PCCR Exam 3 - geriatrics

What are the approaches to initiating the clinical encounter for older adults?

Takes time

Modify clinical environment

Atypical presentation of disease

Dig deep

Functional decline

High stakes

Comprehensive geriatric exam

why does it take time when initiating the clinical encounter for older adults?

pts are complex, stamina low

why do you need to modify the clinical environment when initiating the clinical encounter for older adults?

high prevalence of sensory deficits

why is the atypical presentation of disease when initiating the clinical encounter for older adults?

physiologic changes of aging, often muted presentation

why do you need to dig deep when initiating the clinical encounter for older adults?

pts may underreport out of fear or misinformation

why is functional decline important to consider when initiating the clinical encounter for older adults?

it may be the first or only manifestation of systemic illness

what are the high stakes when initiating the clinical encounter for older adults?

risk for decreased QOL, functional independence and increased morbidity and mortality

when should you consider the comprehensive geriatric exam when initiating the clinical encounter for older adults?

very frail pts

what screening adjustments need to be made when eliciting a hx/pe on a geriatric pt?

psychological issues like mood and memory and polypharmacy

what do you need to obtain on a hx/pe for a geriatric pt?

full psychosocial hx and extensive ROS for disorders and common issues

what do you need to assess for a geriatric pt?

functional status such as ADLs and iADLs and hx of falls

what do you need to recognize for a geriatric pt?

Pt as primary source

Interview pt alone

Impact of multi-morbidity

Ask about concerns

what do you need to consider for a geriatric pt?

Possible geriatric syndromes

Evaluate for frailty

what adjustments do you need to make for family hx for a geriatric pt?

Disorders may manifest solely on functional decline

what is geriatric syndrome?

Multifactorial conditions occurring from accumulated impairments in multiple systems and develop when compensatory mechanism are compromised

what is the significance of geriatric syndromes?

Clearly associated with frailty and increased mortality, important to recognize in primary care setting; poorly defined, highly heterogeneous

what are the significant geriatric syndromes?

Falls, urinary incontinence, frailty, cognitive impairments, delirium, dementia, falls, pressure ulcers, urinary incontinence, insomnia

how do you screen geriatric for activities of daily living?

Katz scale;

6 = full function

4 = moderate impairment

<2 = functional impairment

how do you screen for the instrumental activities of daily living?

lawton scale;

8 responses

what are some problems that may arise from meds that geriatrics take?

Falls, fractures, bleeding/hematomes, accidents, polypharmacy, drug interactions, ADRs, quality of life concerns

screening tool for geriatrics who take tobacco and drugs?

CAGE and short michigan alcoholism screening test - geriatrics (SMAST-G)what

what are the risk factors for under-nutrition?

Consumption of <2 meals/day

Urinary incontinence

Vision impairment/arthritis/immobility

Decreased taste/smell

Xerostomia/dental problems

what is the fried frailty tool?

Screens for:

Unintentional weight loss

Exhaustion

Low physical activity

Slow walking speed

Weakness

what is the screening schedule for older adults?

asked at least annually if they have fallen

what is the screening schedule for frail older adults?

asked each visit if they have fallen

what immunizations should geriatrics receive?

Covid 19

Influenza

Pneumococcal

Shingles

RSV

how do you test gait speed in a geriatric pt?

pt timed while walking a 4 meter walkway

>13 seconds = increased risk for recurrent falls

how do you test muscle strength in a geriatric pt?

assess quadricep strength by observing pt rising from a hard, armless chair

how do you test for both muscle strength and gait in a geriatric pt?

Patient rises from a standard armchair, walks 3 metes, turns, walks back, and sits down again

what cancers should a geriatric pt be screen for?

Breast, cervical, colon, prostate, and lung

what are the 3 D's for a geriatric pt?

delirium, dementia, depression

What is delirium?

medical emergency by acute and fluctuating states of confusion lasting days or months

what are some delirium etiologies?

drugs, dementia, infection, sleep deprivation, low O2 sats

what are the methods of promoting household safety and avoidance of falls for geriatric pts?

Falls screening

Floors = nonskid rugs, clear path

Stairs = fix loose/uneven steps, install handrails

Bedrooms = lamps easy to reach, plug in night lights, install phone on the floor for emergencies

Kitchen = easy to reach, NEVER use step stool

Bathroom = bars

how to screen for balance and mobility?

TUG: sit to stand, turning, cognitive component

<10 sec = normal

>14 seconds = high risk for falls

what is the utility of frailty assessment used for?

Predicts survival of community dwellers

Predicts survival, length of stay and discharge location in acute care settings

Can help contextualize with pts and families

what is the balducci method?

Determines who's at risk for frailty;

Medical comorbidites = 0 fit, 1/2 vulnerable, 3 frail

Functional status = independent ADL/iADL (fit), independent iADL (vulnerable), dependent ADL (frail)

Geriatric syndromes or >80

what is the intervention for polypharmacy?

BEERs list

what are the high risk medications for geriatrics?

aspirin, warfarin, oral hypoglycemic agents, insulin, digoxin

what are the stressors in regards to nutritional hx?

Special diets

Dietary fiber and vitamins

Food accessibility

What are ADLs?

bathing, dressing, toileting, transferring, continence, feeding

what are iADLs?

telephone, shopping, housework, laundry, cooking, medication, finances

what is frailty?

a multidimensional syndrome characterized by increased vulnerability to various stressors

what is a concerning finding when screening for weight loss with the fried frailty tool?

>5% body weight in last year

what is a concerning finding when screening for exhaustion with the fried frailty tool?

positive response

what is a concerning finding when screening for weakness with the fried frailty tool?

decreased grip strength

what is a concerning finding when screening for slow walking speed with the fried frailty tool?

>7 seconds to walk 15 feet

which vaccines are given annually?

covid19 and influenza

which vaccines are a single dose?

pneumococcal

which vaccines are a 2 dose series?

shingles