Wk 10 pt 2: Older adult (9% of final)

Question 1

Define gerontology

Answer 1

The scientific study of the process and problems of aging

Question 2

1) Geriatrics is A branch of medicine that deals with the ______, ___________, and ____________ of the healthcare problems of the elderly, including both the medical aspects, and the social and economic implications of the delivery of that care.
2) True or false: It is not confined to end of life care.

Answer 2

1) prevention, diagnosis, and treatment
2) True

Question 3

1) Define life span or maximum lifespan
2) Define life expectancy

Answer 3

1) The max. obtainable age for a member of a species (for humans, now >120 years)
2) the number of yrs an average person of a given age may be expected to live; affected by several factors: gender, socioeconomic status, habits, environment, chronic disease(s)

Question 4

1) The demographic goal is not just to increase the life span but the “__________” of the older population
-Older adults will maintain full function and live active lives in their homes and communities
2) ___________ is a common myth about the older population
3) _____% of Americans over 65 live in the community; only ____% reside in long-term care facilities

Answer 4

1) “health span”
2) Frailty
3) 95%; 5%

Question 5

1) What is the focus of assessing an older adult?
To accomplish this:
2) You should understand and evaluate how which 3 factors affect the pt?
3) What should the importance of skillset and mindset be directed to?
4) Opportunities for promoting older adults’ long-term health and ____________.

Answer 5

1) Function & healthy or “successful” aging
2) Family, social, and community support
3) Functional assessment
4) safety

Question 6

1) How is assessing an older adult different from the history taking and PE of a younger pt?
2) What does an ideal visit combine?

Answer 6

1) Different from disease-oriented approach of younger pt
2) A disease-oriented approach, focused towards the geriatric patient, with an assessment of functionality.

Question 7

With older adults, your demeanor should convey what 3 things?

Answer 7

Respect, patience, and cultural awareness

Question 8

When taking health history w older adults, what should you pay close attention to?

Answer 8

1) Adjusting the office environment
2) Content and pace of the visit
3) Eliciting symptoms in the older adult
4) Cultural dimensions of aging

Question 9

Communicating effectively w older adults:
1) What should the environment be like?
2) What should you do while speaking to the pt?
3) What do you adapt to the stamina of the patient?

Answer 9

1) Provide a well-lit, moderately warm setting with minimal background noise and safe chairs and access to the examining table
2) Face the patient and speak in low tones; make sure the patient is using glasses, hearing devices, and dentures if needed
3) Adjust the pace and content of the interview; consider two visits for initial evaluations if needed

Question 10

Communicating effectively w older adults:
1) What should you allow time for and who should you include?
2) What should you carefully assess? What in particular?

Answer 10

1) Open-ended questions and reminiscing; family and/or caretakers when needed (especially if the patient has cognitive impairment)
2) Symptoms, esp.: fatigue, loss of appetite, dizziness, & pain, (for clues to underlying disorders)

Question 11

[Communicating effectively with older adults]:
underlined
1) What should you ensure abt written instructions?
2) What should you practice abt speaking?

Answer 11

1) Large print and easy to read
2) Speaking loudly w/o sounding angry

Question 12

[health promo and counseling to older adults]:
1) What 5 things should you encourage?
2) What 4 things should you assess for?

Answer 12

1) Regular health screening exams, exercise, immunizations, household safety, CA screening
2) Vision and hearing, depression, dementia and mild cognitive impairment, elder mistreatment

Question 13

[assessing older adults]
1) What demographic is the approach of history-taking and physical exam different from?
2) What is the focus on?
3) Give 3 examples of this focus

Answer 13

1) Younger patient
2) Healthy or “successful” aging
3) -Understand and mobilize family, social, and community supports
-Importance of skill directed to functional assessment
-Opportunities for promoting older adult’s long-term health and safety

Question 14

List 6 barriers to good geriatric care

Answer 14

1) Communication
2) Underreporting symptoms.
3) Multiple complaints that may interact; “somatization” of emotions
4) Lack of time- be patient; probe relatives or other caregivers, screening tools
5) Measure function, be alert to change, esp. rapid change
6) Track data, treat diagnoses instead of sxs, have pt. familiarity, multiple visits instead of few marathons

Question 15

[barriers to good geriatric care]:
1) What type of change should you be particularly alert for?
2) What tools are important?
3) What may pts do to emotions?

