Older adults

Question 1

BEERS Criteria:

Drug classes to avoid from Table 2 (18):

Name a few and be familiar… don’t need to memorize…

Answer 1

First-line anticholinergics (dimenhydrinate)
Antiparkinsonian agents (benztropine)
Antispasmodics (atropine) 
Anti-infectives (Macrobid)
Antidepressants (TCAs, SNRIs, SSRIs) 
CVS (amiodarone, nifedipine IR) 
Anti-thrombotics (dipyridamide, rivaroxaban, dibigatran)
First and 2nd gen antipsychotics 
Barbituates
Benzos
Z-drugs
Testosterone/Estrogen 
PPIs (risk for bone loss and C-Diff w/ use> 8 weeks)
Sliding scale insulin
Metoclopramide 
Pain drugs - meperidine, ASA > 325, NSAIDS (anyone > 75, taking corticosteroids, anticoags, anti platelet agents)
Always avoid indomethacin or toradol
Skeletal muscle relaxants
Desmopressin (may cause hyponatremia)

Question 2

What are the diagnostic criteria for dementia (BC Guidelines - Cognitive Impairment)?

Answer 2

Impairment of at least 2 of the following cognitive domains: memory, language, visuospatial, executive function, and behaviour

Impairment causes a significant functional decline in usual activities, and

Impairment not explained by delirium or other major psychiatric disorder

Question 3

Types of dementia (6)? What is the most common type?

Answer 3

Alzheimer's - most common
vascular
mixed
Lewy body
parkinson's
frontotemporal

Question 4

Diagnostic criteria for Alzheimer’s?

Answer 4

Cognitive changes that are of gradual onset (months to years)

2 of the following cognitive domains: memory, language, visuospatial, or executive function (memory is the most common)

Impairment causes a significant decline in usual activities or work

Symptoms are not explained by other causes

Question 5

8 steps to diagnosis of dementia or MCI (BC Guidelines)

Answer 5

1) Med review
2) Collect collateral info (if pt consents)
3) MMSE, Clock-Drawing and MOCA
4) Rule out/treat delirium, depression, hyponatremia, thyroid, hypercalcemia, cobalamine deficiency, alcohol dependence, poly pharmacy, co-morbid disease
5) Suspect MCI or dementia: plan visits for diagnostic evaluation
6) Neuro imaging (MRI>CT) if: patient < 60 years, onset is abrupt or rapid progression, Hx head injury, atypical presentation, Hx cancer, new localizing neurological signs/symptoms, suspicion of cerebrovascular disease, anticoagulants, urinary incontinence with gait disorder (may indicate normal pressure hydrocephalus)
7) global deterioration scale to stage
8) referral if: diagnostic uncertainty, rapid decline, under 65 yrs, risk pf self-harm

Question 6

What is the definition of frailty (BC Guidelines)?

Answer 6

increased vulnerability and functional impairment caused by cumulative decline over multiple systems

Question 7

Warning signs of frailty (8):

Answer 7

unintentional weight loss
incontinence
delirium
dementia
declining functional status
immobillity
recent falls
susceptibility to medication side effects

Question 8

What are the 8 domains of an age-friendly community?

Answer 8

1) outdoor spaces
2) transportaion
3) housing
4) social participation
5) respect and social inclusion
6) civic participation
7) communication and information
8) community support and health services

Question 9

What are the 4 chronic diseases that account for 60% of all deaths for Canadians?

Answer 9

DM
CA
CVS
COPD

Question 10

What % of deaths caused by Covid-19 are in individuals > 70 yrs?

Answer 10

90%

Question 11

What chronic conditions are more common in females? (6)

Answer 11

Osteoporosis 
RA
Mood and anxiety disoders
Dementia 
Asthma
OA

Question 12

What chronic conditions are more common in males?

Answer 12

Gout
IHD 
Parkinsonism 
DM
CA
HF

Question 13

DEATH SHAFT

Answer 13

ADLs and I-ADLS

Dressing 
Eating
Ambulating
Toileting
Hygiene 

Shopping 
House keeping 
Accounting 
Food prep
Transportation and Telephone

Question 14

Geriatric ROS:

Answer 14

• General: fatigue, sleep, constitiutional symptoms
• H&N: visual changes, hearing loss, denture use
• GI: incontinence, constipation
• GU: incontinence, frequency, nocturia, sexual function
• Cognition, memory, visuo-spatial, language or time/place orientation concerns, executive function
• CNS/MSK: gait, balance, falls, and other injuries
• Psychiatric: mood changes isolation, recent loss of loved ones
• Nutrition: weight loss, appetite
• Derm: skin integrity, wounds, skin changes
• Safety: abuse, neglect

Question 15

What are the Geriatric Giants and Five I’s?

Answer 15

• Immobility (Falls)
• Intellect (Confusion)
• Incontinence (Incontinence)
• Iatrogenesis (Polypharm)
• Impaired homeostasis (Polypharm)

Question 16

What does DIAPPERS stand for? In the context of transient urinary tract infections.

Answer 16

Delirium 
Infection
Atrophy
Pharm
Psychologic
Endocrine
Reduced mobility
Stool impaction

Question 17

What does SPLATT stand for? In the context of falls.

Answer 17

Symptoms: dizziness, CP/SOB, weakness, LOC
Previous falls (frequency, time of day)
Location, witnesses
Activity
Time of fall
Trauma (physical or psychological)
Other: recent med changes, availability of gait aids or a life line

Question 18

What does SAFE DRIVE stand for?

Answer 18

Safety and record
Attention skills
Family report
Ethanol
Drugs (analgesics, hypoglycemics, anticholinergics, anticonvulsants, antidepressants, antipsychotics, opiates, sedatives, stimulants) 
Reaction time 
Intellectual impairment 
Vision and visuospatial abillity
Executive functions