Please wait while we gather your results.
Recently Published Fast Facts
Underlying science: Normal sound conduction is frequency mapped from the cochlea through the midbrain to the auditory cortex. Damage to the cochlea can result in loss of central inhibition to damaged areas, and cortical plasticity to neighboring active cortical regions.
This Fast Fact determines appropriateness of invasive cardiac intervention in the geriatric cardiology patient through assessment of their overall physical health, cognition and function and social situation.
Clinicians should understand the necessary positioning and mobility requirements for patients undergoing a fluoroscopic study, as geriatric patients are more likely to have mobility and musculoskeletal constraints that limit the ability to perform ordered studies. Knowledge of positioning may help clinicians anticipate the benefit of each study in a particular patient.
Please wait while we gather your results.
A “fall” is defined as an unexpected change in position from one level to another lower level. According to the CDC, 1/3 of adults aged 65 years and older fall annually.
Geriatrics Topics- Falls, Balance, Gait Disorders
- Prevention, Safety, and Transitions of Care
Review of Systems- Cardiovascular
- Head, eye, ears, nose, throat
- Musculoskeletal
- Neurologic
Basic Science Principles- Connective tissue changes
- Impaired homeostasis
ACGME Competencies- Medical Knowledge
- Patient Care
Post-stroke depression (PSD) may be associated with an increased risk of death, including death by suicide.
Geriatrics Topics- Falls, Balance, Gait Disorders
Review of Systems- Musculoskeletal
- Neurologic
Basic Science Principles- Connective tissue changes
ACGME Competencies- Practice-based Learning and Improvement
Negative predictors of outcome include: older age, history of previous stroke, urinary or bowel incontinence, visuo-spatial deficits, cognitive impairment, speech impairment, depression, coronary artery disease, and absence of a supportive caregiver5.
Geriatrics Topics- Falls, Balance, Gait Disorders
Review of Systems- Musculoskeletal
- Neurologic
Basic Science Principles- Connective tissue changes
ACGME Competencies- Practice-based Learning and Improvement
The incidence of gait abnormalities in older adults has been estimated at over 15% over age 64, to more than 35% in those over age 70 [Verghese J et al] and more than 40% above age 85. Gait abnormalities are commonly linked to falls and subsequent injury risks in elderly populations and gait should be assessed at each clinic visit.
Geriatrics Topics- Falls, Balance, Gait Disorders
Review of Systems- Musculoskeletal
- Neurologic
Basic Science Principles- Connective tissue changes
ACGME Competencies- Practice-based Learning and Improvement
The geriatric population may be more vulnerable to ischemic damage because cellular antioxidant defenses decline with age. This suggests the elderly patient may be more susceptible to AKI due to decreased functional renal reserve, attenuated hemodynamic auto regulation, and decreased antioxidant defenses.
Geriatrics Topics- Complex or Chronic Illness in Older Adults
Basic Science Principles- Post-mitotic tissue and age related degeneration
ACGME Competencies- Medical Knowledge
- Patient Care
- Practice-based Learning and Improvement
Data from the United States Renal Data System (USRDS) showed a higher mortality risk for patients 65-74 years old with higher eGFR start times (table 1)2. This may be due to accelerated loss of eGFR following initiation of dialysis.
Geriatrics Topics- Complex or Chronic Illness in Older Adults
- Palliative and End of Life Care
- Prevention, Safety, and Transitions of Care
Review of Systems- Renal and Urinary
- Sexuality
Basic Science Principles- Population Health including Social Determinants
- Post-mitotic tissue and age related degeneration
ACGME Competencies- Communication Skills
- Medical Knowledge
- Patient Care
- Systems-based Practice
Genetic factors, replicative senescence and oxidative stress are all felt to "age" the kidney so that there is arterial sclerosis with hypoxic and ischemic injury that lead to glomerular sclerosis, tubular atrophy, and interstitial fibrosis. The net effect is the decline in renal function (decrease in GFR, decreased diluting capacity and concentrating ability).
Review of Systems- Gastrointestinal
- Renal and Urinary
ACGME Competencies- Medical Knowledge
- Patient Care
- Systems-based Practice
Clinicians cannot use the serum creatinine alone as a measure of renal function in the geriatric patient. No matter what measure is used to estimate the age related physiologic decline in renal function, clinicians must recall that these are estimates. Individual variability exists and patients need clinical monitoring of pharmacotherapy to insure adequate drug dosing and effect, avoidance of toxicities, and optimal patient outcomes. In life threatening situations and for drugs that have significant toxicity, pharmacokinetic profiling with monitoring of drug levels may be needed as an adjunct to estimates of renal function so that precise dosing can occur.
