GERIATRICS

What age is considered geriatric?

above age 65

at what age does prognosis worsen?

age 90

what is delirium?

acute disorder of attention and cognitive function; can happen at any point during an illness (sometimes the only sign) can be reversible

what is dementia?

cognitive impairment interfering w/ daily, social and occupational functioning

what is functional decline?

decreased ability to perform ADLs and IADLs

examples of ADLs?

basic tasks essential for selfcare: bathing, dressing, feed, toileting

examples of IADLs?

complex tasks necessary for independent living; managing finances, shopping, preparing meals, managing meds

what can delirium be caused by?

sepsis, medications, hypoxia

physiology of aging: random damage

accumulates over time; misfolded proteins

physiology of aging: higher order consequence of damage

mitochondrial dysfunction, loss of stem cells

physiology of aging: endogenous pathways that attempt to repair damage

restore function (recycling misfolded protein or regenerating new mitochondrial)

• can contribute to age related diseases

• releases proinflammatory factors cause more damage

what is proven to aid in healthy aging?

exercise, followed closely by nutrition

what is functional reserve?

the capacity of an organ system to increase its function in response to stress or demand beyond its baseline level; as we age that reserve decreases (extra; what you have on the side)

at what age does FEV1 decrease?

age 70

what are the biological theories?

free radical theory, somatic mutation, cross link, telomere theory

what is the free radical theory?

reactive oxygen species and free radicals cause cumulative cellular damage leading to aging

• administrations of antioxidants postpones the appearance of the disease

what is the somatic mutation theory?

dna mutations accumulate in somatic cells, impairing cellular functioning leading to aging

what is the cross link theory?

with age, dna and proteins develop inappropriate attachments or cross links with one another → decreased mobility and elasticity → these unneeded proteins molecules aren’t broken down because of the cross links → stick around and cause issues

what is telomere theory?

shortening of telomeres which limits cellular replication

what is the social theory?

disengagement, activity and continuity

disengagement theory?

mutual withdrawal between older adults and society

what is activity theory?

staying active and engaged leads to increased satisfaction and better aging outcomes

what is continuity theory?

older adults maintain their habits, preferences and lifestyles choices throughout aging → preserves their sense of identity and well being

what are the psychological theories?

scaffolding, cognitive reserve, socioemotional selectivity

scaffolding theory?

brain adopts to age-related changes by recruiting additional neural circuits to maintain cognitive function

what is cognitive reserve?

people with greater cognitive reserve, built through factors like education, occupation and engaging in mentally stimulating activity can better withstand age-related brain changes and pathology w/o being symptomatic

what is socioemotional selectivity?

as people age, they prioritize emotionally meaningful goals and relationships, leading to greater emotional well being despite cognitive and physical declines

what are the 5 geriatric syndromes?

falls, depression, poor nutrition, cognitive impairment, vision and hearing loss

what can reduce falls?

exercise intervention and a comprehensive assessment including meds, postural blood pressure, gait and vision

what are some different mental assessments?

mini cog, montreal and mini mental status exam (mmse)

when should the geriatric population get screening for hearing and vision?

eye exam every 2 years, hearing for those who need it (only screen hearing in vulnerable people in initial visit)

what are the comprehensive health assessment?

prognosis, goals, functional status (ADls/IADLs)

• for functional: physica, psych and socioeconomic

when should you screen for dementia?

you should not screen for dementia in primary care; however early detection of alzheimer’s can expose treatable contributors

what is the ‘‘timed up and go’’ test’’?

measures a person’s ability to get up from a chair, walk 3 meters, return and sit down

what is considered an abnormal result for the timed up and go test?

less than 15 seconds

screening for dementia in primary has…

not shown to improve outcomes; however detection of alzheimers disease and related disorders may help to identify potentially treatable contributors (ex: mini-cog item recall and clock drawing activity)

screening and treatment for depression?

questions about mood should be a part of every geriatric assessment; PHQ-2

Caregiver support for burnout?

The Modified Caregiver Strain Inventory

care provided in an outpatient setting?

primary care or specialty care office

PCMH:

care coordinated through PCP to provide: comprehensive care, patient centered care, coordinated care, accessible serve, commitment to quality and safety. Focuses on tea approach vs. fragmented care

GRACE

model that supports primary care doctors providing care low income elderly adults with multiple chronic conditions to improve health and functional status

PACE

benefit under medicare, provides comprehensive medical and social services to certain ‘‘frail’’ community dwelling adults; not in nursing home but eligible to be 0okk

how does the geriatric population become covered by medicare?

must be homebound and physician must think that skilled services will produce a benefit in a reasonable time (this makes a lot of dependent elders ineligible)

what is assisted living?

each resident is treated like a tenant and has control over their living unit; shared spaces (dining, community spaces) mainly privately paid for; IF medicaid covers: only the services component

who regulates nursing homes?

state and federal guidelines - no reimbursement otherwise

who are nursing homes for?

those who need help with their ADLs 24/7

what are SNFs?

skilled nursing facility; typically short stay and rehab; enrollment from centers for medicare and medicaid services

what are short term stays for nursing homes?

less than 100 days; skilled needs following hospitalization, financed by medicare part A

what are long term/permanent stays for nursing homes?

uses all services available; medical covered by medicare, medicaid or private pay for room and board

how are nursing homes used for hospice?

<6 months prognosis from terminal illness, focused on comfort, medicare part A covers medical, medicaid/private pay for room/board

medicare part A?

Hospital services insurance — available to all who qualify for social security

medicare part B?

Medical service insurance. Pt has to pay premium but subsidized by government

medicare part C?

Medicare advantage; optional; allows people to enroll in managed care plans (commercialized insurance plans like cigna, aetna, etc)

medicare part D?

medications; those who are eligible for medicaid are automatically enrolled in part D,; managed care also includes Part D; otherwise its elective

what is RAP?

resident assessment protocol; surveyors examine resident plan of care to prevent neglect, ensure geriatric syndromes are being managed appropriately and to ensure restraints aren’t being used unnecessarily; certain conditions are ‘‘triggers’’

what is ACE?

acute care for elders; explicit goal to prevent functional decline and improve quality of care

what is HELP?

hospital elder life program; goal is to prevent delirium in older adults