Geriatric Syndromes ppt
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Geriatric Syndromes ppt

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Questions and Answers

Which of the following is NOT considered a common geriatric syndrome?

  • Cognition
  • Diabetes Mellitus (correct)
  • Mobility & Falls
  • Vision Problems

    • What percentage of individuals are affected by dementia by the age of 85?

  • 50-70%
  • 30-50% (correct)
  • 10-20%
  • 20-30%

    • In the context of nutritional risk screenings for weight loss, which lab value reflects a shorter-term nutritional status?

  • Pre-albumin (correct)
  • Body Mass Index
  • Albumin
  • Total Protein

    • Which type of dementia is characterized by early significant behavioral and personality changes?

    <p>Frontotemporal Dementia</p> Signup and view all the answers

    What is a potential medical cause of involuntary weight loss in geriatric patients?

    <p>Hyperthyroidism</p> Signup and view all the answers

    Which component of cognition does NOT characterize dementia?

    <p>Enhanced problem-solving skills</p> Signup and view all the answers

    Which medication is commonly used in the treatment of involuntary weight loss among geriatric patients?

    <p>Megestrol</p> Signup and view all the answers

    What is a primary factor affecting nutrition among elderly individuals?

    <p>Isolation</p> Signup and view all the answers

    Which condition is characterized by a severe deficiency of thiamine (vitamin B1)?

    <p>Wernicke-Korsakoff Syndrome</p> Signup and view all the answers

    What symptom is NOT typically associated with delirium?

    <p>Chronic memory loss</p> Signup and view all the answers

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

    <p>Geriatric Depression Scale</p> Signup and view all the answers

    Which factor is most likely to contribute to urinary incontinence in the elderly?

    <p>Increased post-void residuals</p> Signup and view all the answers

    Which of the following is a consequence of immobility in elderly individuals?

    <p>General deconditioning</p> Signup and view all the answers

    What causes the primary cognitive impairment in alcohol-related dementia?

    <p>Progressive cognitive impairment post-abstinence</p> Signup and view all the answers

    Which condition is characterized by an inherited genetic cause that leads to dementia?

    <p>Huntington’s disease</p> Signup and view all the answers

    Which of the following symptoms is included in the definition of delirium?

    <p>Acute mental disturbance</p> Signup and view all the answers

    What does the acronym PINCH ME stand for in relation to causes of delirium?

    <p>Pain, Infection, Nutrition, Constipation, Hydration, Medication</p> Signup and view all the answers

    What stage of a pressure sore is indicative of full thickness skin loss?

    <p>Stage 3</p> Signup and view all the answers

    In what way can depression manifest differently in elderly patients post-COVID?

    <p>Heightened levels of isolation</p> Signup and view all the answers

    What is an incorrect understanding of how medications can affect elderly patients?

    <p>Water-soluble medications may become too diluted</p> Signup and view all the answers

    Which of the following is classified as a transient cause of incontinence?

    <p>Delirium</p> Signup and view all the answers

    Which age group is most likely to experience gait disorders?

    <p>Individuals aged 65 and older</p> Signup and view all the answers

    What is a primary consideration when assessing the ability of an older adult to live independently?

    <p>Their ability to manage multiple chronic conditions</p> Signup and view all the answers

    Which statement correctly reflects a principle for caring for older adults?

    <p>Not all abnormalities in older adults necessitate treatment.</p> Signup and view all the answers

    What is the primary role of FL2 in the transition of care process?

    <p>To outline the patient's medications and assessments.</p> Signup and view all the answers

    Which intervention could be considered appropriate for managing a multifactorial disorder in older adults?

    <p>Implementing a combination of therapeutic and lifestyle adjustments.</p> Signup and view all the answers

    Which factor is critical to communicate effectively during the transition of care for older adults?

    <p>The patient's spiritual history.</p> Signup and view all the answers

    What percentage of muscle mass can bedridden patients lose in a single day?

