Divine Intervention: Elderly Care

  1. Check vision, hearing, fall risk, ur. incontinence

    • Vision like cataracts, hearing like presbyopia; vision can also lead to greater risk of falls

  2. Polypharmacy- review meds

    • Too many medications at once can result in adverse side effects that complicate the management of existing health conditions and may increase the likelihood of falls or hospitalizations.

  3. BEERS criteria: A set of guidelines outlining potentially inappropriate medications for older adults, aimed at minimizing the risks of polypharmacy and enhancing overall patient safety.

  4. Look out for Elderly abuse

    • If there are signs such as unexplained bruises, sudden changes in behavior, or withdrawal, it is crucial to investigate further and report concerns to the appropriate authorities to ensure the safety and well-being of the elderly individual.

  5. Assess functional ability- assess ADLs

    • ADLs will determine how advanced their cognitive impairment is; if they are found to be severely cognitively impaired, it may be necessary to consider alternative living arrangements or increased support services to ensure their needs are met.

  6. Basic and instrumental ADLs (things that you need to live independently vs things that you need to interact w/ society)

  7. MMSE to evaluate cognitive functioning ( abN <24)

  8. Mini-Cog--> tell pt a series of words then draw a clock then recall the words

  9. Check TSH, B12, meds, S. Na, BNP if they have cognitive dysfunction

    • These are all reversible causes, so they should be checked first

  10. MCC of hearing loss in elderly → presbycusis (high freq hearing loss first)

  11. Best screening test to determine hearing loss-> take history then whispered voice test then audiometry

  12. Access for Presbyopia, macular degeneration, cataracts

    • Vision screening is very important for fall prevention

  13. Rule out depression in the elderly esp in CKD, stroke, CAD pts; older pts have a greater risk of suicide than younger

  14. We don’t always use SIGECAPS for elderly; instead ask have you felt depressed/sad/low and ask have you lost interest in the past 2 wks?

  15. SSRI is D.O.C. do NOT pick TCA (coz of S/E profile)

  16. Fall risk assessment→ ask for h/o problems w/ gait or balance, do a get up and go test (normal is 10-11sec, abN is >20 sec)

  17. Interventions that dec fall risk-> exercise, physiotherapy, Vit D supplementation

  18. Urge incont./ overactive bladder (hypertonic detrusor)-> bladder training is the best Tx, biofeedback, oxybutynin, tolterodine (best avoided in elderly)

  19. Elderly women, G6P6 (multiple deliveries)-> Keigel’s exercise, sling procedure

  20. Overflow incont. (hypotonic detrusor)-> self catheterization, timed voiding

  21. Functional incont. (cognitive problems or arthritis where they can’t move fast enough)--> need caregiver

  22. Living will aka Advanced Directive is a legal document that allows individuals to outline their preferences for medical treatment and care in the event they become unable to communicate their wishes.

  23. Health care proxy (DPOA): A designated person who has the authority to make medical decisions on behalf of an individual if they are unable to do so themselves.

  24. POLST forms--> a health care provider has to be present when pt is signing this

  25. Palliative care < 6 mos prognosis--> initiate Hospice care

  26. Elderly pt driving h/o mild dementia or is taking benzo, TCA or h/o vision problems or h/o falls, ambulation issues, degenerative dz who can have trouble moving neck side to side-> report to DMV

  27. Pressure ulcer--> old pt, sensory issues, chrn illness, stool or ur incontinence, vascular dz all RF for developing Pressure/ Decubitus Ulcer. To prevent it, reduce pressure points by using air beds, reduce friction, reduce shearing forces; 4 stages: stage 1- erythema on skin, non blanchable; stage 2- lose partial thickness of skin epi and dermis; stage 3- subcut tissue is exposed but no involvement of fascia/bone/musc/tendon; stage 4 – involvement of fascia, muscle, tendon or bone; give them as much nutrition as possible, consider debridement for stage 3 and 4 ulcer, apply occlusive dressings

  28. Surrogate decision maker--> use next of kin (spouse then adult children then parents then siblings then other relatives)