Geriatrics

Question 1

Caveats in the evidence-based approach for geriatric patients

Answer 1

1. Prognosis: Screening tests that are typically effective may not be useful in individuals who may not have long enough to act on the condition before it develops, or something else happens.
2. Insufficient evidence for geriatric populations: Most of our evidence base is not for this population, and its applicability may be limited.
3. Patient goals/preferences: Patients’ goals may relate to a functional or health state, symptom control, living situation, or survival. This is on many levels a personal choice.

Question 2

In most medical visits, but especially in geriatric medical visits, the interview should always start with. . .

Answer 2

. . . an assessment of the patient’s agenda and issues, including immediate concerns and threats to quality of life.

Question 3

The longer the range of projections, ___.

Answer 3

The longer the range of projections, the less can be said with certainty about his future health and social needs.

Question 4

In geriatrics, you can gain much more information from the patient’s ___.

Answer 4

In geriatrics, you can gain much more information from the patient’s constitutional symptoms and gait.

Question 5

Value of scheduled home habitus assessments

Answer 5

Home assessment and modifications can reduce falls by 41% among individuals with visual impairment and by 44% among those at high risk for falling

Question 6

Value of vitamin D supplementation

Answer 6

Vitamin D supplementation can reduce falls by 22% and hip and nonvertebral fractures by 20% and 18%, respectively

Question 7

Five M’s of Geriatrics

Answer 7

1. Mind (maintain mental acuity and screen for depression)
2. Mobility (maintain ability to walk and balance, prevent falls)
3. Medications (reduce polypharmacy, de-prescribe unnecessary medications)
4. Multi-complexity (help manage variety of conditions, including social determinants, home conditions important)
5. Matters most (coordinating advance care, help manage goals of care, ensure values reflected in treatment)

Question 8

When to consult a geriatrics specialist

Answer 8

• Significant physical impairment or frailty develop
• Family members and friends are under significant stress as caregivers
• Caregivers have trouble following complex treatments or managing relationships with many healthcare providers for multiple health conditions.

Question 9

Functional status

Answer 9

How an older adult functions on a day to day basis. Includes:

• Basic Activities of Daily Living (ADLs): Bathing, Grooming, Dressing, Toilet use, Feeding, Transferring (bed to chair)
• Instrumental Activities of Daily Living (iADLs): Telephone use, Grocery shopping, Food preparation, Housekeeping/Laundry, Driving/Transportation, Managing Medications, Finances

Question 10

Chair Stand

Answer 10

Ask the patient to rise from a chair without using their hands. Patient who have difficulty may be at higher risk for falls. This exercise also lowers fall risk

Question 11

Gait Speed

Answer 11

How fast a patient walks may predict their risk for falls, hospitalization and even death. Less than 0.8 m/s means the patient is likely to be frail, and at higher risk for adverse outcomes.

Question 12

Orthostatic hypotension

Answer 12

A decrease in systolic BP ≥ 20 mm Hg or diastolic BP of ≥ 10 mm Hg, or lightheadedness/ dizziness when going from lying or sitting to standing. Increase risk for falls.

Question 13

Presbycusis

Answer 13

Age related hearing loss, starts with high pitched sounds. Use the Finger Rub Test and check for cerumen (wax) in the ears. Speak LOW (pitched voice), SLOW (enunciate) and face the patient.

Question 14

Minicog

Answer 14

Brief cognitive assessment: ask the patient to repeat 3 words (banana, sunrise, chair), ask the patient to draw the face of a clock, put in all numbers, and set the time at ten past 11. Then ask the patient to repeat the 3 words. If abnormal, consider a MOCA or longer cognitive test.

Question 15

Delirium

Answer 15

An acute change in mental status from baseline, resulting in confusion, inattention, and sometimes agitation (hyperactive delirium) or somnolence/sleepiness (hypoactive delirium). Common in hospitalized older patients; evaluated by the Confusion Assessment Method (CAM) which includes orientation questions and a test of attention (month of the year backwards)

Question 16

Dementia

Answer 16

A progressive neurocognitive disorder that affects memory, thinking, and eventually the whole body. Alzheimer’s dementia is the most common.

Question 17

Polypharmacy

Answer 17

5 or more medications, or any unnecessary or potentially inappropriate medications

Question 18

The AGS Beers List

Answer 18

list of medications to be used with caution or avoided in older adults

Question 19

Multimorbidity

Answer 19

3 or more chronic health conditions

Question 20

MOLST form

Answer 20

(MA Medical Orders for Life-Sustaining Treatment): an outpatient medical order for patients with advanced serious illness and limited prognosis that documents a patient’s preferences for CPR, intubation, hospital transfer, artificial nutrition, and more

Question 21

Hospice

Answer 21

an insurance benefit that provides primarily nurse-led, home-based care for patients with prognosis <6 months and their families.