    <p>2–5%</p> Signup and view all the answers

    How much more does an elderly acutely ill person experience bone resorption compared to the usual involutional rate?

    <p>50 times</p> Signup and view all the answers

    What happens to the arterial oxygen partial pressure (pO2) for an 80-year old at bedrest?

    <p>Normal: 70; At bedrest: 62</p> Signup and view all the answers

    What is a significant predictor of clinical outcomes in hospitalized elderly patients?

    <p>Under/malnutrition</p> Signup and view all the answers

    What pressure is needed for skin necrosis to occur due to direct pressure?

    <p>32 mmHg</p> Signup and view all the answers

    How much muscle mass can patients with critical illness lose in one week?

    <p>15%</p> Signup and view all the answers

    What is the effect of hospital food on the nutritional status of older adults?

    <p>It often lacks flavor, impacting intake</p> Signup and view all the answers

    What does the acronym ELDERSS stand for in relation to important issues in hospitalized older adults?

    <p>Eating, Lucidity, Directives, Elimination, Rehabilitation, Skin Care, Social Services</p> Signup and view all the answers

    Which of the following electrolyte disturbances can significantly contribute to cognitive decline in elderly patients?

    <p>Hypercalcemia</p> Signup and view all the answers

    What is a prevalent cause of nosocomial infections in hospitalized elderly patients?

    <p>Catheter-associated urinary tract infections (CAUTIs)</p> Signup and view all the answers

    Which factor is most likely to increase the risk of falls in hospitalized elderly individuals?

    <p>Use of bed rails</p> Signup and view all the answers

    Which of the following strategies is NOT recommended for improving health outcomes in hospitalized elderly patients?

    <p>Keeping IV lines and catheters for prolonged periods</p> Signup and view all the answers

    What percentage of elderly individuals is estimated to experience elder abuse or neglect each year?

    <p>10-15%</p> Signup and view all the answers

    Which of the following profiles is considered a common risk factor for elder abuse?

    <p>Physically dependent individuals with severe cognitive impairments</p> Signup and view all the answers

    What is a serious medical condition related to cognitive changes that requires immediate intervention?

    <p>Delirium</p> Signup and view all the answers

    Which approach is essential for effectively involving patients and families in care planning and decisions?

    <p>Use of advanced directives</p> Signup and view all the answers

    Which substance is associated with increased health risks among older adults, with notable gender differences in consumption patterns?

    <p>Alcohol</p> Signup and view all the answers

    What defines the legal threshold for assessing a person's competency to make medical decisions?

    <p>Comprehensive understanding and reasoning abilities</p> Signup and view all the answers

    What best characterizes the concept of caregiver burden among families of elderly individuals?

    <p>Decreased social engagement due to caregiving demands</p> Signup and view all the answers

    Which of the following represents a typical psychosocial topic that may arise when caring for elderly individuals?

    <p>Legal and financial issues related to competency</p> Signup and view all the answers

    What is a potential consequence of immobility in elderly patients during hospitalization?

    <p>Increased likelihood of pressure ulcers</p> Signup and view all the answers

    Study Notes

    Geriatric Syndromes

    • Geriatric Syndromes are multifactorial, require aggressive multifaceted evaluation and a team approach for treatment.
    • Common syndromes include cognitive, mobility & falls, immobility, pain, nutrition, isolation, vision problems, hearing problems, dizziness, polypharmacy, sleep, continence/UTI, and constipation.

    Nutrition & Involuntary Weight Loss

    • Consider medical factors like dental issues, taste changes, and swallowing difficulties.
    • Psychological factors such as depression and social isolation can also contribute.
    • Look for medical causes like mouth ulcers, GI ulcers, dysphagia, thyroid issues, and malabsorption.
    • Use scales for standing, bed, and ramp weight measurements.
    • Assess circumference of arms and hips and their ratios.
    • Conduct nutritional risk screenings.
    • Labs to consider include albumin (20-22 days) and pre-albumin (3-4 days).
    • Diagnosis is usually clinical.
    • Treatment focuses on identifying and reversing the cause.
    • Oral supplements and medications like Megestrol and Remeron can be used.