Answer 15

1) Rapid change
2) Screening tools
3) somatization

Question 16

1) How often is breast cancer screening with Mammography recommended for 40-75 y/o?
2) What abt over 75?

Answer 16

1) Screen yearly or biennially
2) Shared decision-making process about whether to continue screening (dependent on health/life expectancy)

Question 17

1) What age range should be screened for cervical cancer?
2) What age range should be screened every 3 years with cervical cytology alone?
3) What age range should you screen every 3 years with cervical cytology alone, every 5 years with high-risk HPV testing alone, or every 5 years with both tests together (cotesting)?

Answer 17

1) Women aged 21-65 years
2) 21-29 yo
3) 30-65 yo

Question 18

How often should cervical cancer screening be done >65y/o?

Answer 18

If adequate recent screening with normal Pap smears, and not otherwise at high risk for cervical cancer, routine screening is not recommended

Question 19

1) What age should screening for colorectal cancer and premalignant polyps/lesions (USPSTF) for all adults of average risk? (both males and females).
2) When should this screening occur selectively?
3) What is the preferred test option and how often?

Answer 19

1) 45 y/o
2) In pts 76-85 years
3) Colonoscopy every 10 years (other testing options exist if pt is not amenable to colonoscopy)

Question 20

What condition relevant to older adults has screening recommendations that vary depending on source (American Urological Association, American Cancer Society, USPSTF, etc.) and are controversial?

Answer 20

Prostate cancer

Question 21

1) Screening for what condition may offer a small potential benefit, but have risks of harm (false positives, etc.)? What should you engage in bc of this?
2) When should discussion of screening for this condition begin for avg risk men? What abt higher risk?

Answer 21

1) Prostate cancer; shared decision making
2) 50 years; as early as age 40

Question 22

1) What is the prostate cancer screening method?
2) How often and up to what age? What do these vary depending on?

Answer 22

1) Prostate-specific Antigen (PSA) testing
2) Every 1-2 years up to age 69-75 depending on the source (UpToDate recommendations are given above)
-USPSTF: men aged 55-69, individual decision of whether to screen with PSA

Question 23

Who should be screened for lung cancer (USPSTF)?

Answer 23

Adults age 50-80 yo with:
1) 20 pack-year smoking history AND
2) Currently smoke or have quit within the past 15 years

Question 24

1) What is the lung cancer screening (USPSTF) recommendation for those who need them?
2) When should screening be discontinued?

Answer 24

1) Annual screening with low dose computed tomography (LDCT) of the chest.
2) Once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery

Question 25

What is the recommendation for skin cancer screening (USPSTF) for asymptom. adolescents and adults (do not have signs/ symptoms of skin cancer)?

Answer 25

“The current evidence is insufficient to assess the balance of benefits and harms of visual skin examination [whole-body screening skin exam] by a clinician to screen for skin cancer.”

Question 26

1) Osteoporosis screening to prevent osteoporotic fractures (USPSTF) is recommended in women >______.
2) How should you screen them? What does frequency of screening depend on?
3) Screening may begin earlier if woman is _______________ and at increased risk of osteoporosis

Answer 26

1) 65
2) Screen with bone measurement testing (e.g., DEXA scan to measure bone mineral density [BMD]); a number of factors
3) postmenopausal

Question 27

What is the current recommendation for osteoporosis screening to prevent osteoporotic fractures (USPSTF) in men?

Answer 27

“Insufficient evidence to assess the balance of benefits and harms of screening for osteoporosis to prevent osteoporotic fractures in men.”

Question 28

Define dementia

Answer 28

An acquired condition that is characterized by a decline in at least two cognitive domains:
1) Loss of memory
2) Attention
3) Language
4) Visuospatial
5) Executive functioning

Question 29

1) List types of dementia diagnoses
2) Which is most common?
starred

Answer 29

1) Alzheimer disease (AD), vascular dementia, dementia with Lewy bodies, and Parkinson disease with dementia, and dementia of mixed etiology.
2) AD

Question 30

Define delirium

Answer 30

Serious disturbance in mental abilities that results in confused thinking and reduced awareness of surroundings

Question 31

What are 4 non-underlying disease related causes for delirium?

