Advanced Geriatrics Course Quiz

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Questions and Answers

What is the primary distinction between competence and capacity in decision-making?

Both terms can be used interchangeably without differences.

Capacity is a legal term while competence is a psychological evaluation.

Competence is determined by a court, while capacity can be assessed by any licensed provider. (correct)

Competence refers to general decision-making ability, while capacity is specific to the context of the decision. (correct)

In the case of Mrs. Alcorn, which aspect primarily concerns her ability to refuse the flu vaccine?

Her functional deficits suggest she cannot understand the consequences. (correct)

Her age and dementia complicate her ability to make decisions.

Her refusal indicates she has competent decision-making ability.

The nurse has the authority to override her decision.

What does a low MMSE score indicate in a patient like Mr. Walden?

His ability to access his funds is unaffected by his mental status.

He requires immediate intervention to manage his finances.

He has full decision-making capacity regarding his financial matters.

He may be unable to comprehend crucial information needed to make informed decisions. (correct)

Under what circumstances might an advanced directive like a DNR/DNI be countermanded?

In emergency situations where healthcare providers believe intervention is necessary. Signup and view all the answers

What is a critical consideration in advanced care planning?

Prioritizing the patient's personal values and what brings them joy. Signup and view all the answers

Which component is included in the comprehensive geriatric assessment?

Evaluation of functional, cognitive, and medical baselines Signup and view all the answers

What does the Get Up and Go test assess?

Functional mobility and fall risk Signup and view all the answers

Which index is used to measure independence in activities of daily living?

Katz Index of Independence in Activities of Daily Living (ADL) Signup and view all the answers

What does the AGS 2023 BEERS Pocket Guide address?

Medications that are potentially inappropriate for older adults Signup and view all the answers

Which of the following statements best describes the living arrangements of the elderly aged 65-75?

A significant proportion live independently. Signup and view all the answers

What is a key challenge in treating geriatric patients as noted in the content?

Understanding polypharmacy implications. Signup and view all the answers

In the Comprehensive Geriatric Assessment (CGA), who typically assists with data gathering?

Medical assistants and nurses. Signup and view all the answers

Which aspect of geriatric care is emphasized as a difference from general adult medicine?

Exceptions to the rules are common in elder care. Signup and view all the answers

Which of the following questions is crucial to ask a 75-year-old male who fell and has a leg wound?

What medications do you currently take? Signup and view all the answers

Which factor is NOT highlighted as a consequence of poverty in the elderly population?

High educational attainment. Signup and view all the answers

What component is NOT part of the Comprehensive Geriatric Assessment?

Community outreach. Signup and view all the answers

What is the most prevalent cause of death from falls among older adults?

Traumatic Brain Injury Signup and view all the answers

Which demographic factor is associated with a higher risk of fatal falls?

Adults aged 85 and older Signup and view all the answers

What is the primary focus of the special needs addressed by Comprehensive Geriatric Assessment?

Individualized patient care for elderly patients. Signup and view all the answers

Which of the following is NOT a risk factor for falls?

Frequent exercise Signup and view all the answers

What percentage of fall-related injuries treated in ERs in 2013 resulted in hospitalization?

Approximately 28% Signup and view all the answers

What is the leading cause of unintentional injury-related death in New Mexico?

Falls Signup and view all the answers

Which assessment tool is commonly used to evaluate cognitive impairment?

MMSE Signup and view all the answers

Which of the following interventions is recommended for impaired gait and balance?

Tai Chi Signup and view all the answers

What condition is often a hidden cause of falls among older adults?

Malnutrition Signup and view all the answers

What does 'capacity' refer to in the context of medical decision-making?

An individual’s ability to make informed decisions Signup and view all the answers

Which physical exam component is pertinent in assessing fall risk?

Visual acuity Signup and view all the answers

What is the primary focus of visits in Geriatrics?

Function and activities of daily living Signup and view all the answers

Which assessment tool is used to evaluate depression in the elderly?

Geriatric Depression Scale (GDS) Signup and view all the answers

What is the purpose of the 'brown bag' approach in medication review?

To consolidate all medications a patient is taking Signup and view all the answers

Which of the following is NOT an Instrumental Activity of Daily Living (IADL)?