    Cognition

    • Dementia, delirium, and depression are considered the “3 Ds”.
    • Dementia: is characterized by complex attention issues, executive function issues, learning and memory impairment, language difficulties, perceptual-motor function problems, and social cognition changes.
      • Dementia affects approximately 30-50% of individuals by age 85.
      • Alzheimer's disease accounts for roughly 2/3 of dementia cases.
      • Other types include Vascular dementia, Lewy Body dementia, Frontotemporal dementia, Parkinson's disease-related dementia, Creutzfeldt-Jakob Disease, Normal Pressure Hydrocephalus, Huntington's disease, Wernicke-Korsakoff Syndrome, and alcohol-related dementia.
      • Mixed dementia can also occur.
      • Alzheimer's: characterized by short-term memory loss with problems in language and praxis.
      • Vascular dementia: has a stepwise progression with focal deficits on neurological exam.
      • Dementia with Lewy Bodies (LBD): starts with stiffness and slowness along with cognitive loss and associated visual hallucinations.
      • Frontotemporal dementia (FTD or bvFTD): prominent behavioral and personality changes occur early in the course of cognitive impairment.
      • Parkinson’s dementia: impaired attention, memory decline and issues with interpreting visual information.
      • Creutzfeldt-Jakob Disease (CJD): rare, rapidly worsening brain disorder causing muscle coordination, thinking and memory impairment.
      • Normal Pressure Hydrocephalus: can cause dementia-like symptoms, including forgetfulness, difficulty with daily tasks, and loss of interest.
      • Huntington’s: an inherited genetic condition that causes dementia and a progressive decline in movement, memory, thinking, and emotional state.
      • Wernicke-Korsakoff Syndrome: caused by a severe thiamine (vitamin B1) deficiency.
      • Alcohol related dementia: occurs after a period of chronic alcohol abuse.
    • Depression: estimated at 25% of the elderly population.
      • Factors include loss of loved ones, independence, lifestyle, and abilities.
      • Rates are rising in the elderly population post-COVID.
      • Screening tools include the PHQ-2 and PHQ-9.
      • Formal scales include the Geriatric Depression Scale and PHQ-9.
    • Other Psychiatric Disorders:
      • Anxiety: associated with depression.
      • Psychosis: hallucinations and delusions, isolation, sensory impairment, and dementia.
      • Substance Abuse: alcohol, tobacco, and drugs.
    • Delirium:
      • Acute mental status disorder characterized by abnormal and fluctuating attention.
      • There is a disturbance in level of awareness and reduced ability to direct, focus, sustain, and shift attention.
      • Delirium is a symptom – not a disease.
      • The Confusion Assessment Method (CAM) is used to screen for delirium.
      • The CAM identifies delirium based on acute onset and fluctuating course, inattention, disorganized thinking, and an altered level of consciousness.
      • Delirium's causes may include pain, infection, malnutrition, constipation, dehydration, polypharmacy, and environmental factors.
    • 3 Ds Approach
      • Early identification of the cause of cognitive changes is crucial.
      • History is key, including medical history and current situation.
      • Assess medications.
      • Develop care plans.
      • Provide support for families.
      • Utilize a team approach.

    Immobility

    • Reduced mobility in the elderly is not normal and needs to be investigated.
    • Consider physical, psychological, and psychosocial factors.
    • Consequences of immobility are numerous and include general deconditioning, cardiac deconditioning, renal stones, pressure wounds, pulmonary embolism (PE)/deep vein thrombosis (DVT), urinary retention/UTI, atelectasis, reflux, isolation, depression, delirium, worsened chronic diseases, constipation, fecal impaction, pneumonia, and osteoporosis.

