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207 Comprehensive Geriatric Assessment: hearing, urinary incontinence, vision, cognition, fall risk, functional capabilityElderly person taking tons of medications NBS to reduce falls: review medications!PolypharmacyBeers criteria = high-risk medications in elderlyElderly abuseMandated reporting: elderly abuse + child abuse??Functional capabilityDx: ADL = activities of daily livingBasic = things you need to live independently i.e. shower, dress, bathroom, feed, pee/poop on your ownInstrumental = necessary for interaction with society i.e. medications, clean apt, manage finances, make foodCognitive functionDx: MMSE> 24< 24: cognitive dysfunction Vs. mini-cog: words, clock, recall wordsNBS: r/o reversible causes = B12, TSH, medications, BMP (hyponatremia)VisionEt: macular degeneration, presbyopia, cataracts, etcHearingMCC presbycusis = sensorineural hearing loss --> loss of high-frequency hearingDx: Any issues w hearing?Whispered voice testDepressionRF: chronic diseaseHave you felt hopeless, depressed over past 2wk?Have you lost interest in things over past 2wk?SIG-E-CAPSTx: SSRIc/I TCA (ae: sedation, orthostatic hypo-falls, delirium)Fall riskDx:History of falls in the past year?Get up and go test: get up from chair --> walk 10 feet --> come back to chair >20 sec = abnormalAssoc w/ impaired ADLr/o vision lossPpx: exercise regularly, physical therapy, supplement w/ vitDUrinary incontinenceUrge incontinence = hypertonic detrusor muscle --> overactive bladderTx: bladder training exercises/timed voiding, oxybutynin/tolterodine (generally c/I in elderly d/t anticholinergic-delirium)Stress incontinence = incontinence with effort Tx: kegel exercise, sling procedureOverflow incontinence = neurologic --> hypotonic detrusor muscle --> high post-void residualTx: self-catheterization, timed voidingFunctional incontinence = normal exam, but still cannot get to toilet in timeTx: caregiver, timed voiding, commode by bedsideEOL careLiving will/advanced directive: measures to prolong life, ventilator?Healthcare power of attorney/healthcare proxyHealthcare proxy limited to health decisions; negated if decision-making capacity returnsVs. power of attorney: health, finances, etcPOLST = physician orders for life-sustaining treatment Signed when pt is superrrrr old/terminal illness in the case of sudden decline*healthcare provider MUST be present when pt fills this outDrivingc/i: opioids, benzos, MSK pain that prevents proper head movement--> report to DMVPressure ulcersRF: old age, limited mobility, sensory inability, severe PAD, malnourishmentPpx: do not apply continuous pressure, reduce friction w surface, reduce shear forces, nutritionDx:Erythema on skin, non-blanchableLoss of partial thickness of skin @epidermis/dermisLoss of entire layer of skin -->--> necrosis of subcutaneous tissue; no fascial involvement (bone, tendon, muscle)Fascial involvementTx: debridement! Occlusive dressings, etc. prevent cellulitis.Surrogate decision maker? Next of kin SpouseAdult childrenParents Siblings ................
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