Feeding Signup and view all the answers

What is a crucial factor in determining the need for additional evaluations in geriatric care?

Past medical history and data collection Signup and view all the answers

Which screening tool would NOT typically be used to evaluate falls in elderly patients?

PHQ-9 Signup and view all the answers

What major issue contributes significantly to Medicare costs among the elderly?

Falls and related injuries Signup and view all the answers

Which of the following is considered a geriatric syndrome?

Sleep disorders Signup and view all the answers

What aspect is NOT typically included in the monitoring phase after treatment plan implementation?

Assessing financial stability Signup and view all the answers

Which vital sign is commonly emphasized in the assessment of elderly patients?

Blood pressure Signup and view all the answers

Study Notes

Adult and Geriatric Medicine - AGM 1

The course aims to apply evidence-based medical knowledge to improve skills in caring for adults and elderly patients.
Key requirements for the course include learning objectives from the syllabus, completing weekly readings and assignments, and participating in class discussions. Students are expected to take weekly notes for studying.
Weekly formative quizzes on LEARN (no points) and two summative assessments (100% of grade) are part of the evaluation.
Readings for Module 1 include content on geriatric assessment, Medicare 101, CDC STEDI guidelines, Katz index, Lawton IADL, AGS 2023 BEERS pocket guide, and adult preventive healthcare schedule

Course Rationale

Aging is a fundamental fact and will affect healthcare providers' professional lives.
Elderly patients often require unique healthcare considerations; age can correlate with multiple comorbidities, unique medications, and special conditions.

Module 1 - Comprehensive Geriatric Assessment

The course covers the core components of comprehensive geriatric assessment (CGA).
Knowing and describing a patient’s functional, cognitive, and medical baseline is important; methods to assess these aspects are presented.
The evaluation of risk factors and the administration and interpretation of the Get Up and Go test are included in CGA.
Strategies for improving safety and reducing fall risk are explored.
Competency vs. capacity in medical care is contrasted.
Patient care involves interprofessional collaboration, which involves roles and resources available in New Mexico.
Common cancer symptoms in primary care and the USPSTF guidelines for cancer screening in older adults are discussed.

Defining "Elderly"

The World Health Organization (WHO) defines geriatric populations with different age brackets: elderly (65-75), old (76-90), and very old (90+).

Rural New Mexico Demographics

New Mexico has 2.1 million people.
67% of residents live in rural areas.
The state shows a higher-than-average poverty rate for those 65 and over.
Catron and Sierra Counties have 30-40% elderly residents.

National Demographics

31% of all office visits involve patients over 65 years old.
Life expectancy for women at 65 is 84 with independence lasting to 79; for men, it is 80 with independence lasting to 78.

The Geriatric Imperative

The current medical system isn't fully equipped to meet the needs of the burgeoning elderly population, which is categorized as the Silver Tsunami.
Sub-standard housing, low income, isolation, inadequate nutrition and inability to afford prescriptions and healthcare, are some of the issues faced by elderly people.

Poverty in NM Elderly

The poverty rate for seniors in New Mexico is higher than the national average across all ethnicities.
The American Indian/Alaska Native population shows the highest prevalence for poverty among elderly residents in New Mexico.

Philosophy/Mission

The mission of the UNM PA program is to educate PAs for primary care practice in medically underserved rural New Mexico communities.

Course Content

Adult medicine, the "general rule", is compared to geriatrics, the exception.
The learning process involves understanding the general rule (adult medicine) before understanding the exceptions (geriatrics).

Unique Aspects of Elder Care

Ambulatory care versus home care versus institutional care.
Curative care versus palliative care.
Multiple comorbid disorders are common occurrences.
Patient safety and pharmacokinetics (drugs and their effects) are crucial considerations.

Where Are the Elderly?

In 2010, a large percentage of elderly (65-75) resided in community dwellings, but a significant minority of this population (over 85) was found in institutions.

Case Scenarios

Case scenarios provide opportunities to analyze common problems, pose further questions and explore relevant legal and ethical considerations.

What is Your Problem List for this Patient?

Problem lists for 45 and 75-year-old patients are provided.

Comprehensive Geriatric Assessment (CGA)

CGA is a crucial tool for healthcare providers in dealing with the unique needs of the geriatric population.
The assessment process involves gathering data (patient history and physical information), team discussions, creating treatment plans, implementing plans, and monitoring results.