    Gait Issues

    • Gait disorders affect approximately 15% of individuals over 65.
    • By age 80, one in four individuals use a mechanical aid for ambulation.
    • The prevalence of gait abnormalities is even higher in the population aged 85 and above.
    • The Timed Get Up and Go test is used to screen for gait issues.
    • A score of less than 10 seconds is considered good, 10-20 seconds indicates a need for intervention, and 20 seconds or greater requires further workup if no known condition exists.
    • Physical therapy is beneficial in many cases.

    Pressure Sores

    • Stage 1: Blanchable hyperemia (redness that disappears when pressed).
    • Stage 2: Extension through the epidermis (partial-thickness skin loss).
    • Stage 3: Full thickness skin loss (damage to subcutaneous tissue).
    • Stage 4: Full thickness skin loss extending into muscle, bone, or supporting structures.
    • If eschar or slough (dead tissue) covers the wound, it is considered unstageable.
    • Suspected deep tissue injury is an area of blistered skin or a discolored area.
    • Prevention strategies include proper positioning, optimal nutrition (vitamin E, vitamin C, protein), and specialized pressure-relieving surfaces.
    • Treatment includes keeping the wound bed clean and moist to promote healing.

    Urinary Incontinence & Retention

    • Incontinence:
      • Stress incontinence: involuntary urine leakage due to coughing or sneezing.
      • Urge incontinence: inability to delay urination.
      • Overflow incontinence: bladder does not empty fully.
      • Functional incontinence: inability to reach the toilet in time.
      • UTI: can cause incontinence or retention.
    • Retention:
      • Increased post void residual volume.
      • Full retention may require a Foley catheter or intermittent catheterization.
    • Transient causes of incontinence:
      • Delirium, infection, atrophic vaginitis or urethritis, excessive urinary output, restricted mobility, stool impaction, medications, and psychological factors.
    • Treatment:
      • Always treat the transient causes of incontinence regardless of any established causes.
      • Options include exercises, lifestyle modifications, double voiding, and surgery for obstructions.

    Urinary Tract Infection (UTI)

    • UTI presentation differs in the elderly.
    • Work-up is necessary and includes assessing for bacteria in urine, nitrates, and leukocyte esterase.
    • Baseline fever change of one degree may be significant.
    • Avoid contributing to antibiotic resistance.

    Polypharmacy & Pharmacotherapy

    • Adverse drug reactions:
      • Changes in metabolism due to age-related changes in liver and kidney function.
      • Decreased total body water and a relative increase in body fat.
      • Water-soluble medications become more concentrated.
      • Fat-soluble medications have longer half-lives.
    • Be cautious of “natural remedies”.
    • Follow the “start low, go slow” approach to medication administration.
    • Polypharmacy:
      • Maintain a clear understanding of all medications your patient is taking, including prescription, over-the-counter, and those administered by other providers.
      • Annual Medicare Wellness visits are important.
      • Consider financial implications of medications.
      • Recognize that isolation can be caused by poor vision, hearing, mobility, and urinary issues.
      • Isolation can lead to depression and self-medication.

    ELDERSS

    • Important Issues with Hospitalized Older Adults: Eating, Lucidity, Directives for limiting care, Elimination, Rehabilitation, Skin Care, Social Services
    • Decreased muscle strength & aerobic capacity:
      • Bedridden patients can lose 2-5% of muscle mass per day.
      • Older adults can lose up to 10% muscle mass in a week.
      • Critically ill patients may lose over 15% muscle mass in a week.
      • Reconditioning takes longer than deconditioning.
    • Decreased bone density: Individuals at bedrest experience 50 times the usual rate of bone resorption compared to normal aging.
    • Decreased ventilation:
      • Normal aging: pO2 = 90 – (age over 60)
      • Costochondral calcification and weaker muscles reduce lung capacity.
      • Bed rest decreases pO2 by 8 mm.
      • Hypoventilation increases as more alveoli remain unventilated.
    • Altered thirst & nutrition:
      • Taste decreases with age.
      • Hospital food often lacks flavor.
      • Intake declines if food isn't salted or seasoned.
      • 25-30% of hospitalized elderly are undernourished.
      • Undernutrition strongly predicts poor clinical outcome.
      • Markers: serum albumin (after rehydration), Total Lymphocyte Count.
    • Fragile skin:
      • Skin necrosis occurs after more than 2 hours of pressure exceeding capillary filling pressure (32 mmHg).
      • Sacral pressure after short immobilization can reach 70 mmHg.
      • Increased likelihood of shearing forces and moisture escalates the risk of pressure injuries.
      • Prevalence of pressure ulcers is 20-25%.

