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geriatrics > the geriatric patient (Mimis) > Flashcards

the geriatric patient (Mimis) Flashcards

Lectures 1, 2, 3

1
Q

what countries have the highest % population of 80+ y/o?

A

In order

  1. japan
  2. italy
  3. UK
  4. US
  5. china
  6. mexico
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2
Q

The increased survival of older persons has also been accompanied by ____, so the proportion of the population aged 65 and older has _____ dramatically and will continue to for the next 50 years

A
  1. declining birth rates
  2. increased

2050 - 4x as many people +85 y/o as there are now, and almost 200 times as many as there were in 1900.

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3
Q

which sex has a higher life expectancy?

A

F > M
- 75-year-old man - +10 more years
- 75-year-old woman - +12 more years

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4
Q

what is the racial prevalence/statistics with life expectancy

A
  1. The gender differential for blacks (6.5 years) is greater than for whites (4.8 years).
  2. Blacks have a lower life expectancy than whites through age 75 and then have a higher life expectancy at age 85.
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5
Q

Healthcare System Advancements to Address the Increasing Elderly Population

A
  • Medication prescribing practices
  • Fall reduction
  • Pain and symptom control
  • Decreasing caregiver burden
  • Transitions in medical care
  • HOWEVER, a disconnect remains between what happens in offices and what pts/caregivers need at home
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6
Q

Key Psychosocial Factors
Model, what are the 6 parts

A
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7
Q

what are the positive and negative impacts of psychosocial factors?

A
  1. positive
    - Social engagement - Volunteering, Lifelong learning, Intergenerational programs
    - Social environments promoting aging in place
    - Aging services
    - Hospice
  2. negative
    - depression
    - dissatisfaction with life
    - no support
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8
Q

what condition may stem from inflammatory and hormonal abnormalities? (from the biology of psychosocial aging, hint: psych)

A

Late-life depression (LLD)

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9
Q

what condition affects the melatonin secretion from the pineal gland at night that may explain sleep disturbances among older adults

A

age-related decline

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10
Q

how can reduced vision and hearing have affect socially?

A

Reduced vision and hearing may contribute to reduced social interaction.

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11
Q

what may aid in dementia prevention by maintaining brain cellular integrity before gross atrophy sets in

A

Purposeful efforts at social engagement

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12
Q

7 Key Components to Successful Geriatric Best Practice Models

A
  1. Enable older adults to remain safely at home
  2. Prevent functional disability
  3. Preserve patient quality of life
  4. Respect patient values, preferences and goals
  5. Consider patient safety
  6. Address the needs of family caregivers
  7. Appreciate and address patient’s psychosocial needs
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13
Q

Innovative care delivery models funded by the Center for Medicare and Medicaid Innovation (CMMI) hold promise for improving health outcomes and controlling costs.

A

Community-based long-term services and support (CBLTSS)

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14
Q

what services/accesses does CBLTSS include?

A
  • Rely less on physicians and more on specialized nurses or trained lay visitors
  • Disease management, post-acute home health care, and medical day care
  • Home-based geriatric assessment
  • Preventive home visits
  • Medical care in assisted living facilities (ALFs), sheltered housing, and group homes
  • A small number of older adults carry privately funded LTC insurance
  • Ultimately, many exhaust retirement savings and home equity to pay for LTSS, becoming eligible for Medicaid through this “spend-down” process
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15
Q

Forms of CBLTSS

A
  1. Continuing care retirement communities (CCRCs)
  2. A fully independent older adult lives in a single-family home or apartment
  3. Life care at home model
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16
Q

types of home healthcare Providers

A
  1. unskilled - services provided by unpaid caregivers
  2. skilled - formal services delivered by professional providers, such as nurses or physical, occupational, or speech therapists.
  • Medicare - certifies and reimburses home health care agencies (HHAs) to provide this type of care when pt is homebound and has a skilled need.
  • HHAs - provides formal personal care services (bathing, dressing, etc.) under the Medicare home health care benefit while a patient is receiving skilled care.
17
Q

Two Formal Home-Based Medical Care Models

A
  1. Home-based primary care model
    - Physicians, PAs and NPS provide ongoing longitudinal medical care at home
    - provides access to routine and urgent care for older adults who have difficulty getting to a medical office
    - increasing in prevalence in recent years and have been shown to be effective
  2. Hospital-at-home model
    - An emerging care model that provides hospital-level care in a patient’s home
    - Substitutes for an acute hospital admission
    - Has been shown to be associated with better care quality and lower costs than typical hospital care
18
Q

types of caregivers, which is MC

A
  1. informal - unpaid caregivers
  2. formal - MC model of home health care
    - The provider varies with the type of CBLTSS
    - An HHA certified to provide care under Medicare reimbursement rules employs trained caregivers and assigns them to individual patient cases
    - A physician must certify that the patient is homebound and has a skilled need
    - A 60-day certificate
    - A skilled need requires care that is part-time, intermittent, and must be provided by a person with special training
    - Personal care assistance with ADLs such as bathing and dressing is covered during the certification period, but Medicare does not pay for it in the absence of a skilled need.
19
Q

who must catalog each patient’s medical, functional, and socioeconomic characteristics in the Outcome and Assessment Information Set (OASIS)

A

Health Care Agencies (HHAs)

20
Q

A patient can be “recertified” for multiple ?-day periods as long as a skilled need exists.