The More or More Data

Extensive data collection is crucial to properly assess patients' needs and develop effective treatment plans.
Detailed history, multiple provider involvement, and medication review are key aspects in the assessment.
Data points involving depression screening, activities of daily living, falls, incontinence and nutritional status are explored.

Medications

Matching medications to the patient's conditions and the use of a "brown bag" approach for better patient care.
Consideration of Beers Criteria for medication safety in elderly patients.

Activities of Daily Living (ADLs) and Instrumental ADLs (IADLs)

Function is a key component of geriatric care.
ADLs are basic activities of daily living.
IADLs are more complex tasks, such as shopping, managing finances, and using communication tools.

Screening Tools for Geriatric Syndromes

Multiple screening tools are used to assess elderly patients for various conditions.
Examples of common screening tools in CGA that are useful to assess include:
Cognitive Status - Mini Mental Status Examination (MMSE), Geriatric Depression Scale (GDS), Tinetti Performance-Oriented Mobility Assessment (POMA)
Functional Status - Katz Activities of Daily Living (ADL), Lawton Instrumental Activities of Daily Living (IADL)
Nutritional Adequacy - Mini Nutritional Assessment (MNA)

Falls

Falls are a leading cause of morbidity and mortality in the elderly.
Factors that increase fall risk include a history of falls, weakness, age, gender, cognitive impairment, orthostatic hypotension, medications, Arthritis, anemia, hearing/visual impairment, and increased chronic diseases.
Proper assessment of the patient is necessary to develop an effective fall-prevention treatment plan, which includes physical examination(orthostatic hypotension and visual acuity), laboratory tests, and neurological evaluations.

Fall Prevention

Teams are better suited to assess these needs; specific care plans should be developed with the concerns of the patient.
Falls assessment is necessary for effective treatment planning. This could involve assessments such as Timed Get Up & Go and analysis of risk factors.

Incontinence

Incontinence is a common condition in the elderly, and providers need to address it by asking specific and directed questions.

Malnutrition

Malnutrition is a hidden cause of falls and decline in elderly patients and should be evaluated.

Vitals

Weight change, orthostatic blood pressure, irregular heart rate, and oxygen saturation levels should be documented in patients' assessments.

Cognitive Impairment Assessment

Cognitive impairment assessment tools such as MMSE, MOCA, and Min-Cog can assist with proper diagonsis; further discussion of assessment can be covered in Neuro.

Capacity vs Competence

Capacity is an individual's ability to make informed medical decisions, and competence is the legal ability to make decisions, which is determined in a court of law.
Important to consider for decisions involving medical care.

Advanced Care Planning

Early discussions on advanced care planning, DNR/DNI, POA are crucial for effective consideration and legal/ethical implications in patient care planning and implementation. Advanced care directives should be one of the first discussions with patients

Review of CGA components

Comprehensive Geriatric Assessment (CGA) includes past medical history, medications, social history, depression screening, activities of daily living, falls, incontinence, nutritional status, vitals, cognitive function, the Get Up and Go test and review of USPTF recommendations.

Lab/Imaging Tests

Additional diagnostic tools like baseline ECGs, Chest X-rays, drug levels, and labs such as RPR, albumin, pre-albumin, homocysteine, Vitamin B12, and vitamin D may further assist with comprehensive patient assessments.

Patient Risk Factors

A twenty-pack-year smoking history in a 68-year-old female patient may indicate a risk factor for cardiovascular disease, and screening for that potential should be appropriate.

Tools for Assessing Quality of Patient Life and Patient's Goals

Assess the patient's goals; consider areas such as diagnosing areas of concern, medications and compliance requirements, and address concerns with a “Shared Decision-Making” approach to treatment.

Cancer

Cancer is a leading cause of death in older adults.
Age is a risk factor for cancer development and contributing to mortality.
Initial cancer presentation is often excused as part of the aging process, leading to delayed diagnosis.

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Description

Test your knowledge on decision-making distinctions, advanced care planning, and geriatric assessments. This quiz covers key aspects such as competence, advanced directives, and assessment tools used in geriatric care. Perfect for students and professionals in the field of geriatrics.