    DELIRIUM

    • Causes:
      • Drugs (medications, withdrawal)
      • Electrolyte/Endocrine disturbances (dehydration, sodium imbalance, uremia, hypercalcemia, hypoglycemia, thyrotoxicosis)
      • Infection (sepsis, meningitis, encephalitis)
      • Reduced sensory input (vision, hearing)
      • Intracranial (infection, hemorrhage, stroke, tumor)
      • Urinary, fecal (retention, impaction)
      • Major organ system problems (MI, arrhythmia, shock, COPD, hypoxia, hypercapnia, renal failure, liver failure, hypertensive encephalopathy)

    Functional/Cognitive Decline

    • Between 25-60% of hospitalized elderly experience physical function loss.
    • Can lead to nursing home placement.

    Falls

    • 2-12% of patients fall during their hospital stay.
    • Increased risk with: Restraints, Benzodiazepines, Ambien
    • Fall risk assessment (Morse):
      • 0: No risk
      • <25: Low risk
      • 25-45: Moderate risk

      • 45: High risk

    Nosocomial Infections

    • Catheter-associated urinary tract infections (CAUTIs) are the most common in hospitals.
    • Should NOT be used solely for incontinence.

    Strategies for Improving Outcomes in Hospitalized Elderly

    • Geriatric Interdisciplinary team.
    • Primary care nurse (one per patient).
    • Environmental changes (usually by nurses).
    • Family member rooming-in programs.
    • High-quality communication among healthcare professionals.
    • Advance Directives.
    • Early mobilization and participation in functional activity.
    • Discharge planning.
    • Acute care of the elderly (ACE) units

    Ten Commandments for Elderly Care

    • Movement is essential.
    • Limit medications.
    • Remove IV lines and catheters ASAP.
    • Avoid restraints whenever possible.
    • Assess mental/cognitive status daily.
    • Delirium is a medical emergency.
    • Use antipsychotics only when indicated.
    • Monitor for depression.
    • Pay attention to food intake, consider supplements.
    • Initiate discharge planning on admission.
    • Involve patient and family in decision-making and advance directives.

    Psychosocial Topics

    • Legal and Financial, Safety, Wellness, Sensitive subjects.

    Legal & Financial Issues

    • Competency:
      • Medical: Knowledge, understanding, reasoning, appreciation, voluntary choice.
      • Legal: Higher threshold.
    • Agents for the Incompetent:
      • POA (Power of Attorney) & HCPOA (Healthcare Power of Attorney).
      • Guardian (medical & financial).
      • Don't take effect until incapacity.
    • End-of-Life Decisions:
      • Living wills (legal).
      • DNR/MOST forms (medical).
      • POA/HCPOA (legal).
    • Advance Directives
      • Legal documents.
      • Outlines desired treatments under various circumstances.
      • Types: Living will, Durable Power of Attorney, Five Wishes.
      • Completed by patients, families, or POA.
    • Conflict of Interest:
      • People can make competent yet bad decisions.
      • Desire to protect from harmful choices but also honor patient beliefs.

    Safety Issues

    • Crime and Older People, Elder Abuse, Falls and Fractures, Medicines – Polypharmacy, Older Drivers, “Unique Sources of Health Care.”

