Geriatrics

admission is a sentinel event. 30-60% of elderly admitted patients lose the ability to live independently.

AVOIDABLE dependence which often occurs during the course of care.

• 1) pre-existing patient frailty (pre-existing vulneribility to stressors, gait speed to assess)
• 2) Severity of the condition that led to admission
• 3) Hospitalization and Past hospitalization (we sometimes just focus on getting these people out early and just treating the acute condition, people become deconditioned in bed)

• 1) identify at-risk populations
• 2) Establish reference quality standards
• 3) Implement single factor or multi-domain interventions to targeted populations
• 4) Adopt senior friendly principles and continuity of care

• In the first 48 hours you want to address the first five of the following:
• -pain
• -mobility (assess within first 24/24)
• -Cognition
• -Elimination
• -Eating/drinking
• -medical management
• -functional assessment
• -Sleep

1-5% loss in strength per day

• Need first 2
• 1) acute onset and fluctuating course
• 2) Inattention (easily distractable, cant do months backwards)
• also ONE of the following
• 3) disorganized thinking
• 4) altered LOC

haldol bridge (0.5 - 1.0 mg IM or po Q 30 min until calm is achieved)

dont give if parkonsinism is present, watch ECG and tardive dyskinesia (increases stiffness is first sign). NEVER GIVE PRN!!

• 1) promote sleep
• 2) provide aids for sensory impairment
• 3) promote hydration
• 4) promote daytime activity
• 5) no unnecessary catheterization

• 1) 25% readmitted within 30 days
• 2) they are usually rushed
• 3) involve multiple disciplines
• 4) failure to communicate b/n providers and b/n provider and patient
• 5) patients rarely actually know what the plan is

• 1) Choose best care setting
• 2) Arrange services
• 3) Patient and family education (get them to teach it back to you)
• 4) Clinical summary for community caregivers
• 5) Med reconciliation (what was stopped/started and why?)
• 6) Follow up medical care (dates and times for appointments)

• 1) independent living 
• 2) semi-independent living (longest waiting list, some tasks taken care of)
• 3) Personal care homes (private business that provides 24 hour support)
• 4) Special care home (nursing home), people need heavy levels of care

helps patients navigate the continuum of care and access services that help you stay at home

• 1) AD (50%) (gradual onset, aphasia, apraxia, agnosia)
• 2) Vasc Dem (acute onset, cardiac RF's, neuroimaging findings)
• 3) PPD/DLB (hallicinations, parkinson, fluctuations)
• 4) FTD (behaviour probs, early onset, family Hx)

• EVERYTHING!
• big ones are:
• 1) infection
• 2) poor nutrition/dehydration
• 3) limited mobility
• 4) multiple meds
• 5) pain
• 6) sleep probs

• Safe environmant
• Assist with mobility
• Fall risk reduction
• Engage patients and families

• 1) universal fall precautions
• 2) Screen all patients for risks of falls
• 3) Multifactorial risk assessment (SPLAAT hx)
• 4) Create custom care plan addressing specific fall RF's
• 5) Document, evaluate, and educate about falls risk

• Ask 3 questions:
• 1) 2 or more falls in past year
• 2) presents with an acute fall
• 3) difficulty with walking or balance

if no to all and they have had a fall in the past 6 months, do a TUG

• SPLAATT
• Sx immediately prior to fall
• Previous falls and near falls
• Location of falls
• Activity at time of fall
• Ability to get up
• Timing of the fall and Time to get up
• Trauma/injury due to fall

• wall to occiput distance (>5cm is bad)
• rib-pelvic distance (2 finger breadths is bad)

• from sitting to standing:
• change of >10 diastolic
• change of >20 systolic
• change of >30 heart rate

• <10 is freely mobile
• <20 is good mobility
• >30 impaired, needs gait aid

7-8% (closer to eight)

• ASIA A - complete (no motor or sens in S4-S5)
• ASIA B - incomplete (sensory but no motor)
• ASIA C - incomplete (sens and motor and more than half muscles have grade less than 3)
• ASIA D - incomplete (C but over half of muscles have grade 3+)
• ASIA E - motor and sens are normal