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Questions and Answers
Which of the following tools is NOT typically used for depression screening?
Which of the following tools is NOT typically used for depression screening?
Which laboratory test is most relevant for assessing cardiovascular risk in a 68-year-old female patient with a history of smoking?
Which laboratory test is most relevant for assessing cardiovascular risk in a 68-year-old female patient with a history of smoking?
In the context of medication review, what aspect should be primarily considered to align medications with a patient's diagnosis?
In the context of medication review, what aspect should be primarily considered to align medications with a patient's diagnosis?
Which component of the assessment plan emphasizes the importance of patient and family involvement in care decisions?
Which component of the assessment plan emphasizes the importance of patient and family involvement in care decisions?
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What is the primary goal of assessing and planning care for a patient?
What is the primary goal of assessing and planning care for a patient?
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What is the primary focus of geriatric visits?
What is the primary focus of geriatric visits?
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Which of the following is NOT typically considered when developing a treatment plan for elderly patients?
Which of the following is NOT typically considered when developing a treatment plan for elderly patients?
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What commonly used tool is specifically designed for screening depression in elderly patients?
What commonly used tool is specifically designed for screening depression in elderly patients?
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Which of the following is a significant cause of injury and death among the elderly?
Which of the following is a significant cause of injury and death among the elderly?
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Which of the following activities is classified under Instrumental Activities of Daily Living (IADLs)?
Which of the following activities is classified under Instrumental Activities of Daily Living (IADLs)?
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What screening tool is advised to assess falls risk in elderly patients?
What screening tool is advised to assess falls risk in elderly patients?
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Which medication-related concern is specifically highlighted for elderly patients?
Which medication-related concern is specifically highlighted for elderly patients?
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Which recommendation relates directly to monitoring and follow-up for elderly patients?
Which recommendation relates directly to monitoring and follow-up for elderly patients?
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What percentage of falls leading to death in the elderly is attributed to Traumatic Brain Injury?
What percentage of falls leading to death in the elderly is attributed to Traumatic Brain Injury?
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Which of the following is NOT assessed as part of nutritional status in elderly patients?
Which of the following is NOT assessed as part of nutritional status in elderly patients?
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What is a significant characteristic of geriatrics compared to adult medicine?
What is a significant characteristic of geriatrics compared to adult medicine?
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Which component is NOT part of the Comprehensive Geriatric Assessment (CGA)?
Which component is NOT part of the Comprehensive Geriatric Assessment (CGA)?
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What percentage of individuals over age 85 are typically community-dwelling rather than in institutions?
What percentage of individuals over age 85 are typically community-dwelling rather than in institutions?
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In which setting is patient safety especially critical for geriatric patients?
In which setting is patient safety especially critical for geriatric patients?
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Which question is LEAST relevant when assessing a fall in a 75-year-old patient?
Which question is LEAST relevant when assessing a fall in a 75-year-old patient?
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How does the care of elderly patients generally differ from standard adult medicine?
How does the care of elderly patients generally differ from standard adult medicine?
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Which might indicate the need for a comprehensive geriatric assessment?
Which might indicate the need for a comprehensive geriatric assessment?
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Which of the following best describes the challenge in learning geriatrics?
Which of the following best describes the challenge in learning geriatrics?
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What is the third-leading cause of unintentional injury-related death in New Mexico for all ages?
What is the third-leading cause of unintentional injury-related death in New Mexico for all ages?
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Which of the following factors increases the risk of death from falls in individuals over 85 years old?
Which of the following factors increases the risk of death from falls in individuals over 85 years old?
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Which of the following is NOT a recognized risk factor for falls?
Which of the following is NOT a recognized risk factor for falls?
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What is an essential component of a falls assessment to develop an effective treatment plan?
What is an essential component of a falls assessment to develop an effective treatment plan?
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What role do psychotropic drugs have in falls risk?
What role do psychotropic drugs have in falls risk?
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Which diagnostic measure is NOT part of the falls assessment process?
Which diagnostic measure is NOT part of the falls assessment process?
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What common cause of falls may often go unrecognized in patients?
What common cause of falls may often go unrecognized in patients?
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What is the difference between 'capacity' and 'competence' in the context of patient decision-making?
What is the difference between 'capacity' and 'competence' in the context of patient decision-making?
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Which of the following would be a recommended intervention for an individual with impaired gait and balance?
Which of the following would be a recommended intervention for an individual with impaired gait and balance?
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What is an important question to ask patients regarding urinary incontinence?
What is an important question to ask patients regarding urinary incontinence?