    Crime and Older People

    • Frailty makes older people a target.
    • Discuss safety with patients and families.
    • Emphasize home safety and street smarts.
    • Be aware of spam callers.

    Caregiver Burden

    • NC: 9th fastest-growing state for 60+ population.
    • Family caregivers: Adult children and spouses often provide care.
    • NC: 448,000 unpaid caregivers for dementia patients in 2014.
    • 6.2 million dollars in unpaid care.

    Increasing Caregiver Burden

    • 2010: 8 potential caregivers per patient.
    • 2030: 3.9 potential caregivers per patient.

    Care for the Caregiver

    • Missed work, logistics of finding additional care, increased stress, anxiety, depression, and adverse physical effects.

    Elder Abuse

    • Over 500,000 people 60+ experience abuse/neglect annually.
    • Only 21% are reported.
    • Types: Physical, emotional/psychological, sexual, financial exploitation, neglect, abandonment.

    Causes of Elder Neglect & Abuse

    • Caregiver burnout, secondary gain issues, bullying.

    Risk Factors for Elder Abuse

    • Frailty, female, white, severe cognitive or physical impairment, dependence on caregiver, problematic behavior, isolation, caregiver stress.

    Red Flags of Elder Abuse

    • Unexplained trauma, absence of needed supplies, over or under-medication, restraint signs, repeated infections, skin breakdown, malnutrition, caregiver stress.

    Abusers

    • 50%: Adult child living in the same home and financially dependent.
    • 20%: Spouse.
    • 9%: Other relatives.
    • Cuts across all ages, races, and socioeconomic groups.

    Interventions for Elder Abuse

    • Reporting, reducing caregiver stress, respite care, home care services, long-term care facilities, guardianship, acute medical intervention.

    Sensitive Subjects

    • Alcohol use, driving, sexuality in later life, forgetfulness, mourning loss, transition of care.

    Alcohol

    • Over 50% of people 65+ drink daily.
    • Estimated prevalence of alcohol abuse in community dwelling elderly 3-4%.
    • Prevalence higher in men.
    • 5-10% of dementia cases related to alcohol.
    • 15-20% may experience health risks due to alcohol.

    Adverse Effects of Alcohol

    • Falls, medication issues, cognitive issues, sleep issues, dehydration, depression.

    Driving

    • Test reflexes, cognition, distractibility, vision, and hearing.
    • Use third-party source unless a clear problem exists (seizures, etc.).
    • Insurance companies offer discounts.

    Wellness

    • Present exercises, foot care, vaccines, skin care, weather injury prevention in a non-threatening manner.

    Transition of Care

    • Assessment of Instrumental Activities of Daily Living (IADLs) and Activities of Daily Living (ADLs).
    • Can the individual live independently or at home?
    • Levels of care:
      • Home
      • Group home/Family Care Home
      • Independent living
      • Assisted living & Memory Care
      • Skilled nursing facility

    Transition Tools

    • FL2: Diagnosis, medications, ADLs, orders (diet, standing orders, vitals).
    • FL2 is an adult home care form.
    • Know where your patient is going.
    • Communication:
      • Return to spiritual history.
      • Breaking bad news.
      • Cultural sensitivity.
      • "What do you want me to share with your family?"

    Principles for Caring for Older Adults

    • Many disorders are multifactorial and managed by multifactorial interventions.
    • Diseases often present atypically or with nonspecific symptoms (e.g., confusion, functional decline).
    • Not all abnormalities require evaluation and treatment.
    • Complex medication regimens, adherence issues, and polypharmacy are common.
    • Multiple chronic conditions often coexist and should be managed together.

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    Description

    Test your knowledge on geriatric syndromes and the complexities of nutrition in elderly patients. This quiz covers multifactorial aspects of geriatric care, including cognitive issues, mobility, and involuntary weight loss. Answer questions related to causes, screenings, and treatment approaches for common geriatric challenges.

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