Advanced Geriatrics Course Quiz

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.

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.