Geriatrics Topics- Aging Principles
- Medication Management
Basic Science Principles- Post-mitotic tissue and age related degeneration
ACGME Competencies- Medical Knowledge
- Patient Care
- Practice-based Learning and Improvement
The Medicare Short-term Stay Survey from 2007 identified nearly 353,000 patients admitted with a rib fracture diagnosis code, with the true incidence of rib fractures likely higher as bony fractures within the thorax are often under-detected using traditional radiography
Basic Science Principles- Connective tissue changes
- Impaired homeostasis
- Post-mitotic tissue and age related degeneration
ACGME Competencies- Medical Knowledge
- Patient Care
Rib fractures elicit intense pain due to the insertion of inspiratory muscles on the rib bone. Inspiration causes force and subsequent movement of the bone, aggravating the fracture and eliciting pain. Adequate pain control is key in prevention of complications.
Review of Systems- Cardiovascular
- Hematologic/lymphatic
- Neurologic
Basic Science Principles- Connective tissue changes
- Impaired homeostasis
- Post-mitotic tissue and age related degeneration
ACGME Competencies- Medical Knowledge
- Patient Care
Over 30% of elderly patients experience delirium during hospitalization. Assessment of a patient’s baseline mental status is vital, as two thirds of confirmed cases of delirium occur in patients with baseline dementia.
Review of Systems- Cardiovascular
- Hematologic/lymphatic
- Neurologic
ACGME Competencies- Medical Knowledge
- Patient Care
Patient needs medications for pain, medical management, etc. but the medications required can cause delirium. Patient has a history of dementia.
Review of Systems- Cardiovascular
- Neurologic
- Renal and Urinary
Basic Science Principles- Impaired homeostasis
- Post-mitotic tissue and age related degeneration
ACGME Competencies- Medical Knowledge
- Patient Care
Meta-analysis data has shown that treating hypertension is imperative for preventing strokes and cardiovascular events.
Geriatrics Topics- Aging Principles
- Medication Management
- Prevention, Safety, and Transitions of Care
Review of Systems- Cardiovascular
- Renal and Urinary
Basic Science Principles- Connective tissue changes
- Impaired homeostasis
ACGME Competencies- Medical Knowledge
- Patient Care
Because symptoms of delirium include decreased attention span and a waxing and waning type of confusion, delirium often is unrecognized or misdiagnosed and commonly is mistaken for dementia or depression. This Geriatrics Fast Fact addresses how to assess delirium.
Geriatrics Topics- Cognitive, Affective & Behavioral Health
Basic Science Principles- Behavioral & Social Sciences including Bioethics
- Impaired homeostasis
- Post-mitotic tissue and age related degeneration
ACGME Competencies- Medical Knowledge
- Patient Care
Falls are the leading cause of injury in the elderly and result in 18,000 deaths due to fall related injuries annually.
Geriatrics Topics- Falls, Balance, Gait Disorders
Review of Systems- Cardiovascular
- Head, eye, ears, nose, throat
- Musculoskeletal
Basic Science Principles- Behavioral & Social Sciences including Bioethics
- Connective tissue changes
- Impaired homeostasis
- Post-mitotic tissue and age related degeneration
ACGME Competencies- Medical Knowledge
- Patient Care
Five patient risk factors that may predispose a patient to fall are listed and paired with ten interventions that decrease fall risk.
Geriatrics Topics- Falls, Balance, Gait Disorders
Review of Systems- Cardiovascular
- Head, eye, ears, nose, throat
- Musculoskeletal
- Neurologic
Basic Science Principles- Behavioral & Social Sciences including Bioethics
- Connective tissue changes
- Impaired homeostasis
ACGME Competencies- Medical Knowledge
- Patient Care
A thorough knowledge of common medications (and their alternative medication) used in the geriatric patients with otolaryngologic diseases can prevent adverse drug events in the elderly.
Review of Systems- Cardiovascular
- Endocrine
- Musculoskeletal
- Neurologic
- Pulmonary & respiratory functions
- Renal and Urinary
Basic Science Principles- Impaired homeostasis
- Post-mitotic tissue and age related degeneration
ACGME Competencies- Medical Knowledge
- Patient Care
This Fast Fact includes a use and dosing chart for water-based, non-water-based, and oil-based ceruminolytic agents.
Review of Systems- Head, eye, ears, nose, throat
ACGME Competencies- Medical Knowledge
- Patient Care
Initial evaluation of an elderly patient complaining of vertigo should focus in differentiated peripheral from central causes to minimize morbidity and mortality associated with serious cardiovascular and neuro-vascular conditions.
Geriatrics Topics- Aging Principles
- Complex or Chronic Illness in Older Adults
- Falls, Balance, Gait Disorders
- Medication Management
- Prevention, Safety, and Transitions of Care
Basic Science Principles- Immunosenescence
- Impaired homeostasis
- Post-mitotic tissue and age related degeneration
ACGME Competencies- Medical Knowledge
- Patient Care
Despite the fact that in up to 40% of patients with syncope no etiology is found, in some studies, cardiac pathology accounts for approximately 10-20% of syncope in the older adult and is associated with higher mortality rates irrespective of age.