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What is one potential consequence of an individual lacking the capacity to make informed decisions?
What is one potential consequence of an individual lacking the capacity to make informed decisions?
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In Case 1, what factors could indicate Mrs. Alcorn's competency regarding her refusal of the flu vaccine?
In Case 1, what factors could indicate Mrs. Alcorn's competency regarding her refusal of the flu vaccine?
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What determination can only a court make in relation to individual rights?
What determination can only a court make in relation to individual rights?
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In Case 2, what is Mr. Walden unable to recall which raises concerns about his competency?
In Case 2, what is Mr. Walden unable to recall which raises concerns about his competency?
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What does the USPSTF grading system primarily aim to address?
What does the USPSTF grading system primarily aim to address?
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During advanced care planning, what is a crucial area of discussion with the patient?
During advanced care planning, what is a crucial area of discussion with the patient?
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What might be considered a major risk factor for cancer in older adults?
What might be considered a major risk factor for cancer in older adults?
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Which of the following is an example of advanced directives?
Which of the following is an example of advanced directives?
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What should be the first step when discussing a patient's future care wishes?
What should be the first step when discussing a patient's future care wishes?
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What is one option available for an individual who does not want someone to make decisions on their behalf?
What is one option available for an individual who does not want someone to make decisions on their behalf?
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What are common components of a geriatric assessment?
What are common components of a geriatric assessment?
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The geriatric assessment includes evaluating both physical and mental health.
The geriatric assessment includes evaluating both physical and mental health.
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Older adults are less likely to experience adverse effects from medications compared to younger adults.
Older adults are less likely to experience adverse effects from medications compared to younger adults.
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What is the primary goal of a geriatric assessment?
What is the primary goal of a geriatric assessment?
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Match the following aspects of geriatric care with their descriptions:
Match the following aspects of geriatric care with their descriptions:
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What is the primary focus of geriatric assessment?
What is the primary focus of geriatric assessment?
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Geriatric assessments are only necessary for individuals over the age of 80.
Geriatric assessments are only necessary for individuals over the age of 80.
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Study Notes
Adult and Geriatric Medicine - AGM 1
- This course is an introduction to Adult and Geriatric Medicine (AGM).
- The course is taught by Laura Wylie, MPAS, PA-C.
- The course instructor's email is [email protected].
Course Content
- Adult Medicine is the general rule.
- Geriatrics is the exception.
- A major challenge of geriatric care is understanding the rule before learning the exceptions.
- Caregivers often deal with more complex situations, such as multiple co-morbid disorders and polypharmacy.
Unique Aspects of Elder Care
- Care of the elderly involves various settings, such as ambulatory, home, and institutional care.
- Curative and palliative care may need to be considered.
- Multiple co-morbid disorders are commonplace in the elderly.
- Patient safety is an important aspect of elder care.
- Polypharmacy and pharmacokinetics are vital topics to consider in the elderly.
Where are the Elderly?
- 2010 data suggests elderly living in community dwelling vs. institutions
- 65-75: 95-99% community dwelling, 1% in institutions.
-
85: 85% community dwelling, 15% in institutions.
Case Scenarios
- A 45-year-old male presents with a leg wound from a fall, a week prior.
- Problem list includes: 1 week ago fall; possible infection; tetanus status.
- Questions to ask include: How did the fall occur?; Are there any medications?; Does it hurt?; Remainder of 7 dimensions
- A 75-year-old male presents with a leg wound from a fall
- Problem list includes: 1 week ago fall; possible infection; tetanus status; 75-year-old
- Questions to ask include: How did the fall occur?; Are there any medications?; Does it hurt?; 7 Dimensions included (Where were you able to get up on your own?; Do you use an assistive device?; Have you fallen in the last year?)
Comprehensive Geriatric Assessment (CGA)
- CGA is used to manage the specific needs of the geriatric population.
- Six components of CGA: data collection; team discussion; treatment plan development; treatment plan implementation; medications; referrals; monitoring.
- Requires an interdisciplinary approach.
- Each stage of the CGA process is completed with data gathering, team discussion and development of the treatment plan.
The More Data Collected, The Easier The Assessment
- Past medical history (extending back as far as possible).
- Medications (include Beers Criteria, multiple provider input).
- Social history (occupation, finances).
- Depression screening (PHQ-2, PHQ-9, GDS).
- Activities of Daily Living (ADLs).
- Instrumental Activities of Daily Living (IADLs).
- Falls and Gait.
- Incontinence.
- Nutritional status.
- Vitals.
- Cognition.
- Get Up-And-Go Test.
- Advanced care planning.
