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Clin Med 4.5
| Question | Answer |
|---|---|
| 1/6 adults | will be 65+ by 2050 |
| 8% US population | will be 80+ by 2050 |
| 4% US population | current % of US population that's above 80 |
| Geriatric | 65+ |
| Shift practice mindset from acute care focus to | promote healthy aging |
| Goal of geriatric care | provide high-quality effective care in various settings |
| Transition of care programs | Major focus between settings of care |
| Why we need follow ups with geriatrics | to consolidate care |
| Fall | An event that results in a person coming to rest inadvertently on the ground, floor, or lower level wo loss of consciousness |
| Leading cause of death from injury in geriatrics | Complications from falls |
| Screening test for falls | Timed get up and go |
| When to do timed get up and go | fall in the last 12m, + screening |
| Over 2 falls in a year | Need multifactorial fall risk assessment |
| Falls exclude | syncope or seisures |
| Associated symptoms to ask about with a fall | Dizzy, cardiovascular, focal neurologic, volume depletion |
| Meds to worry about with falls | Ones that cause bradycardia or orthostatic hypotension, CNS active meds, and general |
| Meds that can cause bradycardia | Cholinesterase inhibitors, antiarrhythmics, BB |
| Meds that cause orthostatic hypotension | Antihypertensive, nitrates, SGLT2, Diuretics, Antipsychotics, Some antidepressants |
| CNS active meds | Benzos, Antidepressants, antipsychotics, anticonvulsants |
| General meds you are concerned about with falls | Anticholinergic, antihistamines, insulin and oral hypoglycemics, narcotics, sedative hypnotics |
| Diagnostics tests to possibly order w falls | BMP, CBC, Vit D + B12, EKG and Echo, Neuro imaging, spinal imaging, bone density |
| Incontinence | Common but not normal part of aging |
| Incontinence symptoms | Urgency, frequency, nocturia |
| Kinds of incontinence | Stress, urge, overflow, neurogen |
| Meds that may impact incontinence | Sedative/reduced mobility, urgency/frequency, sensory, sphincter tone, edema, cough, incomplete emptying, bladder irritants |
| Diagnostics of incontinence | Depression, Post void residual, bladder diary, BPH, Cystoscopy or cytology, urodynamic testing, UA, Blood glucose, calcium, renal fxn, B12 |
| Med for urge/overactive incontinence | Muscarinic receptor antagonist, B3 agonist |
| Med for overflow incontinence | Alpha blockers |
| Med for stress incontinence | Kegels and fix underlying |
| Muscarinic receptor antagonist side effects | confusion and increased fall risk |
| B3 agonist side effect | HTN, drug interactions |
| Alph blocker side effect | Orthostatic HOTN, dizzy |
| Polypharmacy | Therapeutic duplication or medical insufficiency through 5+ meds |
| Medication reconciliation | know each med and know what each med is used for |
| Meds we worry about w polypharmacy | Bezos, opioids, anticholinergic, sedatives/sleep, muscle relaxants, tricyclic antidepressants, antipsychotics |
| Insomnia | Difficulty falling or staying asleep, waking up to early, associated w daytime impairment |
| Amount of sleep needed with age | decreases w age |
| Consequences of insomnia | Lower health related quality of life, increased medication use, cognitive decline, greater health care utilization |
| Hx of pt w insomnia | Sleep log, psych, cardiopulm, GI, urologic, neuro, alcohol and caffeine use |
| Tests for insomnia | polysomnography and in-home portable sleep-monitor |
| Meds that impact sleep causing lighter, shorter/fragmented sleep | alcohol, sedatives, and cholinesterase inhibitors |
| Meds that can cause nightmares | antidepressants, anti-Parkinson, anti-HTN, cholinesterase inhibitor |
| Meds that cause nocturia | Diuretics |
| Meds that cause sedation | Antidepressants, clonidine, phenytoin, sedatives |
| Meds that keep you awake (stimulants) | Bronchodilators, caffeine, nicotine, corticosteroids, sympathomimetics, antidepressants |
| Nonpharm management for insomnia | Stimulus control, sleep restriction, cognitive intervention, relaxation, cognitive behavioral therapy, light |
| Pharm for insomnia | Smallest dosage, shortest duration |
| Short acting meds for insomnia | zolpidem, zaleplon, suvorexant |
| Geriatric syndromes | Common health conditions in older adults hat do not fit into distinct organ-based disease categories and often have multifactorial causes |
| Leading cause of death from injury | falls |
| >2 falls in the last 12 months need | multifactorial fall risk assessment |
| With falls you must exclude | syncope or seizure |
| Medications that can cause bradycardia | Cholinesterase inhibitors, antiarrhythmics, BB |
| Drugs that cause orthostatic hypotension | Antihypertensives, diuretics, Nitrates, antipsychotics, certain antidepressants, SGLT2 |
| CNS active meds | Benzodiazepines, antipsychotics, antidepressants, anticonvulsants |
| PE with a fall to figure out why they may be falling | orthostatic vitals, cognitive assessment, eye exam, cardiovascular exam |
| Diagnostic tests for falls | based on pt in front of you |
Created by:
kendallmk