36. Elderly

Question 1

In the elderly patient taking multiple medications, avoid polypharmacy by doing what ? (3)

Answer 1

• monitoring side effects.
• periodically reviewing medication (e.g., is the medication still indicated, is the dosage appropriate).
• monitoring for interactions.

Question 3

Describe : Comprehensive Geriatric Assessment (5)

Answer 3

• Medical
• Psychological
• Function
• Polypharmacy - Meds
• Social and Environmental

Question 4

Name elements in MEDICAL geriatric assessment (7)

Answer 4

• Immunizations (influenza, tetanus/diphteheria, pneumococal, herpes zoster)
• Habits (smoking, alcohol, substance, sexual)
• Nutrition (diet, appetite, weight loss, dentition,m swallowing)
• Bowel and Bladder (incontinence, constipation, diarrhea)
• Communication (vision, hearing)
• Pain
• Cancer screening

Question 5

Name elements in PSYCHOSOCIAL geriatric assessment (3)

Answer 5

• Cognition: MCI vs dementia vs. Delirium– MMSE / MOCA
• Mood – Depression (MSIGECAPS) – PHQ-9 or geriatric depression scale
• Elder mistreatment/abuse (ELDER ABUSE SUSPICION INDEX © (EASI))

Question 6

Describe SMART approach for Behavioural and Psychological Symptoms of Dementia

Answer 6

• Safety – remove patient to safe environment
• Medical – perform an organic workup to treat reversible causes; reduce medication load
• Assess competency – decisions regarding personal care, finances, driving; protect assets
• Rest, nutrition, hydration ensured; address problems with pain, ambulation, vision, hearing, constipation
• Trial of medication – cholinesterase inhibitor/antipsychotic/antidepressant/ mood stabilizer

Question 7

Name elements in FUNCTION geriatric assessment (5)

Answer 7

• AVD-AVQ
• Fall risk (postural hypotension, vertigo), Vision, Hearing
• Physical activity
• Mobility
• Driving

Question 8

What to consider in meds in geriatric (4)

Answer 8

• Non-prescription medication (herbal, OTC, vitamins)
• Consider efficacy/side effect profiles : Convenient dosing/route, Dispill / Blister pack
• Avoid treating side effect with another medication (medication cascade)
• Beer’s Criteria, STOPP/START criteria

Question 9

Name elements in SOCIAL AND ENVIRONMENTAL geriatric assessment (5)

Answer 9

• Social activities, hobbies, interests
• Care support, POA
• Local resources
• Managing at home (financial, legal). Anticipate need for increased services
• Advance care planning (resuscitation)

Question 11

Name MEDICAL Modifiable Risk Factors in the Elderly (9)

Answer 11

• Visual/hearing impairment
• Polypharmacy
• Dizziness or orthostasis
• Incontinence
• Diabetes
• Depression
• Cognitive impairment/Dementia
• Vaccines
• Cancer, AAA screening
• Osteoporosis (Calcium, vitamin D, BMD)

Question 12

Name MOBILITY Modifiable Risk Factors in the Elderly (5)

Answer 12

• Balance/gait impairment
• Muscle weakness
• Exercise level
• Environmental lighting
• Footwear

Question 13

Name HABITS Modifiable Risk Factors in the Elderly (2)

Answer 13

• Smoking
• ROH

Question 14

Name atypical presentations in geriatric population

Answer 14

• Lack of symptoms (eg. fever), or may present with confusion/delirium
• Commonly missed diagnoses are cancer, pulmonary embolus, coronary disease, aneurysms, appendicitis
• Depression can present with somatic complaints (cognition, functional, sleep, energy)