everything geri (NO SMILES FOR LIFE)

2 stages of sleep

REM

NREM

what is REM sleep

dream sleep

4-5 throughout the night

what is NREM sleep

4 stages

stages 3 and 4 = delta sleep

age related changes in sleep

stage 3 and 4 (delta) decrease = increased wakefulness overnight

MC sleep complaint in older adults

insomnia

what is insomnia

difficulty falling/staying asleep

wake during the night

early morning awakening

causes of insomnia

chronic illness

meds

anxiety

depression

poor sleep hygiene

trx of insomnia (psyc)

CBT

sleep hygiene education

trx of insomnia (pharm)

lorazepam, temazepam, zolpidem, zaleplon, trazodone, melatonin

antihistamines - be careful

RF for OSA

increases with age

M > F

SS OSA

loud snoring

apnea episodes

daytime sleepiness

dx OSA

sleep study (polysom)

trx OSA

CPAP (GOLD STANDARD)

wt loss

position changes

SS restless leg syndrome

urge to move legs

worse at rest and night

relieved by movement

what is restless leg syndrome assoc w/

iron def anemia

renal dz

neuropathy

restless leg syndrome trx

iron (if iron def)

DA agonist or gabapentin

SS REM sleep behavior disorder (RBD)

acting out dreams

vocalizations

limb movements during REM sleep

what is REM sleep behavior disorder (RBD) assoc w/

Parkinson's/ neurodegen dz

trx for REM sleep behavior disorder (RBD)

clonazepam

melatonin

safety modifications in sleep enviro

SS circadian rhythm disorders

sleepiness in early evening or early morning awakening

trx for circadian rhythm disorders

light therapy in the evening

melatonin

chronotherapy

cause of malnutrition

decreased appetite

dysphagia

poor dentition

socioeconomic challenges

chronic illness

SS malnutrition

wt loss

muscle wasting

fatigue

weakness

edema

consequences of malnutrition

increased r/o falls

infx

pressure ulcers

mortality

causes of unintentional wt loss

cancer

depression

dementia

GI dz

hyperthyroidism

SS unintentional wt loss

loss of muscle mass

frail

low BMI

consequences of unintentional wt loss

reduced functional ability

poor recovery from illness

causes of Vit D def

reduced sun exposure

SS Vit D def

bone pain

muscle weakness

osteoporosis

causes of B12 def

decreased gastric acid

malabsorption

SS B12 def

anemia

neuropathy

cog decline

causes of iron def

chronic blood loss

low iron intake

SS iron def

fatigue

pallor

spoon-shaped nails

causes Ca def

decreased dietary intake of Ca

malabsorption

SS Ca def

bone fragility

muscle cramps

causes of dehydration

reduced thirst sensation

mobility limitations

cog impair

SS dehydration

dry mucous membranes

poor skin turgor

confusion

hypOTN

consequences of dehydration

electrolyte imbalance

UTI

constipation

causes of obesity

reduced physical activity

high calorie diet

metabolic slowing

SS obesity

BMI > 30

central adiposity

consequences of obesity

increased risk of DM, HTN, OA, CVD

causes of sarcopenia

decreased prtn intake

decreased physical activity

hormonal changes

SS sarcopenia

decreased muscle strength

impaired mobility

consequences of sarcopenia

increased risk of falls

frailty

management of malnutrition

high calorie/prtn diet

supplements (ensure, boost)

trx of Vit D def

Vit D supplements 800-1000/day

trx of Ca def

1200/day

trx of B12 def

PO 1000/day or IM injections

trx of iron def

iron supplements PO with Vit C (helps with absorption)

dehydration trx

increase to 1.2-2L a day (unless C/I)

what is elder abuse?

acts whereby a trusted person causes or creates a risk of harm to an older adult

types of elder abuse and the MC one?

physical

emotional

sexual

financial

neglect

abandonment

self neglect (MC)

RF for elder abuse

cog impair

physical disability/frail

social isolation

hx of fam violence

caregiver stress/burnout

substance abuse/mental health issue of caregiver

financial dependence

crowded living

financial hardship

signs of elder abuse

inconsistencies bw injuries

vague answers to questions

signs of fear around caregiver

bruises

frx or burns

poor hygiene/malnutrition

pressure ulcer

genital ulcer or bruise

depression, anxiety, withdrawal

sudden changes in mood/behavior

fear of being alone

unexplained financial transactions

sudden changes in will or power of attorney

how to address elder abuse?

ask pt

ask caregiver

what do you do if abuse is suspected?

