Lecture 5

Question 1

What is the MoCA test for?

Montreal cognitive assessment

Answer 1

More sensitive for detecting milder forms of cognitive impairment.

Question 2

What are the 4 main areas of importance in a PE of a geriatric patient?

Answer 2

1. Visual/auditory acuity
2. Gait and ambulation
3. Abdomen - aortic dilation
4. Mental status and cognitive function

Question 3

What affects BP in an older patient?

Answer 3

• Volume depletion
• Aging
• Med use, such as antiHTNs, vasodilators, or TCAs

Question 4

What might suggest poor overall function in a geriatric patient upon physical exam?

Answer 4

• Unkempt
• Poor personal hygiene

Could also indicate depression or caregiver neglect.

Question 5

When an elderly patient presents with diminished turgor, what should we do?

Answer 5

Do it over the chest or abdomen to check if it is due to volume depletion or atrophy of subQ tissue.

You can also check mucous membranes or urine SG.

Question 6

What might occur to the GU system more commonly in the elderly and how does it present?

Answer 6

• Atrophy of the testicles or vagina
• Results in dyspareunia or dysuria

Testicular atrophy is normal.
Atrophic vaginitis may benefit from treatment.
Pelvic Prolapse is common and may be unrelated to symptoms.

Question 7

When should labs not be ordered for elderly patients in general?

Answer 7

If their life expectancy is < 10 yrs, only order labs if they will improve prognosis or quality of life.

Question 8

What might be the only sign of a stroke in a geriatric patient?

Answer 8

Arm drift.

Question 9

What common lab test is often reflective of nutritional status in an elderly patient?

Answer 9

Serum albumin

Question 10

Are interstitial lung changes common or abnormal in a geriatric patient?

Answer 10

Common.

Question 11

What lab tests are UNAFFECTED by aging?

Answer 11

1. Hgb/Hct
2. WBC
3. Platelets
4. Lytes
5. BUN
6. LFTs
7. FT4
8. Ca
9. P

Abnormality requires no additional workup.

Question 12

Decrease in what lab studies is not due to aging and suggests undernutrition or GI blood loss?

Answer 12

Decreases in serum iron/iron-binding capacity/ferritin.

Question 13

Which of these is considered abnormal in an aging patient:

• Asymptomatic pyuria
• Bacteriuria
• Hematuria

Answer 13

Hematuria is the most abnormal and warrants further eval.

The other two are common.

Question 14

What is an ADL and an IADL?

Answer 14

• ADL = Activities that people need to be able to do to take care of themselves.
• IADL = Activities that allow an individual to live independently in the community.

ADLs = ambulation, bathing, dressing, eating, transferring, continence, toileting.

IADLs = transportation, shopping, cooking, using the telephone, managing money, taking meds, cleaning, laundry

Question 15

Who generally performs an environmental assessment for a geriatric patient and when is it indicated?

Answer 15

• PT, OT, or speech therapy.
• Usually performed if NO reversible cause for loss of ADL or IADL can be found.

Question 16

What situations would prompt us to reassess ADLs and IADLs?

Answer 16

• Post-admission
• Severe illness
• Loss of spouse or caregiver

Question 17

What point totals on a mini nutritional assessment suggest that a patient is at risk of malnutrition? Malnourished?

Answer 17

• 8-11 = risk
• 0-7 = malnourished

Question 18

What BMI and weight loss is considered abnormal in a geriatric patient?

Answer 18

• BMI < 20
• Unintentional weight loss of 10 lbs in < 6 months.

Question 19

What two micronutrients are highly recommended to take for an elderly patient?

Answer 19

• Ca++
• Vit D
• Multivitamins should cover the rest.

NIH recommended.

Question 20

What happens to body weight as we get older?

Answer 20

Plateaus around 60yo for 10 years, then begins declining.

Question 21

What macronutrient changes are recommended for geriatric patients?

Answer 21

• NO changes!
• Continue to eat omega-3 and 6 since we cannot synthesize.
• Fat < 30% of total intake
• Carbs should be around 55% of total calorie intake

Question 22

When should food supplements be taken relative to a meal?

Answer 22

1 hour prior

Not a replacement for actual food!

Question 23

How should we approach bereavement in a geriatric patient?

Answer 23

Intervene early

Question 24

What score on a geriatric depression scale is suggestive of depression?

Answer 24

Greater than 5.

Question 25

How might depression present in a geriatric patient?

Answer 25

* Fatigue, weakness, anorexia, wt loss * Pain all over * Apathy * Feelings of guilt * Lack of concentration | Often deny dysphoria.

Question 26

How do we approach widowhood?

Answer 26

* Encourage volunteering and social engagement. ## Footnote Better outcomes seen in people who were previously independent.

Question 27

Define elder abuse.

Answer 27

Intentional or neglectful acts by a caregiver or trusted individual that may lead to led to harm of a vulnerable, older adult. ## Footnote Often self-reported.

Question 28

What are the 5 types of elder abuse?

Answer 28

* Physical * Sexual * Psychological/emotional * Financial * Neglect

Question 29

What kind of geriatric patients are most susceptible to elder abuse?

Answer 29

Those with cognitive impairment.

Question 30

What suggests physical elder abuse?

Answer 30

* Patterns of bruising or burns * Unexplained injuries * Open wounds/cuts * Untreated injuries

Question 31

What suggests sexual elder abuse?

Answer 31

* History of unusual sexual behavior * Bruises around genitals/breasts * Unexplained STIs * Unexplained anal/vaginal bleeding * Bloody underwear * Pain with walking or sitting

Question 32

How do we screen for elder abuse?

Answer 32

Elder abuse suspicion index (EASI) | A yes to questions 2-6 = red flag ## Footnote Interview patient **alone** to prevent intimidation

Question 33

Who can we contact to help with elder safety?

Answer 33

Adult protective services (APS) | Every state has one.