Perfect Endings. Home Alone. Senior Estimate. Staying Alive. Medication Madness

Transcription

1

2 Senior Estimate Home Alone Staying Alive Perfect Endings Medication Madness

3 Senior Estimate - 10 Patients who have multiple interacting medical and psychosocial problems that are amenable to treatment and/or disorders that require rehabilitation therapy are the group most likely to benefit from what type of intervention?

4 Senior Estimate - 10 Comprehensive Geriatric Assessment (CGA) Other indications for CGA include: transitional living situation, recent onset of physical or cognitive impairment, patients with fragmented or complex specialty care, evaluation of competency/capacity, other medico-legal issues.

5 Senior Estimate - 20 About what percent of hospitalized older adults will lose the ability to perform an ADL during their hospitalization? (+/- 3%)

6 Senior Estimate %

7 Senior Estimate - 30 Which cognitive screening tool was originally made to assess for Mild Cognitive Impairment (MCI)?

8 Senior Estimate - 30 Montreal Cognitive Assessment (MoCA)

9 Senior Estimate - 40 Name the 6 Activities of Daily Living (ADLs)

10 Senior Estimate - 40 Bathing Ambulating Transferring Toileting Eating Dressing

11 Senior Estimate - 50 Progressive constriction of physiologic reserve that occurs with aging in every organ system.

12 Senior Estimate - 50 Homeostenosis

13 Home Alone - 10 Mrs. C is an 89 year old woman who can no longer live alone and her family is unable to care for her. She is dependent in all of her IADLs and in 4 of her ADLs (bathing, dressing, toileting, and ambulating). What is the best living situation for her?

14 Home Alone - 10 Nursing Home/Long Term Care Explanation: Nursing homes are for those who are dependent in IADLs and 4 or more ADLs.

15 Home Alone - 20 Name 3 different bathroom safety devices

16 Home Alone - 20 Shower Chair Transfer Benches Grab Bars Elevated Toilet Seat Bathtub Lifts Handheld Shower Heads Walk-in Tubs Nightlight Nonslip mat/decals/strips

17 Home Alone - 30 Mr. R is a 75 year old man with moderate Alzheimer s Type Dementia. He recently started wandering, but he forgets to use his walker and is falling more frequently. His daughter is now unable to care for him at home. He is dependent in all IADLs, and in 4 ADLs (bathing, dressing, toileting, walking). What is the best living situation for him?

18 Home Alone - 30 Memory Care Unit Explanation: Despite having 4 ADL dependencies, he is still somewhat mobile. Therefore a memory care unit with locked doors would be the safest location for him.

19 Home Alone - 40 Mr. S is an 83 year old man with newly diagnosed mild cognitive impairment (MCI). He is very concerned about future planning while he still can. In addition to working with his healthcare team on advanced care planning for health related issues, what other type of professional can he turn to for help with planning for financial and living arrangements?

20 Home Alone - 40 Elder Care Attorney Also known as an Elder Law Attorney; help older adults and their families navigate the complicated financial and legal decisions they face such as care coordination, government benefits, guardianship and financial representation.

21 Home Alone - 50 About how many informal caregivers in the United States care for loved ones in their last year of life?

22 Home Alone - 50 Half a million Explanation: Hospice care is mostly provided by informal caregivers such as spouses, adult children, and other relatives. 98% of hospice care occurs in the home with these informal caregivers as the primary caregivers.

23 Staying Alive - 10 Term for age related loss of lean muscle

24 Staying Alive - 10 Sarcopenia

25 Staying Alive - 20 What is the best type of exercise to help prevent falls?

26 Staying Alive - 20 Balance Exercises Explanation: 30 percent of people ages 65 to 80 and 50 percent of those over 80 will experience a fall each year. Of note, walking programs have not been shown to reduce fall risks, and this is thought to be because walking does not require shifts in balance and center of gravity.

27 Staying Alive - 30 What is considered abnormal weight loss in an older adult?

28 Staying Alive % of total body weight in 1 month OR 10% of total body weight in 6 months Explanation: Weight loss of these amounts indicates nutritional risk and predicts morbidity and mortality, functional limitations, increased health care costs, and increased need for hospitalization. Weight loss of 5% over 3 years is associated with increased mortality. Don t forget to trend weights in your geriatric patients.