Geriatrics Topics- Aging Principles
- Complex or Chronic Illness in Older Adults
- Medication Management
- Prevention, Safety, and Transitions of Care
Basic Science Principles- Immunosenescence
- Impaired homeostasis
- Post-mitotic tissue and age related degeneration
ACGME Competencies- Medical Knowledge
- Patient Care
ED patients who present with dizziness may describe symptoms of syncope, near-syncope, imbalance, weakness, loss of equilibrium, or agitation. It is useful to approach common causes of these symptoms by a systems-based approach.
Geriatrics Topics- Aging Principles
- Complex or Chronic Illness in Older Adults
- Medication Management
- Prevention, Safety, and Transitions of Care
Basic Science Principles- Immunosenescence
- Impaired homeostasis
- Post-mitotic tissue and age related degeneration
ACGME Competencies- Medical Knowledge
- Patient Care
The home environment remains increasingly important as people age.
Geriatrics Topics- Aging Principles
- Medication Management
- Prevention, Safety, and Transitions of Care
Review of Systems- Head, eye, ears, nose, throat
- Musculoskeletal
- Psychiatric
Basic Science Principles- Behavioral & Social Sciences including Bioethics
- Connective tissue changes
ACGME Competencies- Patient Care
- Practice-based Learning and Improvement
Age is an important determinant of outcome in patients with coronary artery disease. Antiplatelet therapy may improve outcomes.
Geriatrics Topics- Complex or Chronic Illness in Older Adults
- Medication Management
ACGME Competencies- Medical Knowledge
- Patient Care
Echocardiography is a non-invasive test that may help to determine treatment of any current conditions as well as provide information regarding overall cardiac morbidity and mortality.
Geriatrics Topics- Complex or Chronic Illness in Older Adults
Basic Science Principles- Connective tissue changes
- Impaired homeostasis
- Post-mitotic tissue and age related degeneration
ACGME Competencies- Medical Knowledge
- Patient Care
This Fast Fact determines appropriateness of invasive cardiac intervention in the geriatric cardiology patient through assessment of their overall physical health, cognition and function and social situation.
Basic Science Principles- Impaired homeostasis
- Population Health including Social Determinants
ACGME Competencies- Medical Knowledge
- Patient Care
This Fast Fact Identifies systemic medications as the etiology of ocular signs and symptoms in a geriatric patient.
Geriatrics Topics- Aging Principles
- Medication Management
- Palliative and End of Life Care
Review of Systems- Endocrine
- Head, eye, ears, nose, throat
Basic Science Principles- Impaired homeostasis
- Population Health including Social Determinants
ACGME Competencies- Medical Knowledge
- Patient Care
Blinding disorders such as glaucoma and macular degeneration increase in prevalence with aging. The high prevalence of these potentially treatable or preventable conditions necessitates frequent ophthalmic examinations and treatments for the geriatric population.
Review of Systems- Head, eye, ears, nose, throat
- Musculoskeletal
Basic Science Principles- Immunosenescence
- Impaired homeostasis
- Post-mitotic tissue and age related degeneration
ACGME Competencies- Medical Knowledge
- Patient Care
Blinding disorders such as glaucoma and macular degeneration increase in prevalence with aging. The high prevalence of these potentially treatable or preventable conditions necessitates frequent ophthalmic examinations and treatments for the geriatric population.
Geriatrics Topics- Medication Management
- Prevention, Safety, and Transitions of Care
Review of Systems- Head, eye, ears, nose, throat
ACGME Competencies- Medical Knowledge
- Patient Care
Clinicians should understand the necessary positioning and mobility requirements for patients undergoing a fluoroscopic study, as geriatric patients are more likely to have mobility and musculoskeletal constraints that limit the ability to perform ordered studies. Knowledge of positioning may help clinicians anticipate the benefit of each study in a particular patient.
Geriatrics Topics- Complex or Chronic Illness in Older Adults
- Injury and Trauma
Review of Systems- Gastrointestinal
- Head, eye, ears, nose, throat
- Pulmonary & respiratory functions
Basic Science Principles- Connective tissue changes
- Post-mitotic tissue and age related degeneration
ACGME Competencies- Medical Knowledge
- Patient Care
Underlying science: Normal sound conduction is frequency mapped from the cochlea through the midbrain to the auditory cortex. Damage to the cochlea can result in loss of central inhibition to damaged areas, and cortical plasticity to neighboring active cortical regions.
Geriatrics Topics- Aging Principles
- Complex or Chronic Illness in Older Adults
- Medication Management
Review of Systems- Head, eye, ears, nose, throat
- Neurologic
Basic Science Principles- Connective tissue changes
- Immunosenescence
- Post-mitotic tissue and age related degeneration
ACGME Competencies- Medical Knowledge
- Patient Care