Gerontology Exam Overview: Spring 2025

• The exam consists of multiple choice and select all that apply questions.
• The exam will take place in Spring 2025
• The exam has 40 questions
• Candidates have 80 minutes to complete it.

Week 1: 3-5 items

• The aging population's demographic trends are important.
• Growth is slowing, and the 65+ population will almost double by 2060.
• The population is becoming more ethically diverse.
• International migration contributes the most to U.S. population growth.
• Advancing healthcare results in longer life expectancy and lower infant mortality.
• Gerontology focuses on the 4Ms: Mobility, Medication, Mentation, and What Matters.
• Medication includes concern for Polypharmacy, medication reconciliation, and deprescribing.
• Mentation includes concern for Cognitive impairment and using the Mini-Cog assessment.
• It's important to ask older adults what matters to them!
• Ageism: Stereotypes, feelings, and actions based on age

Week 2: 6-8 items

• Assessment techniques and barriers for older adults should be understood.
• Utilize the opportunistic exam: capitalize on opportunities so you don't have to return
• Techniques include: listening patiently, allowing for pauses, asking unasked questions, observing for minute details, using all available data sources, and cultural etiquette.
• Use good communication skills in a quiet environment with good lighting and at eye level.
• Ensure glasses or hearing aids are on, conduct visits earlier in the day, actively listen, and ask one question at a time.
• The Fulmer SPICES assessment tool focuses on Sleep, Problems with eating or feeding, Incontinence, Confusion, Evidence of falls, and Skin breakdown.
• The FANCAPES assessment tool focuses on Fluids, Aeration, Nutrition, Communication, Activity, Pain, Elimination, Socialization, and social skills.
• The ABCDETT assessment tool focuses on Ambulation, Bathing, Continence, Dressing, Eating, Toileting, and Transfers.
• Assessment barriers often include physical and cognitive limitations.
• Assessment tools are necessary for their intended purpose.
• The Katz ADL measures functionality for ADLs on a scale from 6 (best) to 2 (worst).
• Katz ADL assesses Bathing, dressing, toileting, transferring, continence, and feeding.
• The Lawton's IADL measures the ability to live independently on a scale from 8 to 0.
• Lawton's IADL assesses shopping, using the telephone, cooking, housekeeping, laundry, driving, handling medications and finances.
• The Mini-Cog involves giving the patient three words, asking them to draw a clock, and then recalling the words.
• Scoring: 1 point per word recalled, 2 for a normal clock, 0 for abnormal (3-5 negative for dementia, 0-2 positive).
• The TUG test involves the patient standing up, walking three meters, turning around, and sitting back down.
• <10 seconds: freely mobile, 10-19 seconds: mostly independent, 20-29 seconds: variable mobility, >29 seconds: impaired mobility
• Functional Assessment: Evaluating the level of function and self-care abilities & the ability to complete ADLs and IADLs
• Functional assessment includes conducting TUG tests, Katz and Lawton assessments, assessing Fall risk, cognitive status, and identifying care needs/resources.
• Environmental/Home Safety: Prevent falls and promote safety in the home including flooring, lighting, stairways, electrical cords, kitchens, and bathrooms as well as identifying hazards.
• Normal aging changes impact sensory, musculoskeletal, and neurological functions affecting teaching and learning
• Normal aging causes loss of all senses, specifically vision and hearing
• Changes in musculoskeletal function leads to pain with movement, decreased bone mass, and decreased flexibility.
• Neurological changes may include altered memory and an increase in processing time.
• Atypical presentations may manifest as a vague presentation of illness.