29 Staying Alive - 40 In 2015 what was the average remaining life expectancy of a 75 year old in the United States? (+/- 1 year)

30 Staying Alive years Explanation: CDC Life Tables from /015.pdf

31 Staying Alive - 50 What is the oldest documented age any human has ever lived to?

32 Staying Alive years old Jeanne Louise Calment

33 Perfect Endings - 10 Name an online resource for determining prognosis in the non-palliative geriatric population

34 Perfect Endings 10 e-prognosis Explanation:

35 Perfect Endings - 20 One out of five hospice patients will experience disenrollment. Name a common reason for disenrollment from hospice.

36 Perfect Endings 20 Patient preferences Dissatisfaction with hospice care Admission to a hospital that does not have a hospice contract Becoming ineligible for the Medicare Hospice Benefit.

37 Perfect Endings - 30 A prognostic scale that predicts the number of days of life remaining in palliative patients using these five domains: Ambulation, Activity & Evidence of Disease, Self-Care, Intake, Conscious Level

38 Perfect Endings 30 Palliative Performance Scale

39 Perfect Endings - 40 Physicians typically overestimate prognosis in patients. By how much do they overestimate prognosis on average?

40 Perfect Endings 40 On average physicians overestimate prognosis by a factor of 3.

41 Perfect Endings - 50 When determining if a preventative treatment or screening is appropriate in the older population, what prognostic strategy is most useful? (Ex. When determining whether or not an older woman should continue to get mammograms, or whether or not to start a statin for hyperlipidemia in an older adult?)

42 Perfect Endings 50 Time to Benefit

43 Medication Madness - 10 Term for the use of multiple medications, or at least one medication that is not clinically indicated?

44 Medication Madness 10 Polypharmacy Explanation: Community-based elderly take an average of 2 to 9 prescription medications daily almost 90% take > 1 OTC medication almost 50% take 2 to 4 OTC medications 47 to 59% take a vitamin or mineral 11 to 14% take herbal supplements

45 Medication Madness - 20 Which formula for calculating creatinine clearance is the best choice to use in older adults?

46 Medication Madness 20 Cockcroft-Gault Equation Explanation: The egfr is most frequently reported on lab, but has not been validated in adults over the age of 70. The Modification of Diet in Renal Disease (MDRD) equation has not been verified in a geriatric population. The Cockcroftgault equation takes extremes of age into account, and it is the equation the FDA uses when determining renal drug dosing. Of note, adjusted body weight should be used in the cockroft-gault equation when actual body weight is >20-25% of ideal body weight. CrCl = Male: (140-age)(weight in kg) 72 x serum creatinine (mg/dl) Female: CrCl = 0.85 x calculation for males

47 Medication Madness - 30 Does the lean muscle to body fat ratio increase or decrease with age?

48 Medication Madness 30 Decrease Explanation: As we age there is loss of lean muscle (sarcopenia), increased body fat, and decreased total body water. Therefore the volume of distribution of lipid soluble drugs like diazepam increases leading to longer half-lives and duration of action. The volume of distribution of water soluble drugs like digoxin and lithium decreases leading to increased peak concentrations of these drugs.

49 Medication Madness - 40 Name two different explicit criteria for helping to reduce potentially inappropriate medication use in older adults.

50 Medication Madness 40 Beers Criteria and STOPP/START Criteria Explanation: Beers Criteria for potentially inappropriate medication use in older adults was first developed in 1991 for elderly nursing home residents. It was expanded in 1997 to include all patients >=65 years of age. In 2002 and 2012, US Consensus Panel of Experts revised and updated criteria and in 2015 there was a comprehensive systematic review done with grading of evidence and support from the AGS. It now incorporates the following categories: Potentially inappropriate medications and classes to avoid in older adults Potentially inappropriate medications and classes to avoid in older adults with certain diseases and syndromes Medications to be used with caution in older adults Drug-drug interactions that are highly associated with harmful outcomes in older adults Potentially inappropriate medications based on kidney function STOPP/START Criteria stands for Screening Tool of Older Persons potentially inappropriate Prescriptions and Screening Tool to Alert doctors to the Right Treatment. This list was updated in 2014 to include new drugs and a more extensive list of potentially inappropriate medications.

51 Medication Madness - 50 What is the prevalence of Adverse Drug Reactions (ADRs) in elderly patients admitted to the hospital? (+/- 2%)

52 Medication Madness 50 20% Explanation: Some studies suggest that 3-17% of all hospital admissions are for ADRs and older adults are twice as likely as others to come to emergency departments for adverse drug events. Some studies suggest that 20% of admissions of older adults involve an ADR.