Approach to the Geriatric Patient Flashcards
In general, older people are more likely to present with ___________ problems.
multifactorial (as in, not confined to a single cause)
Older people have a long lag between _____________.
treatment and improvement
In older adults with serious infections, ___________ is often absent.
fever
As such, fever in an elderly person is defined as greater than 99º. Amazingly, lowering the fever threshold to 99º does not lower the specificity.
A study on iatrogenic immobility showed that _________________.
those 65 and older spent 83% of their hospital admission flat on their backs; 13% of their time sitting; and only 3% of the time standing or walking
Research shows that muscle mass begins to decline after ________ supine.
24 hours
The HYVET study showed that ______________.
people 80+ with HTN greater than 160 benefited from treatment; this lecturer thinks that some doctors take this study too far, because many elderly people will have high blood pressure in the hospital but be hypotensive at home (thus making antihypertensive therapy dangerous)
Also, the HYVET study excluded people with even moderate orthostatic hypotension and only included community-dwelling adults.
What are the ADLs?
- Bathing
- Dressing
- Transfering (out of bed)
- Toileting
- Grooming
- Feeding
If the patient can’t do these, then likely they will not be able to be discharged. Often bathing is the first to go.
What are IADLs?
Instrumental activities of daily living: •Using the telephone •Shopping • Food preparation •Housekeeping • Doing laundry • Utilization of transportation • Ability to medicate •Ability to handle finances
What is the brown bag review?
Once or twice a year, geriatricians ask their patients to bring in all their medications in a brown bag.
During the “get up and go” test, doctors ask older patients to stand and walk 10 ft and then sit back down. If a patient takes longer than _________, they are at increased risk of falls.
10 seconds
If it’s greater than 20 seconds, consider a referral to physical therapy or other ancillary services.
The most common symptom of myocardial infarction in the elderly is _____________.
dyspnea
Decreased hospital mobility has been shown to ______________.
increase functional decline
How should you confirm physical activity in hospitalized elderly people?
- Order PT and confirm follow-up
- Encourage them to ambulate
- Discontinue IVs, catheters, etc. when possible
A positive depression screen is considered ______________.
answering yes to either “in the last two weeks have you felt (1) hopeless or depressed or (2) have you felt little interest in doing things?”
______________ should be screened for osteoporosis.
Women over 65
