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CLINICAL MEDICINE- GERIATRICS 2025-2026|
QUESTIONS WITH ANSWERS 100%|A+ GRADED
Geriatrics the branch of medicine or social science dealing with the health and care of the elderly Gerontology the scientific study of old age, the process of aging, and the issues specific to the elderly Geriatric care is most effectively provided within the framework of an ___________ care team that includes members well versed in care coordination who have expertise and knowledge regarding community resources available to assist older adults and their caregivers integrated Frailty An aging-related syndrome of physiological decline, characterized by marked vulnerability to adverse health outcomes. Frail older patients
often present with an increased burden of symptoms including weakness and fatigue, medical complexity, and reduced tolerance to medical and surgical interventions. Awareness of frailty and associated risks for adverse health outcomes can improve care for this most vulnerable subset of patients. Social relationships of aging Social interactions thought to "buffer" stressors Family support emotional support instrumental support informational and organizational support financial support The U.S. Department of Agriculture (USDA) defines food security as... the ability for all persons in a household to have ready access to nutritionally adequate, safe foods through socially acceptable means
Differ from nursing homes or skilled nursing facilities in that they are not licensed to provide skilled nursing care (eg, wound care, rehabilitation, and medication titration) Many frail and dependent older adults are "one caregiver away" from a crisis that leads to placement in ___________________. institutional care Most caregivers are ___________, with an average age of 50 years. female Caregiver Strain Index (CSI) Can be used to more objectively assess for stress and burden A score of >7 should prompt intervention to assist the caregiver Caregivers & Familial Support Resources Temporary stays at senior living center Adding some in home care
Adult Day Care Geriatric care manager - help with decision making Sitter and companion services Support groups National and state toll free lines Caregiver Self-Assessment Questionnaire Elder Mistreatment: Abuse cruel and violent treatment of a person or animal Elder Mistreatment: Neglect fail to care for properly Elder Mistreatment: Exploitation the action or fact of treating someone unfairly in order to benefit from their work Elder Mistreatment: Abandonment
Discharge planning integral component of any rehabilitation program across various settings Potential risks of rehabilitation include aggravation of pain and fatigue Nursing Home/Skilled Nursing Facility a place of residence for people who suffer from physical or mental disabilities, and who require constant nursing care to perform their daily living activities such as taking a bath, getting dressed and going to the bathroom Palliative care Can begin at diagnosis, and at the same time as treatment An interdisciplinary medical specialty that focuses on preventing and relieving suffering and on supporting the best possible quality of life
for patients who are facing a serious and/or life-threatening illness, as well as their families Hospice care Begins after treatment of the disease is stopped and when it is clear that the person is not going to survive the illness. Palliative Care: Goals of care communicate prognostic info with the patient/family in a clear but compassionate way that allows them to express their fears, hopes, and goals for EOL care Palliative Care: Cardiopulmonary resuscitation ensure discussions about cardiopulmonary resuscitation (CPR) have taken place Deactivation of cardiac implantable electronic devices — For patients with cardiac implantable electronic devices discontinuation at the terminal phase of illness is appropriate
Management of the dying patient: Pain Opioids are the mainstay of treating pain. We use a short-acting oral/sublingual opioid, usually morphine in the liquid concentrate form (20 mg/mL). We generally stop sustained release opioids in the dying phase, as they may accumulate excessively. Management of the dying patient: Dyspnea The most common treatments include oxygen and opioids Management of the dying patient: Delirium Treat reversible causes If none, haloperidol 1-2 mg PO or 1mg SC/IV +- Lorazepam Management of the dying patient: Airway secretions Discontinuing non-essential IV fluids or enteral feedings, combined with positioning the patient on their side, may help to move the secretions out of the airway Suctioning
The main determinant of capacity is... cognition, and any condition or treatment that affects cognition may potentially impair decision-making capacity. Capacity Describes a person's ability to a make a decision. In a medical context, it refers to the ability to utilize information about an illness and proposed treatment options to make a choice that is congruent with one's own values and preferences Competency Refers to a legal judgment, informed by an assessment of capacity, relating to whether individuals have the legal right to make their own decisions Informed consent The process by which competent adults make voluntary decisions following adequate disclosure of the relevant information.
This cancer is getting the better of you. The treatments that have helped you in the past are no longer working. I understand your desire to feel better and to be better—but it is not realistic Death, Dying, and Loss: Step 3 Identifying End of Life Goals As your PA, I want to make sure we are always doing the things that might help you, and that we never do anything that either can't help you, or you wouldn't want. So I need to know what things are most important to you, given your illness. How do you want to spend your remaining time? Death, Dying, and Loss: Step 4 Developing a Treatment Plan You have previously said to me that when your time comes, we will let nature take its course. I will make sure that you are comfortable at all times, and that ultimately, you are able to die comfortably. We will not
plan to use cardiopulmonary resuscitation or breathing machines or an intensive care unit. Am I correctly stating your preferences? Failure to Thrive Syndrome manifested by weight loss greater than 5 percent of baseline Associated with increased infection rates, diminished cell-mediated immunity, hip fractures, decubitus ulcers, and increased surgical mortality rates Decreased appetite Poor nutrition Inactivity True or False: Failure to thrive should not be considered a normal consequence of aging, a synonym for dementia, the inevitable result of a chronic disease, or a descriptor of the later stages of a terminal disease. True
Medications Associated with Failure to Thrive Anticholinergics Benzodiazepines Beta blockers High dose diuretics Opioids TCA Evaluation of Failure to Thrive Functional Assessment Cognitive Status Depression Malnutrition Nutrition Weight loss of 5% or more of baseline body weight over 6 to 12 months is associated with increased morbidity and mortality and should prompt clinical investigation May develop because of poor dietary protein or caloric intake, increased metabolic demands as a result of illness or trauma, or increased nutrient losses
Polypharmacy Older individuals are often at risk for drug interactions and adverse events. When prescribing medications to older adults, consider pharmacokinetic and pharmacodynamic changes that are observed with aging. Pressure Ulcers Also known as decubitus ulcers, pressure sores and bedsores Occur on bony prominences due to pressure, shearing, frictional forces, moisture Pressure Ulcers Stage 1 Non blanchable erythema Pressure Ulcers Stage 2 Partial thickness skin loss involving epidermis, may extend to dermis
Treat underlying conditions Wound care with cleansing, debridement, specialized wound care products Antibiotics if infected Pain management, nutritional support Pressure Ulcers treatment (surgical) Ulcers that are large, Stage IV, or non-healing should be referred to surgery Surgical debridement, skin grafting Overview of Wound Care Products for Pressure Ulcers Wet gauze Films: transparent gas-permeable films that mimic skin, for Stage I Foams: polyurethane semipermeable foams, for non infected Stage II or III Hydrocolloids: Self adhesive dressing that forms a gel on the wound surface, for non infected Stage II or III Alginates: highly absorbent material, for Stage III or IV with copious drainage
Silver-impregnated dressing: Contain nanocrystalline silver (antimicrobial), for infected ulcers Pressure Ulcers Patient Education/Prevention Maintain personal hygiene, consider lotions containing fatty acid Adequate nutrition/hydration Evaluate and manage incontinence Position to alleviate pressure, sheering forces Use lifting devices to avoid sheering Pressure Ulcers complications Pain Cellulitis Osteomyelitis Sepsis Delirium Typically caused by acute illness or drug toxicity (sometimes life threatening) and is often reversible
