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Summer 2 > 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
What what regular physical activity provide in older adults
increased balance and stamina improved CV conditioning, strength, tone, and muscle mass Fall and osteoporosis prevention Flexibility
26
How much physical activity should older adults get
150 minutes a week of moderate intensity
27
What suggests poor nutrition
low BMI unintentional >10lb wt loss in 6 months (kcal needs decline, but ntr requirements stay the same!)
28
What is a Mini Nutritional Assessment
assessment of ntr status to help ID those at risk for malntr
29
Obesity puts older adults at risk for
decreased physical activity | also an indicator of poor diet quality
30
How can you prevent DJD (osteoporosis)
Pharm and non-pharm! walking (increase skeletal load)- limited benefit Strength training* improves and maintains bone mass
31
What is function affected by
``` genetics health status comorbidities mood cognition beliefs ```
32
How can we prevent disability
encourage elderly to do as much themselves as possible! | Verbal encouragement to bathe, dress, and go for a walk
33
What is the most preventable problem in older adults
``` Iatrogenesis! Ex include under diagnosis bed rest polypharmacy enforced dependency environmental hazards transfer trauma oversedation, overTx delirium, fluid overload, dehydration, etc. ```
34
What is "narrowing of the therapeutic window"
space between a therapeutic dose and toxic dose narrows with age
35
Are hospitals always good for older individuals
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
Elective surgery can result in
post-op oversedation w/ pain meds= resp fxn decline= mechanical ventilation= VAP= sepsis and death
37
PNA or CHF admit can lead to
immobility= UTI= catheter= deconditioning, delirium, sepsis
38
Potential complications of bed rest in older adults includes
pressure ulcers, bone resorption, hypercalcemia, postural hypotension, PNA, atelectasis, thrombophlebitis, Urinary/fecal incontinence, decreased muscle strength, contractures, depression, anxiety, sensory deprivation
39
How can you prevent iatrogenesis
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
What can fear of falling lead to
adverse effects on functional status and overall QoL
41
Falling can result in
``` significant injury significant disability (2/2 fear of falling, loss of self confidence, restricted ambulation) ```
42
Lab evals of elderly who fall include
Non-specific markers Based on H&P findings! BUT, can do an ambulatory ECG if you suspect transient arrhythmia
43
Other interventions for elderly who fall include
``` PT/OT gait training muscle strengthening Eval/train use of assistive devices environment manipulations use hip protectors if at risk for hip Fx ```

Summer 2 (8 decks)

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