Show This episode of CRACKCast covers Rosen’s chapter 183, approach to the geriatric patient. Our geriatric patients can often mask serious diagnoses with vague presentations and multiple co-morbidities. Shownotes–PDF HERERosen’s In PerspectiveTaking care of the elderly is hard! Given the Silver-Tsunami that is currently crashing down on us, we better get comfortable with this population. But our classic history & gestalt can be difficult in the population
Screening tools are important: Box 183.1 Identification of Seniors at Risk (ISAR) Tool
Each “yes” response counts as 1 point, for a total score ranging from 0 to 6. A patient is considered at high risk when the score is 2 or more. Adapted from McCusker J, Bellavance F, Cardin S, et al: Detection of older people at increased risk of adverse health outcomes after an emergency visit: the ISAR screening tool. J Am Geriatr Soc 47:1229–1237, 1999. bCAM Assessment (Brief Confusion Assessment Method) Figure 183.2 Need both of:
AND need one or more of:
CAM Screen is positive if BOTH features 1 and 2 plus 3 or 4 are positive. [1] List 10 items found on a functional assessment of the elderly (ADLs & IADLS).Table 183.1: Functional Assessment
[2] List 6 factors that lead to altered pharmacokinetics in the elderly.
[3] List reason why the elderly are predisposed to adverse drug reactions.
[4] List 15 Physiologic changes of aging that affect illness in the elderly, and list age-related changes to the cardiovascular system.
Table 183.2: Age-related changes to the cardiovascular system.
[5] Describe an approach to generalized weakness in the geriatric patient based on onset and focality.See Figure 183.3 Focal Weakness Acute Focal Causes
Acute Bilateral Causes
Non-Focal Weakness Acute Non-Focal Causes
Chronic Non-Focal Causes
[6] List 8 predisposing risk factors for sepsis in the elderly.See Figure 183.4
[7] What is sundown syndrome?As per uptodate “Sundowning — Delirium should be distinguished from “sundowning,” a frequently seen but poorly understood phenomenon of behavioral deterioration seen in the evening hours, typically in demented, institutionalized patients. Sundowning should be presumed to be delirium when it is a new pattern. Patients with established sundowning and no obvious medical illness may be suffering the effects of impaired circadian regulation or nocturnal factors in the institutional environment (eg, shift changes, noise, reduced staffing).” Wisecracks[1] What are the most common medications implicated in adverse events for the elderly?
[2] List the reasons why diagnosing abdominal pain may be difficult to diagnose in the elderly.
[3] List the most common abdominal pathologies in the elderly.60% is surgical!
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CRACKCast Co-founder and newly minted FRCPC emergency physician from the University of British Columbia. Currently spending his days between a fellowship in critical care and making sure his toddler survives past age 5.
Chris Lipp is one of the founding Fathers for CrackCast. He currently divides his time as an EM Physician in Calgary (SHC/FMC) and in Sports Medicine (Innovative Sport Medicine Calgary). His interests are in paediatrics, endurance sports, exercise as medicine, and wilderness medical education. When he isn’t outdoors with his family, he's brewing a coffee or dreaming up an adventure….. How do you talk to a geriatric patient?Use proper form of address. Establish respect right away by using formal language. ... . Make older patients comfortable. ... . Take a few moments to establish rapport. ... . Try not to rush. ... . Avoid interrupting. ... . Use active listening skills. ... . Demonstrate empathy. ... . Avoid medical jargon.. What are the 5 I's of geriatrics?German-speaking physicians encapsulate them in the “five I's”: immobility, instability (falls), incontinence, intellectual impairment, and iatrogenic complications, e.g., resulting from inappropriate medication.
What are special considerations for geriatric patients?Issues of Concern
Geriatric assessment should include detailed medical history and physical examination, with particular focus on problems specific to the elderly such as vision, hearing, nutrition, fall prevention, urinary incontinence, osteoporosis, and preventative health.
What are the principles of geriatric nursing care?Principles of Geriatric Care. Biopsychosocial approach: the integration of consideration of physical, psychological, and social factors in providing health care.. Use of multidisciplinary teams.. Importance of chronic illnesses and geriatric syndromes.. Importance of showing respect to older patients.. |