[01.06] CMD - Approach to the Elderly Patient V2.pdf

16.5%

What is the projected percentage of the senior population in the Philippines by 2050?

Infections

What is the leading cause of morbidity among the elderly population?

31.4%

According to the DSWD, what percentage of older people in 2000 were living in poverty?

39.8%

What percentage of older people in the Philippines receive an old-age pension?

RA 344

Which law ensures that public buildings and facilities are accessible to persons with disability, including older persons?

RA 7876

Which law mandates the establishment of a Senior Citizens Center in every city and municipality?

RA 8425

Which law provides a mechanism for older persons to participate in policy formulation through the National Anti-Poverty Commission?

RA 10155

Which act mandates government agencies to allocate 1% of their budget for programs for older persons and PWDs?

RA 9994

What is the law known as the Expanded Senior Citizens Act of 2010?

Elderly Filipino Week

What is observed during the first week of October every year according to Presidential Proclamation No. 470?

Executive Order No. 105

Which policy directed the implementation of group homes and foster homes for neglected or abandoned older persons?

Geriatrics

What term refers to the medical care specifically for older adults?

Gerontology

What is the study of aging, including its biologic, sociologic, and psychological changes?

70 to 80

At what age range do most people begin to require specific geriatrics expertise in their care?

Performance of function

While traditional medical evaluation focuses on disease, what is the primary focus of a Comprehensive Geriatric Assessment?

Multidisciplinary

What type of team approach is best for administering a CGA?

Physical, Functional, Psychological, and Social

What are the four main dimensions covered in a CGA?

Screening or targeting appropriate patients

What is the first step in the three-step process of CGA?

High-risk, frail, or chronically ill

Which specific groups of older patients benefit most from a CGA?

Main problem, HPI, PMH, and Family/Social history

What are the components of the "augmented history" in a CGA?

Atypical manifestations

Why can diagnosing an older person be difficult compared to younger adults?

Polypharmacy

What term describes the use of multiple medications, often more than clinically indicated?

Personal hygiene

Observation of what factor during the physical exam can provide clues about mental status and self-care ability?

Fatigue

Why might the physical examination of an older patient need to be spread across multiple sessions?

Typical day

Asking the patient about what specific topic is useful during the first meeting to elicit info on QOL and function?

Weber Test

Which hearing test evaluates both sensorineural and conductive hearing loss?

Rinne Test

Which hearing test evaluates only conductive hearing loss?

6 cm

In the Whisper Voice Test, how far away from the patient's ear should the examiner whisper?

50%

What is the passing score for repeating whispered words in the Whisper Voice Test?

Presbyopia

What condition involves the lens becoming less elastic and less able to focus on close objects during aging?

Snellen Chart

What is considered the gold standard for testing visual acuity?

Jaeger Chart

Which chart is used to test near vision and is held 14 inches away from the eyes?

20/40 line

Decreased visual acuity is defined as the inability to read which line on the Jaeger chart?

Arcus senilis

What term describes the common finding of whitening at the limbus in older adults?

Enophthalmos

What is the term for the gradual sinking of the eye backward into the orbit due to loss of orbital fat?

Arteriovenous nicking and cotton-wool spots

What are two common fundoscopic findings in hypertensive retinopathy?

Serum albumin

What is the most studied biochemical marker for predicting mortality and morbidity in the elderly?

BMI less than 18

What BMI value indicates undernutrition and predicts future mortality in the elderly?

10 pounds in 6 months

What specific amount of unintentional weight loss is considered an indicator of malnutrition?

MNA-SF

Which nutritional screening tool is considered the most validated and effective for use with the elderly?

0 to 7

A score in what range on the Mini Nutritional Assessment signifies malnutrition?

12 to 14

A score in what range on the MNA indicates a well-nourished status?

Incontinence

What condition is often a key deciding factor for placing an older person in a nursing home?

Functional status

What term refers to the ability to perform activities necessary or desirable in daily life?

Quality of life

For the older person, functional independence is often equated with what?

KATZ ADL and Lawton IADL

What are the two primary instruments used for assessing functional ability?

Eating, Dressing, Bathing, Transferring, Toileting, Continence

What are the six self-care activities assessed by the KATZ ADL scale?

12-hour caregiver support

Dependence on at least 2 tasks in ADL/IADL signifies the need for how much caregiver support?

24-hour caregiver support

Dependence on at least 4 tasks in ADL/IADL signifies the need for how much caregiver support?

Lawton IADL

Which scale assesses more complex activities like managing finances, using the phone, and doing laundry?

