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Summer Disciplines > Prevention > Flashcards

Prevention Flashcards

1
Q

Health status of older adults is composed of

A

chronic diseases and number of them
underlying physiologic changes in aging
susceptibility to acute illnesses and injuries

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2
Q

What happens to probability of chronic diseases with age

A

they increase; ex: osteoarthritis
17-44: 5%
45-65: 25%
65+: 50%

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3
Q

What are some major causes of mortality in the elderly

A 
heart disease 
cancer (lung, breast, colorectal) 
lung disease 
CVA 
PNA, Flu
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4
Q

How are chronic disease and life span related

A

People are living longer with chronic disease 2/2 meds, vaccinations, surgery technology, imaging, and the fact that we are managing people better
ex: 40% of older people have HTN (1/3 have CAD and have survived MI, etc.)

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5
Q

What is a major health outcome of chronic disease

A

Disability! (also death) if you have one chronic disease, you likely have another

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6
Q

How can you prevent other chronic diseases

A

management! change your lifestyle, stop smoking, eat a good diet, and exercise
also genetics
this can help make sure if you have HTN, you dont develop other diseases in addition

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7
Q

What is disability

A

Having difficulty with ADL
half are chronic and progressive
half are catastrophic

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8
Q

The most feared outcome of disability is

A

loss of independence, not being able to care for yourself and do your ADL’s

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9
Q

What are some precursors to disability

A

difficulty walking
cognitive impairment
visual impairment
-this is why we measure a person’s ability to preform ADL and IADL

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10
Q

How do we modify consequences of disease

A

Health habits: affect likelihood of people developing a chronic disease
Screening: if at high risk
Immunizations: decrease risk of flu/PNA
Access to healthcare: hard to get around
Education: how well ppl manage their own dz
Community services: support as ppl age

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11
Q

What are the types of preventive healthcare

A

primary: prevent disease/injury from occurring
Secondary: prevent early condition from progressing (has CAD, stop smoking)
Tertiary: improve care, avoid later complications (+/- rehab)

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12
Q

What is a central theme in geriatrics

A

tertiary prevention

but, all three are used

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13
Q

The benefit of prevention depends on

A

Prevalence of the problem

Likelihood of an effective intervention

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14
Q

Is prevention different in older adults?

A

yes, their target is prevention of syndromes (falls, dizziness, and functional decline)
0Iatrogenic disease is also a problem

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15
Q

Examples of primary prevention

A

vaccines, BP monitoring, smoking cessation, exercise, cholesterol, Na restriction, social support, seat belts, med review, oral care, home eval

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16
Q

Examples of secondary prevention

A

Mammography<75 y/o
colonoscopy <79 y/o
screening for hypothyroid, vision, TB, and oral cavity
skin care (hygiene, growths)

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17
Q

Examples of tertiary prevention

A 
Proactive PCP 
CGA
foot care 
dental care 
toileting efforts 
rehab/exercise
dietary protein
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18
Q

Health people 2020 says the most relevant injury intervention is

A

reducing rate of hip Fx hospitalizations

reducing rate of ED visits s/p falls

19
Q

Considerations in assessing prevention in older patients includes

A 
Baseline risk 
Competing risks/ limited life expectancy 
Time to achieve an effect
Vulnerability/risk of harms 
response to intervention 
value of health gained
cost of preventive activity
20
Q

The ACP and ASIM currently recommend

A

broad screening for older patients at risk for becoming disabled/ losing independence

  • IADL/ADL screening
  • Cognitive screening
  • Health status eval
21
Q

The USPTF currently recommends

A

a “welcome to medicare” visit
periodic screening to detect conditions in ASx people w/o dz
If 65+: screening, counseling, immunizations

22
Q

What is in a “welcome to medicare” visit

A

PMHx
FHx
current health conditions/Rx
Check BP, vision, weight, and height for baseline
Preventive screenings/services (immunizations, cancer screening)
Order tests 2/2 pt general health Hx
Give pt/care giver a list of medicare-covered screenings/preventive services they need

23
Q

What is a challenge to preventive care in older adults

A

The behaviors that need to change have been there for their whole life, and they likely enjoy them;
weigh QoL benefits against impact on individual
Ex: putting a 90 y/o diabetic on a strict diet, probs not a great idea

24
Q

What screenings are available to identify psychosocial problems

A

Pt health questionnaire-9
Beck depression inventory-II
Geriatric depression scale (short version, 15 items- common depression Sx)

25
Q

What what regular physical activity provide in older adults

A

increased balance and stamina
improved CV conditioning, strength, tone, and muscle mass
Fall and osteoporosis prevention
Flexibility

26
Q

How much physical activity should older adults get

A

150 minutes a week of moderate intensity

27
Q

What suggests poor nutrition

A

low BMI
unintentional >10lb wt loss in 6 months
(kcal needs decline, but ntr requirements stay the same!)

28
Q

What is a Mini Nutritional Assessment

A

assessment of ntr status to help ID those at risk for malntr

29
Q

Obesity puts older adults at risk for

A

decreased physical activity

also an indicator of poor diet quality

30
Q

How can you prevent DJD (osteoporosis)

A

Pharm and non-pharm!
walking (increase skeletal load)- limited benefit
Strength training* improves and maintains bone mass

31
Q

What is function affected by

A 
genetics 
health status 
comorbidities 
mood 
cognition
beliefs
32
Q

How can we prevent disability

A

encourage elderly to do as much themselves as possible!

Verbal encouragement to bathe, dress, and go for a walk

33
Q

What is the most preventable problem in older adults

A 
Iatrogenesis! Ex include 
under diagnosis 
bed rest 
polypharmacy 
enforced dependency 
environmental hazards 
transfer trauma 
oversedation, overTx 
delirium, fluid overload, dehydration, etc.
34
Q

What is “narrowing of the therapeutic window”

A

space between a therapeutic dose and toxic dose narrows with age

35
Q

Are hospitals always good for older individuals

A

No, they are dangerous 2/2 multimorbidity and diminished reserves in cognitive, renal, and hepatic function
-Iatrogenesis, cognitive changes, testing, central lines, catheters, Tx changes, providers dont know pt, caregivers are not informed of what goes on

36
Q

Elective surgery can result in

A

post-op oversedation w/ pain meds= resp fxn decline= mechanical ventilation= VAP= sepsis and death

37
Q

PNA or CHF admit can lead to

A

immobility= UTI= catheter= deconditioning, delirium, sepsis

38
Q

Potential complications of bed rest in older adults includes

A

pressure ulcers, bone resorption, hypercalcemia, postural hypotension, PNA, atelectasis, thrombophlebitis, Urinary/fecal incontinence, decreased muscle strength, contractures, depression, anxiety, sensory deprivation

39
Q

How can you prevent iatrogenesis

A

Rx new meds ONLY if necessary; start low, go slow. Use beers criteria. stop unnecessary meds
Maintain philosophy of care that focuses on optimizing physical activity and function

40
Q

What can fear of falling lead to

A

adverse effects on functional status and overall QoL

41
Q

Falling can result in

A 
significant injury 
significant disability (2/2 fear of falling, loss of self confidence, restricted ambulation)
42
Q

Lab evals of elderly who fall include

A

Non-specific markers
Based on H&P findings!
BUT, can do an ambulatory ECG if you suspect transient arrhythmia

43
Q

Other interventions for elderly who fall include

A 
PT/OT 
gait training 
muscle strengthening 
Eval/train use of assistive devices 
environment manipulations 
use hip protectors if at risk for hip Fx

Summer Disciplines (6 decks)

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