1. tell pt you are concerned

2. document any injuries

3. document pt words

4. document if pt has decision making capacity

how to manage elder abuse

- talk to pt alone

- ensure pt safety

- trx injuries

- contact ADULT PROTECTIVE SERVICES (APS)

- document with direct quotes

- social worker, legal advisors

- hospital stay if unsafe to stay in community

what is APS

adult protective services

- hotline for adult abuse reporting

what is NCEA

national center on elderly abuse

- resources and support

what is long term care ombudsman

investigates abuse in nursing homes

what is national domestic violence hotline

supports victims of abuse

what is legal aid services

assists w/ protection orders and legal rights

what is geriatric care managers

help w/ placement and care coordination

4 dif types of dizziness?

1. vertigo

2. presyncope

3. disequilibrium

4. nonspecific

what is vertigo?

spinning sensation, often vestibular

- BPPV, Meniere's dz

what is presyncope?

feeling faint, usually CV - ortho hypOTN

what is disequilibrium?

unsteady while walking, often neuro or MSK

what is nonspecific?

vague sensations, multifactorial - anxiety, med-induced

what is the eval of dizziness like?

super thorough history and PE and labs

(its like everything you can think of tbh)

dizziness trx: arrhythmia/valve d/o

cardio referral

dizziness trx: ortho hypOTN

increase hydration

increase salt

cardio referral

dizziness trx: stroke/aneurysm/brain mass

neuro

neurosurgery

dizziness trx: BPPV

MECLIZINE

epley maneuver

ENT referral

dizziness trx: balance

PT referral (balance exercises)

dizziness trx: med-induced

review polypharm STOPP/START

dizziness trx: falls

home safety eval

educate on fall risk reduction

5 NORMAL age related changes in gait in the elderly

1. decreased speed

2. shorter strides

3. increased double support time

4. wider base of support

5. decreased arm swing

what is ANTALGIC gait?

limping

shortened stance

causes/SS ANTALGIC gait?

cause = OA, frx, peripheral neuropathy

SS = jt pain, discomfort

what is ATAXIC gait?

unsteady

wide base

irregular steps

difficulty tandem walking

causes of ATAXIC gait?

cerebellar dysfunction (stroke, tumor)

chronic alc use

what is PARKINSONIAN gait?

shuffling

small steps

causes/SS PARKINSONIAN gait?

causes = parkinson's

SS = bradykinesia, tremor

what is HEMIPLEGIC gait?

affected leg swings outward

+/- arm in flexed position

causes of HEMIPLEGIC gait?

stroke

u/l cerebral lesion

what is SPASTIC gait?

stiff

scissoring

legs crossing midline

causes/SS SPASTIC gait?

causes = UMN lesions (MS, cerebral palsy)

SS = hypertonia and hyperreflexia

what is FRONTAL gait?

slow

shuffling

difficulty to start walking (feet stuck to ground)

causes of FRONTAL gait?

normal pressure hydrocephalus

frontal lobe lesions

what is SENSORY ATAXIA gait?

unsteady

stomping with high steps (2/2 impaired proprioception)

causes/SS SENSORY ATAXIA gait?

causes = peripheral neuropathy, Vit B12 def

SS = + romberg

what is the focus of palliative care?

improving QoL for pt w/ serious, chronic or life-limiting illnesses

what is a serious illness?

a condition that has a high risk of mortality

negatively impact QoL and daily function

and/or burdensome in sxs , trxs or caregiver stress

goals of palliative care

SS manage

improve QoL

Pt and fam support

decision support

4 principles of palliative care

1. pt centered

2. interdisciplinary

3. concurrent with curative care

4. early integration

conditions that require PC

cancer

COPD

heart failure/CHF

dementia

neurodegen dz

CKD

PC trx: dyspnea

trx underlying

- if not responsive give LOW-DOSE opioid (morphine)

- O2 if hypoxic

PC trx: N/V toxin (chemo/opioids)

DA antagonist = prochloroperazine, olanzapine

5HT3 antagonist = zofran/ondansetron

NK1 R antagonist = aprepitant

PC trx: N/V (vestibular)

antichol = scopolamin patch

antihist = diphenhydramine

PC trx: N/V (gastro/bowel obstruction)

prokinetic agent = metoclopramide

complete/refractory bowel

- H2 blocker = famotidine

- ocreotide

- corticosteroids