Well elder Flashcards
Risk factors adverse effects
Age >85
Low BMI
6+ chronic conditions
Creatinine clearance
Prealbumin
19-38 mg/dl if 13 malnourished do not give protein bound drug
shows nutritional status over a week or two
Creatinine clearance calculation
(140-age in years)x body weight kg
___________________________
72 x serum creatinine
for women x all by .85
Depression
somatic- nonspecific complaints
find out baseline
lack of energy, somatic, difficulty getting along with others, isolation, withdrawal, lack of hygiene/appearance, self-destructive behaviors
Depression screening tools
Sleep Interest Guilt Energy Concentration Appetite Pscyhomotor Suicide (SIGECAPS)
PHQ2 PHQ9 Geriatric depression scale
Cognitive function AKA
normal aging=
“mentation”
slower thought process
decline in recent memory
multitasking more difficult
Cognitive function assessment tools and what they test
1)
2)
Mini mental status exam:
Orientation, registration, recall, attention, calculation, language, visual spacial
Mini cog:
3 item recall, clock drawing
Functional assessment
ADL
IADL
ADL: dressing, bathing, grooming, feeding, walking, toileting
IADL (skills needed to remain in community): laundry, shopping, medication management
Physical activity benefits
Bone/muscle strength function QOL bowel function sleep wellbeing decrease falls and depression decrease body fat lower BP and cholesterol
Pain assessment Pain is \_\_\_ by HCP Elders\_\_\_\_ or \_\_\_\_\_ pain Cognitive impairment assessment: Untreated pain:
% who report pain:
pain is undertreated by HCP
elders minimize or underreport pain as they think its a normal part of aging
cognitive impaired- grimace agitated
untreated pain: adl impairment, cognitive dysfunction, depression, anxiety, social isolation, appetite and sleep impairment
25-50% community dwelling, 45-80% nursing home
Driving
Assessment
history of falls in last 1-2 years
visual deficit (visual fields, acuity, contrast sensitivity, delayed light accommodation)
cognitive deficit (trail making, clock drawing)
prior hx of accidents
current use of benzos or TCAs
motor function (ROM, strength, rapid pace walk)
Nutritional considerations
- disease process
- chewing/swallowing diff. (dentures, thrush)
- tooth loss/pain
- reduced social contact
- finances
- multiple medications
- low BMI 10 lbs in 6 mos)- sentinel event in LTC
- appetite stimulants (megace- cancer drug)
Biggest reason elderly are institutionalized
Urinary or fecal incontinence
Sexuality
medications: beta blocker SSRI impotence
Caregivers formal vs. informal
formal- health care professionals informal- family friends church community (unpaid)
HEALTH MAINTENANCE
immunizations
influenza: recommended for ________
nasal approved for_______ who not approved for?
everyone >6 months old including pregnant women and chronic health conditions
nasal approved for ages 2-49
HEALTH MAINTENANCE
TB
Recommended for:
Two step- why?
not needed for people at low risk
risk:
exposure to TB
HIV infections or immunosuppressed
Symptoms of TB (fever, night sweats, cough, weight loss)
TB common country (Latin america, caribbean, africa, asia, eastern europe, russia)
Occupation in us (homeless shelters, prisons, nursing homes)
Illicit drug users
Two step: useful for health care workers who will be tested periodically, decreases likelihood that a boosted reaction to other TB tests will be mistaken as infection
HEALTH MAINTENANCE Shingles vaccine FDA approved for \_\_\_\_\_ 50-59? How long does it last for? Previous shingles?
adults over age 50; however, routine use not recommended for adults 50-59, risk is greatest after age 60
Last: for 60+ vaccine protection decreases after 5 years
You CAN get the vaccine even if had shingles, do not have to wait after getting it
HEALTH MAINTENANCE More on shingles vaccine: other name\_\_\_\_\_\_ # doses Maximum age Live or attenuated Contraindicated in
Zostivax One time vaccine No max age Live Pregnancy and immunocompromised
HEALTH MAINTENANCE
Pneumococcal
1)
2)
Can these be given on the same day?
Pneumococcal conjugate (PCV13 or prevnar 13)
Age 65+
OR adults 19+ immunocompromised (HIV, organ transplant, leukemia lymphoma, severe kidney disease)
Pneumococcal polysaccharide (PPSV23 or pneumovax)
65+
2+ at high risk for disease
19-64 who smoke or have asthma
NO: do not give at same time, PCV13 first then pneumovax
Welcome to medicare visit
New medicare beneficiaries within first year
ID and decrease health risks, educate preventive services
Written shared plan, recommendations referrals, follow up annual visit q12 months
Medicare?
Seven components for reimbursement
1) Med/surg history
2) Risk factors depression/mood
3) Functional ability and safety
4) PE: ht/wt/BMI/BP/visual
5) end of life planning
6) Education, counseling, referral
7) Orientation to preventive services
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-Documents: life sustaining treatments (MOLST)
(DNR.DNI, artificial hydration, nutrition, medications, do not hospitalize)
-Goals of care
-Health care proxy
Patient self determination act 1990
informs patients of rights regarding health care decision making
most health care facilities required to provide this: right to refuse or accept tx, right to participate in own medical care decision making
