of a hangover?

Question 46

1) What test is preferred over CAGE?
2) What does this test identify?
3) How many questions and what’s the scoring?

Answer 46

1) Alcohol Use Disorders Identification Test-Concise (AUDIT-C)
2) Not just harmful drinkers detected by CAGE, but also hazardous drinkers who have not yet reached that level of harm (early intervention to reduce consumption)
3) 3 Questions, scored from 0-12

Question 47

What are the 3 questions for the Alcohol Use Disorders Identification Test-Concise (AUDIT-C)?

Answer 47

1) How often did you have a drink containing alcohol in the past year?
2) How many drinks did you have on a typical day when you were drinking in the past year?
3) How often did you have 6 or more drinks on one occasion in the past year?