Geriatrics Exam 1

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What changes in the circulatory system make the heart work harder?

Blood vessels becoming narrow and less elastic

The max heart rate decreases from 195 bpm to what?

155 bpm

With vision, what is markedly reduced after age 40-50?

Les accommodation

Hearing acuity declines beginning at what age?

12

The decline in hearing is steepest with what type of pitches?

High pitches

The number of taste buds is reduced by what %?

70%

Weight decreases by how much?

7%

What functions in the digestive system are reduced?

Peristalsis and liver function

Why is there decreased circulation to the kidneys?

Perfusion decreases by 50%

What decline at 10 mL per decade?

Creatinine clearance

With the endocrine system, what is impaired and declines at 10 mg/dl per decade?

Postprandial glucose tolerance

There is a decrease in the production of what in the endocrine system?

DHEA

When does clinically significant impairment occur?

When demand exceeds function reserve

There is an insidious reduction in stamina that occurs beginning when?

In the 20s

What is it called when the reductions in stamina and fatigue are so great that they become the defining feature in one's physiologic status?

"Frailty"

T/F: As soon as an older person can get up, they should, as soon as they can walk, they should.

True. Studies show immobility is bad for older persons.

T/F: Without bonds, older persons are at high risk for isolation, depression, and institutionalization.

True

What can multiple multisystem deficits create?

"Geriatric syndromes"

What is the role of the PCP with geriatrics?

Identify functional deficits that adversely affect the pt.'s prognosis and quality of life

Dressing, bathing, eating, changing positions, going to the toilet are examples of what?

Activities of Daily Living

A person will quality for a nursing home if they are dependent in at least _______ ADLs

2

What are tasks that are required to maintain a household but do not need to be done every day? Examples include talking on the phone and shopping.

Instrumental Activities of Daily Living

Frequently unreported symptoms like ALCOHOL USE, depression, CI, incontinence and MS problems are termed what?

"Icebergs"

What is the leading cause of death from unintentional injury in the age range of 65-74?

Motor vehicle accidents

How often should a geriatric patient have an evaluation/physical done for driving management?

Every 6 months

What are 3 common iatrogenic problems in geriatrics?

Adverse drug effects, AKI and adverse surgical outcomes

What is the most common reason for nursing home placement?

Dementia

Confusion in the elderly can also be due to what?

Undetected alcohol use

What is alcohol use defined as?

At least 1 drink in the past 30 days.

What is the most age appropriate screening test for alcohol use in the elderly?

24 item MAST-G

What is the most sensitive lab test that will be elevated in excessive alcohol drinkers?

GGT

What is safe treatment that is effective in preventing relapse and reducing alcohol cravings in the elderly?

Naltrexone

What is the duty to respect a patient's right to self-determination and right to be provided with sufficiently adequate and truthful information to exercise self-determination?

Autonomy

The clinician's responsibility " to do good" is called what?

Beneficence

What is the duty to treat patients fairly?

Justice

What refers to the ability to choose a lifestyle consistent with one's own values, beliefs, and habits?

Authenticity

T/F: The presence of dementia does not, by itself, indicate that the patient lacks "decision-making capacity."

True

These are verbal or written directions provided by an individual outlining what medical decisions are to be made on that individual's behalf when that person no longer possesses decisional capacity:

Advanced directives

What is a written statement of preferences for care when decision- making capacity is lost?

Living will

What requires healthcare organizations ask pts whether they possess advance directives, to provide written information regarding individual's rights and educate staff and community about advanced directives?

Federal Patient Self-Determination Act

What summarizes the patient's wishes for life-sustaining treatment and combines preferences that may have been expressed separately on a DNR form, living will, health care proxy, or other advance directives?

Physician Order for Life Sustaining Treatment

What is it called when a proposed treatment is unlikely to provide benefit or is clearly pointless?

Futility

What is the principle that says it is morally allowable to perform an act that has at least 2 effects, one good and one bad?

Double Effect

What are the 4 domains of the geriatric assessment?

Mental, physical, Functional and Social/economic

When should the patient's document be updated with a reconciled med list?

Each and every visit

What should you have a patient ALWAYS bring to a vist?

Medications, including OTC meds

What is the ability to perform tasks necessary to participate in daily life?

Functional status

What test should be used to observe a geriatric patient's balance?

Modified Romberg test

Loss of smell may be an early sign of what disease?

Alzheimer's

What is critical for successful patient management outside the office setting?

Education

How long after an initial visit should a follow up visit be done?

4-6 weeks

What should be reviewed at every visit?

Medications and functional status

T/F: Geriatrics have similar smoking quit rates as younger adults, but are less likely to receive counseling cessation!

True

If the person is a fall risk, how many days/week should they do exercise that improves/maintains balance?

3

What suggests poor nutrition?

Low BMI (< 20) or unintentional weight loss of > or = to 10 lbs in 10 months

What is the most effective prevention of stroke caused by Afib?

Warfarin

What should be done for all women beginning at age 65?

Bone Density Screen (DEXA)

How much calcium per day should geriatric patients take in?

1200-1500 mg

How much sunlight exposure should patients > 70 have per day?

600-1000 IU

USPSTF recommends screening mammography every ____________ for women 50-74

2 years

What often causes conductive hearing loss?

Cerumen Impaction

What is the most common cause of age related hearing loss that has a hallmark of bilateral, symmetric, high-frequency hearing loss?

Presbycusis

What age range does the USPSTF recommend screening for colon cancer?

50-75

The American Cancer Society recommends screening for colon cancer beginning at what age?

45

There is no screening for colon cancer past what age?

86

The USPSTF recommends against screening past what age for cervical cancer if patients have adequate prior screening and are not otherwise high risk?

65

No more than how much calcium at one time optimizes absorption?

500mg

What drugs can prevent first events of nonfatal MI in patients with HTN and should be started on lower dose due to changes that increase risk of low CO and bradycardia?

Beta blockers

Which types of beta blockers can cause hypoglycemia and are contraindicated in asthma and COPD due to bronchoconstriction?

Nonselective beta blockers like Propranolol