- Review USPSTF recommendations.
Medications
- Match medications to problem list.
- Utilize a "brown bag" approach.
- Multiple provider input.
- Include Beers Criteria, allergies, and side effects.
In Geriatrics, Function is Primary
- Activities of Daily Living (ADLs): personal care, continence, mobility, feeding.
- Instrumental Activities of Daily Living (IADLs): shopping, finances, telephone, driving, cooking, housekeeping.
Multiple Screening Tools for the Elderly
- Tools help screen for Geriatric Syndromes
- Focus areas: Nutrition, Frailty, Pressure Ulcers, Incontinence, Syncope, Falls, Dizziness/Vertigo, Delirium, Sleep Disorders, Abuse
- Common Tools in CGA:
- Cognitive Status (MMSE, MOCA, Mini-Cog)
- Affective Status (Geriatric Depression Scale - GDS)
- Mobility-Gait & Balance (Tinetti Performance-Oriented Mobility Assessment - POMA)
- Functional Status-Activities of Daily Living (Katz ADL, Lawton IADLs)
- Nutritional Adequacy (Mini Nutritional Assessment - MNA)
Falls
- Leading cause of injury/death in the elderly.
- Many falls are unreported.
- In 2014, falls resulted in 7 million injuries.
- Significant economic burden on Medicare.
- 50% of deaths from falls are attributed to traumatic brain injuries
Falls Assessment is Crucial
- Essential for effective treatment plan development.
- Risk factors: history of falls; lower extremity weakness; age; female gender; cognitive impairment; balance problems; psychotropic drugs; arthritis; orthostatic hypotension; anemia; hearing loss; visual impairment; increased number of chronic diseases.
- Assessments: Timed Get Up and Go; Physical Exam (orthostatic HTN, appropriate vision correction, hearing, extremities, neuro); Diagnostics (CBC, vitamin D, cardiac studies)
- Interventions- falls prevention using multidisciplinary teams
Patient Incontinence
- Patients rarely discuss incontinence unless asked directly.
- Consider the following phrasing: “In the past year, have you ever lost your urine or gotten wet?”; “Have you ever not been able to make it to the bathroom in time?”
Malnutrition
- Malnutrition is often a hidden cause of falls and decline among the elderly.
Vitals
- Significant weight changes over time
- Orthostatic blood pressure
- Irregular heart rate and palpitations
- Undiagnosed conditions revealed by blood oxygen saturation levels.
Cognitive Impairment
- MMSE, MOCA, Mini-Cog.
- (Neurology will provide more detail)
Capacity vs Competency
- Capacity: An individual's ability to make informed decisions (medical).
- Competency: A legal state of mental soundness to make decisions.
Advanced Care Planning.
- Essential part of discussion with patients about end-of-life options.
- DNR/DNI
- Advanced Directives (Who, When, Exceptions)
- POA (more than one; alternate; anyone to avoid)
- Patients' Priorities, Joy, and Future Goals
Other Diagnostic Tests
- Labs: Baseline ECG, Chest X-ray, complete blood count (CBC), vitamin D levels, drug levels, RPR, albumin, pre-albumin, homocysteine, B12, Vitamin D
Case Studies (Examples):
- Case studies are included to illustrate application of principles,
- Example Scenarios presented involve patient refusal of flu vaccine, or a patient with dementia wanting bank access.
Patient Quality of Life
- Assessment should focus on the goals, concerns, and priorities of each patient.
- Discuss patient and family desires.
- Goals should include function, independence, and comfort.
- Document a negotiated plan
- Shared decision making is important
USPSTF Screening Guidelines
- Guidelines are to prevent major illnesses before symptoms manifest.
- Provides a systematic tool for clinicians to identify appropriate preventive services for patient characteristics.
Cancer
- The biggest risk factor for cancer is age, with 60% of new cases and 70% of deaths occurring.
- A variety of theories are used to describe cancer risk and its origin.
Initial Presentation of Illness
- Initial symptoms of illness are often assumed to be simple aging processes
- A variety of symptom examples are shown in a table, to highlight this phenomenon
Review the Components of the CGA
- Past medical history; medications; social history; depression screening (PHQ-2, PHQ-9, GDS); ADLs; IADLs; falls; incontinence; nutritional status, vitals, cognitive function (Get-up and Go Test); patient-specific USPTF recommendations; advanced care planning considerations are reviewed
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Description
Test your knowledge on geriatric patient assessments and care planning. This quiz covers various tools, screening methods, and considerations vital for elderly patients. Ideal for healthcare professionals and students specializing in geriatric care.
