LECOM Geriatrics

Currently what is the ratio of greater than 65 to the US population?

1:8 / 12.4%

What is age group trend of aging?

Older populations(ie 85+ are growing fater than ever)

What is the difference in living situations between men and women over 65?

Women are much more likely to live alone(men die early)

What is the disparity of healthcare consumption by the elderly?

13% of population, half of hospital days, physian hours

What is the average medical status of a 75 year old?

3 chronic medical conditons, 25% are 'disabled'

What is the effect of chronic disease on healthcare consumption?

Consume 70% of hospital stays and 60% of costs

What are the professions most affected by impending geriatic specialist shortages?

Geriatricians and Geri Physchiatrists

What benefits does Medicare A pay for?

Hosptials, SNF, home-care, Hospice

how do you qualify for Medicare A?

Work and apy Mcare tax for 10years or work and pay prorated fee

What benefits does Medicare B pay for?

PEOPLE (docs, NP, OT, Social Worker, psychologist, EMS, Lab and imagin, Durable medical equiptment)

How do you qualify for medicare B?

Be entitles to part A, pay $78 per month

What is the pathology of muscle rigidity in the elderly?

Dcreased dopamine decretion in BG, increased reaction time.

What is the pathology of sleep disturbances?

Decreased melatonin decretion

When is 30% of muscluature lost?

3rd to 8th Generation

What increases with GI tract with aging?

Nothing, everything is less better

What is vascular pathology is associated with isolated systolic hypertension?

atherosclerosis

What is the benefit of aerobic exercise?

Increases effeciency of aerobic enzymes

What is the difference between ADLS and IADLS?

IADLS are at the college level

What is aging?

Accumulation of physical psychologic and social changes over time

What is senescence?

a decrease in cell division growth and function over time

Differentiate young, middle and oldest old

65-76-84-85+

What is the Selectivity Social Theory of aging?

There is both disengagement and activity theory simultaneously

What is the hayflick limit?

Number of times a population of cells will divide before it stops (dependent on # of cell divisions)

What is a major consequense of immuno system theory aging?

Decreased immune mediated tumor suppresion

What is the mutation of the Werner's Syndrome?

WRN mutation (helicase)

Normal elderly temp range oral then rectal?

96.4-98.2 / R 98.2-98.9

Elderly criterion for fever?

Oral>100, rectal> 99, Persistantly above 99, 2* overbaseline

what is common presentation of ischemia?

Dyspnea (increased EDP causes LV failure

What are the autonomic changes?

decreased beta no change alpha

Why to elderly trend hypohydrated?

Decreased thirst, decreased ADH response, Decreased urine concentration, decreased ANP response

What is the acid base abnormality seen with hypohydrated eldery?

Metabolic Alkalosis

Percent of Gram negative and Gram Positive causing sepsis?

(-)65% (+)25%

What is the greatest effector of M&M in speptic elderly patients?

Antibiotics with in 24hrs

What is the geriatric persentation of AMI?

Tachycardia with CHF , less CP, STEMI, LBBB Enzyme elevation

What is the geriatric presentation of hyperthyroidism?

Fine tremor, moist/smooth skin, (bowel changes. Opthalmopy

What maybe an atypical presentation of hyperthyroidism?

Sudden abatement of chronic sonstipation, anorexia, weightloss, masting muscles, depression, new or worsening cardivascular symptoms

What symptoms are associated with depression?

Female, Isolation, insomnia, poor, illness

What is anhedonia?

Inability to experience pleasure

What is the last option to medicate for depression?

Tricyclic Antidepressents

What are the order of medication classes for depression?

1.) SSRI (citalopram) 2.) SNRI (especially for chronic pain patients-(Cymbalta/Effexor)

Name the most common interactino prone medications?

Warfarin, Aceinhibitors, Dig, Theophylline

What does warfarin interfere with?

NSAIDS, Sulfas, Macrolides, Quinolones, dilantin

what does Aceinhibitors interact with?

K+ supplements, Spironoloactone

what does digoxin interact with?

Amiodarone and Verapamil

What does throphyline interact with ?

Quinolones

What is the most significan change that will influence drug dosing?

Renal clearance (liver not important unless bonafide liver disease)

Which pharmacokinetic parameter should guide medication selection?

Half life(longer is worse)

Name long half life meds to specifical avoid

(diazepam, flurazepam, chlordiazepoxide, Fluoxetine)

Order of meds for OA?

1. Tylenol 2. NSAID

Order of antiplatlets for stroke?

1. ASA 2. Plavix

What is monitored with Statins?

LFTs, CK, muscle strength

What is the max Tylenol dose?

2-4g/day

What is the risk of a Sulfonylurea(Glipizide/Glyburide)?