A

60

21
Q

what HHA model allows selected patients to choose, train, and pay their personal care providers directly with designated state funds (usually from Medicaid programs).
In these programs, care providers can be family members or other previously unpaid caregivers.

A

A “consumer-directed” or “cash and counseling”

22
Q

Recent Tech and Social Advances

A

Telemedicine
Point-of-care diagnostic and therapeutic technology
Social, medical, and financial support
Care Management for High-Cost Beneficiaries (CMHCB)

23
Q

Emerging Models of CBLTSS

A
  • Physician house calls
  • Team-based primary care coordination
  • Population-based pay-for-performance
  • current fragmented system of CBLTSS will be untenable in the coming years as the number of older adults with complex multimorbidity and functional disability increases.
24
Q

Who is the Geriatric Population? (age)

A

65 y/o is often used because this is the age that determines eligibility for Medicare insurance in the US.
(there is no set age to define old age)

25
Q

the study of aging, including biologic, sociologic, and psychologic changes.

A

gerontology

26
Q

top 5 causes of death in +65 y/o (CDC)

A
  1. heart disease
  2. malignancy
  3. COVID
  4. cerebrovascular disease
  5. alzheimers
27
Q

what is the normal pathological process of aging

A
  • inevitable, irreversible decline in organ function that occurs over time even in the absence of injury, illness, environmental risks, or poor lifestyle choices (e.g., unhealthy diet, lack of exercise, substance abuse)
  • reduced capacity of each organ to maintain homeostasis under stress (e.g., illness, injury)
28
Q

MC affected systems with aging

A

CV
renal
CNS

29
Q

with the process of aging, what should clinicians not do?

A
  1. mistake aging for disease
  2. mistake disease for aging
  3. ignore increased risk of adverse drug effects on weak-link systems stressed by illness
  4. forget that older adults often have multiple underlying disorders that accelerate potential for harm
30
Q

what are the phenotypes of aging? they all result in what?

A
  1. phenotypes
    - changes in body composition
    - energy imbalance production/utilization
    - homeostatic dysregulation
    - neurodegeneration
  2. they all contribute to physical an cognitive FRAILTY
31
Q

A vicious cycle of declining energetics and reserves that leads to a progressive decline in health and function.
what is this term?

A

frailty

32
Q

The primary causes of physiologic decline that start at the molecular level

A

Biological Mechanisms
Pathophysiologic Biomarkers
Clinical Presentation (cognitive and physical Impairments)

33
Q

what causes the symptoms of an illness?

A

The body’s stress response

34
Q

Aging considerations – Presentation & Dx

A
  1. Atypical presentations of medical conditions is common
  2. may not have fevers or elevated WBC with an infection
  3. Heart disease may be silent
  4. Cognitive and affective disorders are common and may be undiagnosed in early stages
  5. Reversible and treatable conditions can be under-diagnosed and under-evaluated (e.g., fall risk, urinary incontinence, elder abuse and neglect)
35
Q

testing and imaging for aging (considerations)

A
  1. Imaging may reveal abnormalities that may or may not be related to sx’s
  2. Consider no subsequent testing and tx who will not suffer morbidity/mortality from the disease because of limited life expectancy (e.g., prostate cancer, colorectal cancer screening)
  3. Physiologic changes associated with aging can affect results of diagnostic tests; interpret with caution
  4. Cardiac monitoring can identify arrhythmias; must be linked to sx or adverse outcomes before considering potentially toxic medications or invasive procedures

36
Q

Key Principles for Effective Care of the Geriatric Population

A
  1. Aging is due to homeostenosis
  2. Medical conditions are often multiple (“multimorbidity”) and multifactorial in origin
  3. Many reversible and treatable conditions are under-diagnosed and under-evaluated
  4. Cognitive and affective disorders are common
  5. Iatrogenic illnesses are common (illness related to exam or tx)
  6. Functional ability and quality of life are key goals of care
  7. Social hx, social support, and pt preferences are critical
  8. Effective geriatric care requires interprofessional collaboration
  9. Geriatric care is provided largely outside the hospital
  10. Ethical issues, palliative care, and end-of-life care are critical aspects of caring for the elderly

geriatrics (12 decks)

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