Geriatrics Review

QuickHitterLogoWe had a great lecture yesterday reviewing important high-yield concepts on Geriatrics from Dr. Ami DeWaters. Some highlights:

  • Older person with some concern for their driving? Refer to OT for driving therapy
  • Cognitive rehabilitation is helpful for MCI (mild cognitive impairment)
  • To remind: dementia is < 24, and negativity affects of daily life
  • Medication effect common with patients >65 yo  for example taking gabapentin (17% of acute hospitalization lined to ADE)
  • Pressure ulcer stages: Stage I (non-blanchable redness), II (blister, partial dermis loss III (sub cut fat visible), IV (involve bone, tendon, joint). Debridment of Stage III and IV, no hyperbaric O2, neg pressure or vitamin C/zinc do not help. Surgical flap for those who failed conservative therapy
  • Vitamin D and exercise or PT recommended to prevent falls for > 65 yo  (USPSTF) – improves muscle strength and stability. Although new study from Denmark showed low and high levels of 25(OH)D were association  (reverse J-relationship) with cardiovascular disease, stroke, and acute myocardial mortality*
  • Palpable breast mass in >40 y.o –> go to FNA even if mammogram negative
  • Elderly with palpitations + syncope? Require inpatient cardiac monitoring
  • Advanced Alzheimer’s dementia worsening: start discussion about hospice care

Bonus: 26 yo w/ sort throat, fever, neck pain without exudate, Lemierre’s Syndrome: Jugular vein suppurative thrombophlebitis, frequently with antecedent pharyngitis, median age 20 years old. (commonly caused by fuosbacterium species). Diagnose with CT neck. Treat with Augmentin or Zosyn (if catheter associated, add Vanc). Note: plain neck films are usually for epiglottitis, peritonsilar abscess (presents with drooling and muffled voice)

*http://press.endocrine.org/doi/10.1210/jc.2014-4551