Falls

What is the leading cause of hospitalization and injury-related death in persons 75 years and older?

Intrinsic

Age-related factors, musculoskeletal issues, and neurologic factors are examples of what kind of fall risk factor?

Extrinsic

Clutter, poor lighting, and improper use of assistive devices are examples of what kind of fall risk factor?

Timed Get Up and Go Test

Which test requires a patient to arise from a chair, walk 3 meters, turn, and sit back down?

Less than 16 seconds

A patient should complete the Timed Get Up and Go Test in how many seconds to be considered at low risk for falling?

Frailty

What term describes a state of increased vulnerability to poor health outcomes, often screened using the FRAIL scale?

3 or greater

On the FRAIL scale, what total score indicates that a patient is frail?

Sarcopenia

What is the progressive and generalized loss of skeletal muscle mass and strength?

SARC-F

Which questionnaire screens for sarcopenia based on strength, walking assistance, rising from a chair, climbing stairs, and falls?

4 or more

What score on the SARC-F indicates the presence of sarcopenia?

DEXA Scan

What is the most common method for diagnosing osteoporosis?

T-score of -2.5 or below

What T-score on a DEXA scan indicates osteoporosis?

5% to 10%

What is the estimated prevalence of depression in individuals over age 65?

Anhedonia

What is the term for having little interest or pleasure in activities that were previously enjoyed?

Geriatric Depression Scale

Which 15-item self-report measure is validated for older adults with no or mild cognitive impairment?

Suicidality

What critical mental health concern is NOT assessed by the Geriatric Depression Scale?

12 to 15

A score in what range on the GDS indicates severe depression?

Forgetfulness in the last 12 months

What simple screening question for cognitive dysfunction asks about the impact on daily life?

Delirium

What memory disorder is characterized by a rapid onset over days or weeks?

Folstein Mini Mental State Exam

What is the most widely used assessment tool for cognitive status?

MMSE-P

What is the locally validated version of the MMSE used in the Philippines?

3 points per year

MMSE scores typically decline by how many points annually in individuals with Alzheimer's?

10 to 18

What MMSE score range indicates moderate cognitive impairment?

Mini-Cog

What 3-minute screening tool combines word recall with a clock-drawing test?

5 points

What is the maximum total score possible on the Mini-Cog?

Less than 3

What cut-off score on the Mini-Cog is traditionally validated for dementia screening?

Private homes, assisted living, and skilled nursing

What are the three basic types of housing arrangements for older persons?

Social worker or nurse

Which members of the multidisciplinary team often evaluate social and environmental safety?

Home visits

What method of assessment is best for identifying "clinic factors" that could lead to erroneous results?

Informal

What term describes a family member who provides uncompensated care to an older relative?

Financial circumstances

Which dimension of social assessment directly impacts a patient's ability to comply with medical advice?

Personalized Care

What concept involves the older person, their carer, and the healthcare provider working as equals?

Social and psychological needs

Besides medical treatment, what two other types of needs must be addressed in "Care and Support"?

Prepare, Discuss, Document, Review

What are the four key steps in developing an effective care plan?

Goal setting

What process is central to maintaining and improving an older person's health rather than just preparing for decline?

Medical paradigm

Traditionally, goal setting focused on cure, stabilization, monitoring, and maintenance, known as what?

Patient's personal targets

In modern geriatric care, effective care plans require goals based on what?

Periodical health examinations

What is essential to maintain physical well-being and includes appropriate immunizations?

Community-based

The Philippine Plan of Action for Senior Citizens gives priority to what type of care approaches?

Active aging

What concept emphasizes preventive and promotive aspects of health within communities for seniors?

Financial security and independence

Promoting self-sufficiency and self-reliance in senior citizens is a goal for what domain?

Loss of orbital fat

What age-related change causes the appearance of sinking eyes?

Whitening at the limbus

What is the visual description of Arcus senilis?

Handheld Jaeger card

Which vision test is performed at a distance of 14 inches?

Wall-mounted Snellen chart

Which vision test is considered the gold standard for visual acuity?

Optic nerve degeneration and macular degeneration

Fundoscopy is used to detect which two specific eye conditions?

Arteriovenous nicking

What is a common fundoscopic finding in an elderly patient with long-term hypertension?

Hypocholesterolemia

What lab finding, when combined with low albumin, is associated with increased mortality in the elderly?

Muscle wasting

A decreased mid-arm or calf circumference is an indicator of what condition?

12-hour caregiver

A patient who cannot manage their own medications or do laundry but can bathe and eat likely needs what level of support?