Week 3: 13-15 items

• Altered or non- presentation of illness is important to note.
• Polypharmacy: Using 5+ medications with herbal meds, supplements, OTC, prescribing cascade, multiple conditions, OTC, recent or frequent hospitalizations, and uncoordinated care.
• ADVERSE DRUG EVENT: Risk increased in those with 6+ chronic diseases, taking 12+ meds/day, having lower BMI, higher age, or a history of ADE.
• Beers Criteria: Guidelines used to limit drug interactions and adverse events.
• Changes in the body impact pharmacokinetics & pharmacodynamics.
• Absorption: Decreased GI motility, increased gastric pH due to low acid production, and increased antacid use resulting in increased pH.
• Distribution: Decreased body water, increased body fat, and decreased serum protein.
• Metabolism: Decreased liver blood flow and size increases toxicity.
• P450 slows down (enzymes in the liver), increasing risk with the number of medications.
• Excretion: Decreased renal blood flow and GFR.
• Other effects include changes in receptor sensitivity, iatrogenic concerns, visual/hearing and cognitive function changes, and impact of chronic diseases.
• Medication administration involves starting low and going slow.
• Herbals often interact with anticholinergics.
• Chamomile should be used cautiously with sedatives.
• Gingko biloba may alter blood sugars and cause bleeding.
• St John's Wort should be avoided in adults
• Anticholinergics: Block neurotransmitters such as Antihistamines (benadryl), Antiparkinsons (benztropine), Antimuscarinics(mucinex) and antipsychotic medications like clozapine.
• Medication assessment considers what meds are used and their dose, route, reason, and reconciliation.
• Medication management/adherence involves strategies, organizers, notes, and visibility.
• Adherence: Risk factors include forgetfulness, complicated regiment, visual impairment, language/communication barrier, and competence.

Week 4: 13-15 items

• Age-related changes and adaptations.
• Presbyopia causes loss of vision change affecting near vision. as well as reduced accommodation and pupillary reaction, hardening/thickening/yellowing of the lens, decreased pupil diameter, delayed pupillary reaction, and increased light/glare sensitivity.
• Decreased tear production can occur, but is assisted by artificial tears
• Due to decreased visual acuity and depth perception driving limits are necessary as well as going upstairs becomes dangerous
• ARC risk for injury includes falls so home safety providing lighting and contrast, and paint as well as home medication safety using pill organizers and education with health providers.
• Driving- involvement in fatal crashes increases at age 70 as well as impacts aaccess to healthcare while medications impact driving ability.
• Presbycusis and conductive hearing loss interfere with communication, enjoyment, safety, social interaction, and independence. Risks include age, hereditary,exposure
• Cerumen build up causes conductive, reversible hearing loss.
• Sensorineural hearing loss is caused by damage or atrophy to the inner ear.
• Presbycusis affects men more than women and causes gradual, bilateral, irreversible damage and distorted speech.
• Other causes are ototoxic meds tumors, smoking, and head injuries.
• Assess by asking about symptoms and noticing changes.
• Cerumen impaction is important to eliminate.
• Taste (dry mouth/xerostomia) as hypogeusia occurs around 70 as number and functions are affected.
• Taste buds decreases due to saliva production oral condition, olfactory sense as well as medical conditions which cause malnutrition but is assisted through seasonings, herbs, separate food.
• Good oral health is important. Cataracts-slow and painless unilateral bilaterally with lens opacities affecting light
• Risk factors for cataracts include age, smoking, obesity, diabetes, trauma, sun exposure, and long-term corticosteroid use.
• Symptoms: Blurry vision, Glare, Halos around objects Double vision, Difficulty contrasting colors, Poor night vision.
• Treatment can involve corrective lenses
• Surgical/ Laser education
• Glaucoma causes result in optic nerve damage as increased obstruction increases intraocular pressure usually at standard of 10-20 mmHG- drainage occurs
• Risk factors for cataracts include age, smoking, obesity, diabetes, trauma, sun exposure, and long-term corticosteroid use.
• Symptoms: Blurry vision, Glare, Halos around objects Double vision, Difficulty contrasting colors, Poor night vision.
• Treatment can involve corrective lenses
• Surgical/ Laser education
• Glaucoma causes result in optic nerve damage as increased obstruction increases intraocular pressure usually at standard of 10-20 mmHG- drainage occurs
• Open-angle glaucoma is the most common type, causing slowed drainage of aqueous humor that causes painless and gradual peripheral vision loss Closed angle Glaucoma obstructs drainage with blurred vision along with unusual headache, vision blurring,unilateral, photophobia Factors that are risky is increased ICP and the glaucoma must be managed.
• Macular degeneration: Can be dry (most common and unknown cause) or wet (severe acute vision loss due to leaking blood/serum).
• Risks include older than 60, family history, and hypertension.
• Symptoms: Blurry or distorted vision with Diagnosis that are managed.
• Can be treated with UV light.
• Meniere's involves vertigo, tinnitus, and spasmodic eye movement treated through antivirals and diuretic along with a low sodium. Safety is a priority.
• Management with impaired hearing includes asking about use, as they affect assesment and can cause dementia