The Geriatric Assessment Lecture Powerpoint Flashcards
Geriatric syndromes
Common health conditions of geriatric patients that do not fit into distinct organ based disease categories (typically multiple categories of organ systems involved) such as cognitive impairment, incontinence, falls, etc
Functional status
The ability to perform activities necessary and desirable in daily life, influenced by health conditions, envirionment, and social network. Changes should prompt eval, intervention and treatment
Basic ADL’s (5)
- bathing
- dressing
- toileting
- grooming
- feeding
Intermediate ADL’s (7)
- shopping for groceries
- technology use
- housework
- meal prep
- laundry
- taking medications
- handling finances
Advanced ADL’s (1)
Vary by individual, include societal, community, family, recreational, and occupational roles
Vulnerable elders scale (VES-13)
Survey that detects vulnerable group (4x chance of death or functional decline) and does not require direct observation as it can be done over phone, includes age, comparative/self rated health, difficulties with ADL’s, physical activities, etc
Gait speed predicts these 2 things in older adults
- functional decline
- early mortality
Get up and go test
Monitoring how fast a geriatric can move 20 feet, with 7-10 being mobile, 11-14 being fairly mobile, 15-19 variable mobile, 20-29 severe restriction, and greater than 30 functionally dependent. >12 seconds HIGH risk for falling**
Tinetti Performance oriented mobility assessment (POMA)
Comprehensive observational assessment tool for balance and gait, predicts fall risk (low, moderate, or high risk)
One fall means increases these 2 things in geriatric populations
- increased likelihood of more falls
- loss of independence
Fall and gait interventions (3)
- minimize medications
- exercise program
- treat underlying cause (vision impairment,postural hypotension, heart rate and arrhythmias)
- modify home environment
__ of seniors die with some form of dementia
1 in 3
Mini mental state examination (MMSE) advantages (2) and disadvantage (1)
- can track over time
- highly specific and sensitive
-not quick
Mini cog
Mental assessment involving clock drawing and registration and recall of 3 words, quick as not limited by language or educaiton
MoCA
Longer mental assessment than MMSE that involves visuospacial, naming, memory, attention, language, delayed recall, abstraction, and orientation
SLUMS**
Mental status assessment involivng orientaiton, recall, problem solving, oral comprehension considering education level and is highly sensitive and specific
FAST scale
Functional assessment staging test for rating dementia that includes mental status as well as ADL’s and motor function to determine hospice eligibility
CDR scale
Clinical dementia rating scale used to assess memory, orientation, judgement, community affiars, interests/home tasks, and personal care rated from none to mild to moderate to severe
Patient Health Questionnaire 2 (PHQ2)
High sensitive good specificity series of 2 questions (frequency of depressed mood and frequency of anhedonia) that is fast but does not guide treatment regarding diagnosing depressive illness often but not always in geriatric population
Patient health questionnaire 9 (PHQ9)
9 questions regarding frequency of feelings graded from minimal to severe AND recommends a plan on what to do often but not always used in the geriatric population
Geriatric depression scale (GDS)
15 yes/no questions that allow to follow progression/regression specific to the geriatric population, focuses more in the present convenient for those who have dementia
Polypharmacy
Tendency for older patients to see many providers and need review of medications AND supplements at each visit to ensure there aren’t any interactions or complications, eased by EMR’s generally
Beers criteria
List of medications deemed to be generally inappropriate for older patients (mainly nursing home) as they are either ineffective or at high risk for adverse events and had higher risk of hospitalization and death
3 categories of drugs/patient type that account for most adverse drug events seen in emergency departments in geriatric populations
- Anticoagulants (heparin, warfarin, xarleto, elequis pradaxa)
- Antiplatelets (clopidegrol AKA plavix)
- Hypoglycemics
Anticholinergic toxicity symptoms (8)
- flushing
- dry skin and membranes
- mydriasis
- altered mental status
- sinus tachycardia
- fever
- urinary retention
- hypertension
Drug classes that can cause anticholinergic toxicity (3)
- 1st gen antihistamines (benadryl and hydroxyzine)
- antispasmotics (scopolamine, dicylomine)
- TCA’s (amitriptyline)
Specific drug used for UTI that should be avoided for geriatric populations due to pulmonary toxicity, hepatotoxicity, etc
Macrobid (nitrofurantoin)
Drugs that can cause issues in geriatrics (7)
- amiodarone (thyrotoxic)
- coumadin
- spironolactone (arrhythmias)
- antipsychotics
- benzos
- sliding scale insulin
- sulfonyureas (help pancreas secrete more insulin, such as glyburide, prolonged half life in older adults lead to hypoglycemia)
Healthy A1C in geriatric populations vs in normal population
7.5% (4-5.6% in normal populations but have to let it go in these populations that have had these conditions for years)
Megestrol (Megace)
Appetite stimulant for cachexia that can be used in geriatric populations BUT increases risk for thrombotic events so often not used
3 most comon ailments among older adults
- hypertension
- arthritis
- presbycusis (gradual hearing loss)
2 Hearing surveys in geriatric patients
- whisper voice test
- hearing handicap inventory for the elderly
Etiologies of hearing loss (7)
- genetics
- noise exposure
- ototoxic drugs
- middle and inner ear inflammation
- chronic dz
- tumors
- cerumen
Nutrition in elderly
Up to 15% are malnourished, vitamin D important, protein and energy supplements can help
4 types of elder neglect and abuse
- physical
- sexual
- psychological
- financial exploitation
Elder mistreatment
act of neglecting and abusing geriatric populations, most often committed by those with ongoing relationship with them not strangers, consequences include more hospitalizations, medical nonadherence, poor living conditions, falls, increased mortality