Hypoglycemia

What is the risk of Metformin?

Lactic Acidosis

What is the risk of Thiazolidinediones (Rosiglitazone)?

Fluid retention/CHF

What are the highlighted risk factors for osteoporotic fracture?

Smoking, Lifelon Low Calcium Intake, Sedentary Lifestyle, ETOH use

Basic screening ages for no risk osteoporosis?

Women 65+, Men 70+

What type of DEXA is for diagnosis?

Central (hip)

What is the DEXA definition for osteopenia vs osteoporosis?

-1 to-2.5--> osteopenia, -2.5-->osteoporosis

What is the RDA of Ca++ for age51+

1000 males, 1200 females

What is the RDA of Vit D for >70?

600IU

what is the RDA of VIT D for <70

800IU

What is recommended serum D3 level?

50nmol/L

Indications Pharm therapy for Osteoporosis?

Dexa >-2.5, Hx of Fx, Post menopausal women older and high Fx probablily

How long is PTH (Forteo) used for ?

no more than 2 years (only for severe osteoporosis)

Oder of therapys for Osteoporosis?

1.Bisphosphonates(actonel/Fosamax), 2. IV Reclast(reloxifene) 3. Boniva

What is Polypharmacy?

Use of more than 5 medications or a med with no indication or duplication of a meds

What are riskfactors for not medication adherence?

Poor literacy and short term memory

What is a pharmacologic error of omission?

Underuse or appropriate medication

What are are errors of comission?

Inappropriate drug use

What the prescribing cascade?

Misattribution of an adverse event to a medical problem and leading to inappropriate use of second drug

What is a multidisciplinary approach?

uses skills from different disciplines and each member approaches from their perspective

What is intradisciplinary approach?

uses skills from different disciplines and team members collaborate and are interdependent

What is transdiciplinary approach?

Members share knowlede, skills and responsibilities across traditional boudnaries , requires confidence in one another

What is a parameter not routinely measured that must be considered with geriatric populations?

Functional outcome before(2 weeks,) during and afterhospital stay

What are the hazards of bed rest?

deconditioning, constipation, pneumonia

Why must geriatric syndromes beconsidered in addition to systems review?

Syndrome encompass many multiple systems

What is the goal of a GEM unit?

improves ADLs physical performace, quality of life

What is the goal of a HELP program?

Prevent dilerium (manages 6 factros, cognitive impairment, sleep deprication, immobility, visual impairment, hearing imparment, dehydration

What is the goal of an ACE program?

achieve independence in ADLs (environment promotes oietnation, patient centered nurse initiated protocols, early social worker interventia, medical care review to promote optimal prescribing

What can ameliorate delirium?

Avoid certain medicines, treat infections.fever, detect metabolic abnormalities, avoid excessive bed rest

What is the cause of falls in the elderly?

Complex interactions between many factors, often not a single cause

What is a good gait test?

Get up and Go test

What is a lab work up for a fall victim?

CBC, CMP, B12, TSH, INR, EKG, Drug Levels (PRN Holter, Echo, Imaging studies, EEG, Vestibualr testing)

Medds that promote falls?

Benzos, Sedative,s antidepressants, hypoglycemics

H2O intake to prevent postural hypotension?

.5c water ever 30 min for first 8 hrs of day

Write out what I hate falling stands for?

Inflamation of joints, hypotension, auditory/visual abnormalities, Tremor, Quilibrium, foot Problem, Arrhythmia, leg length, lack of conditioning, illness, nutrilion, gait dysfuntion

Dementia

Memory impairment and a cognitive domain

Diffuse Lewy body dementia

parkinsonism, visual hallucinations, fluctuating cognitive impairment

What is a limitation of Mini Mental Status Exam?

Frontal Dementias are missed

What is the mainstay of pharmacotherapy for Alzheimers?

Donepezil (w/ parkisons-->Exelon

What is the mainstay of pharmacotherapy for dementia?

Namenda

What is delirium?

daily flucation in consciousness where symptoms are not accounted for by changes in physiologic status or preexisting dementia

What is the A test?

Read a list of 60 letter to Patient, they indicate you sayin g 'A'. If they miss more than 2, its abnormal

Transketolase deficiency would make one prone to what?

Thiamine deficiency/Wernicke

What is frailty?

syndrom of decreased reserves in multiple systems

What is characteristic of patient with frailty?

Weakness, weight loss, lower exercise tolerance, slow performance of any task

What is comorbidity?

Diagnosis of 2 or more medically diagnosed disease in the same individual

What associated with frailty in the inflammatory process ?

Higher WBC counts and IL-6

How long must a patient be experiencing major syptoms to be diagnosed with a major depressive episode?

2 Weeks