Answer 31

1) Intoxication
2) Sleep deprivation
3) Medications
4) Illegal drugs

Question 32

Elder abuse:
1) What should screening include looking for?
2) What is the prevalence of elder abuse? What group is it higher in?
3) Why may abuse not be detected?

Answer 32

1) Screening should include looking for abuse, neglect, exploitation, and abandonment.
2) Prevalence ranges from 5-10%
Higher in elders with dementia and depression
3) Elders less likely to report, therefore abuse may not be detected

Question 33

Why are elders less likely to report, therefore abuse may not be detected? (4 reasons)

Answer 33

1) Fear of retaliation
2) Physical or cognitive inability to report.
3) Unwillingness to expose the abuser
4) 90% are family members

Question 34

1) Past age _____, there is wide diversity among individuals in function and health (heterogeneity)
2) Geriatrics encompasses _____ to _____ years of human life span* (not avg. life expectancy)

Answer 34

1) 65
2) 40 to 60

Question 35

True or false: There is no greater health variability among same age patients than in geriatric patients

Answer 35

True
(for instance- 20 y.o. pts. tend to vary much less than 60 y.o. pts.)

Question 36

By living longer, patients are exposed to more health threats (illness, injury, aging changes) which contributes to _____________ in the population’s health

Answer 36

heterogeneity

Question 37

Why is there so much heterogeneity in the elderly?

Answer 37

It’s a combination: disease + disuse + normal aging
1) Disease: multiple different diseases, different severity, combinations, and treatments with varying results
2) Disuse: tremendous variation in habits, activity, from person to person & from year to year
3) Normal aging: affects each person differently; involves coping skills, perseverance, optimism

Question 38

1) The great heterogeneity in older pts health contributes to the difficulty in distinguishing between __________ aging verses ____________ conditions.
2) This makes it harder to answer what question?

Answer 38

1) intrinsic; pathologic
2) “When to treat?”

Question 39

What should you focus on when determining pathology or normal aging?

Answer 39

Focusing on function helps with above distinction; changes in function can be trended & quantified, then treated

Question 40

1) If undecided on whether to treat, then evaluate what abt a pt’s function?
2) What should determine your decision after that?

Answer 40

1) Whether function is sufficiently impaired
2) If so, then treat; if not very impaired, then watch, wait, reevaluate

Question 41

Healthy aging refers to effective actions taken to do what 3 things?

Answer 41

1) Prevent or lessen disease
2) Minimize disuse
3) Adapt to and cope with events of normal aging

Question 42

There are special areas of concern when assessing common or disturbing symptoms; each of these areas should be reviewed carefully with older patients in regard to health history.

Give examples of these areas:

Answer 42

1) Activities of daily living
2) Instrumental activities of daily living
3) Medications
4) Nutrition
5) Acute and persistent pain
6) Smoking and alcohol
7) Advance directive and palliative care

Question 43

List 6 ADLs (activities of daily living)

Answer 43

Bathing
Dressing
Toileting
Transferring
Continence
Feeding

Question 44

1) What main thing should you ask abt ADLs?
2) In general, what are ADLs?
3) What 3 questions should you ask to help answer the main question?

Answer 44

1) Ask how well the patient performs the ADLs
2) Basic self-care abilities
3) -Can the patient perform these activities independently?
-Does the patient need help?
-Is the patient completely dependent on others for ADLs?

Question 45

1) What main thing should you ask abt Instrumental Activities of Daily Living (IADLs)?
2) In general, what are IADLs?
3) What 3 questions should you ask to help answer the main question?

Answer 45

1) Ask how well the patient performs the IADLs
2) Activities which are higher level functions
3) -Can the patient perform these activities independently?
-Does the patient need help?
-Is the patient completely dependent on others for IADLs?

Question 46

Give examples of IADLs

Answer 46

1) Using the telephone
2) Shopping
3) Preparing food
4) Housekeeping
5) Laundry
6) Transportation
7) Taking medicine
8) Managing money