Deprescribe this!
Lewy Body Dementia is characterized by parkinsonism, visual hallucinations and fluctuating cognition. What class of drugs should not be used for treatment of the hallucinations?
What are antipsychotics?
Antipsychotics such as risperidone, as this can result in worsening parkinsonism and extrapyramidal symptoms (from dopamine D2 receptor blockade).
Rivastigmine is a cholinesterase inhibitor and is a first-line pharmacologic therapy.
According to the USPSTF colorectal cancer screening should not be offered routinely after this age
What is age 75?
This screening tool includes delayed recall, visuospatial skills and executive function and is more sensitive than the MMSE for detecting mild cognitive impairment?
What is the MoCA (Montreal Cognitive Assessment)?
This electrolyte imbalance, common in older adults with infections and exacerbated by SSRIs, increases the risk of delirium, falls and seizures
A new Fair Health study shows that in the U.S.A. this class of preventable disease climbed 4.8% from 2020 to 2023, with a 23.8% surge in people aged 65 and older.
What are STDs?
Cholinesterase inhibitors often cause this common side effect resulting in their discontinuation.
Diarrhea or GI effects
Choosing Wisely: Don’t prescribe cholinesterase inhibitors for dementia without periodic assessment for perceived cognitive benefits and adverse gastrointestinal effect
In a change from their 2014 guidelines, the USPSTF 2022 guidelines advised to not use this medication for primary prevention of cardiovascular disease in patients older than 70.
What is aspirin?
Your patient scores a 21/30 on the Mini mental status exam. You advise them that they have mild dementia which can last up to 7 years before progressing to moderate dementia. You provide anticipatory counseling by defining the characteristics of dementia. Fill in the blank.
Mild – instrumental activities of daily living are impaired
Moderate – _______are impaired
Severe – loss of continence and awareness
What are basic activities of daily living?
According to the American Geriatric Association Choosing Wisely recommendations you should NOT use these when managing behavioral issues in hospitalized older adults with delirium
What are physical restraints?
This simple bedside test asks a patient to stand up, walk 10 feet, turn around and return to the chair. A result over 12 seconds is considered abnormal.
What is get up and go?
A family of an 85-year-old man with dementia comes in due to a concern of worsening appetite. No other evidence of acute illness. According to the American Geriatric Society you should:
a) start an appetite stimulant
b) send to the ER
c) high-calorie supplements
c) none of the above
None of the above
Avoid using prescription appetite stimulants or high-calorie supplements for treatment of anorexia or cachexia in older adults; instead, optimize social supports, discontinue medications that may interfere with eating, provide appealing food and feeding assistance, and clarify patient goals and expectations
This is the best evidence-based intervention to prevent falls in seniors.
Deficiency in this can mimic dementia and cause peripheral neuropathy
What is Vitamin B12?
During COVID-19 this acid-base disturbance frequently affected patients who couldn't tolerate non-invasive ventilation resulting in worsening confusion and a decision to intubate.
What is respiratory acidosis?
Functional decline from hospitalization is best prevented by this early and often-overlooked intervention.
What is early ambulation or ambulation within 24 hours of admission?
This common over-the-counter sedative that is found in most cold or flu treatments is a common cause of worsening cognitive impairment due to its anti-cholinergic effects.
Diphenhydramine (Benadryl) or Doxylamine
What is the greatest predictor of fall risk?
What is a previous fall ?
According to the American Geriatric Society Choosing Wisely campaign you should NOT offer this intervention in patients with advanced dementia; instead offer oral assisted feeding.
What is percutaneous feeding?
Up to 20% of hospitalized older adults are readmitted within 30 days. The most common cause is this is...
Studies have shown that fear of this is the biggest reason why seniors refuse treatments recommended by their doctors.
What is fear of side effects?
Highlighting the importance of open and thorough discussions about potential side effects during shared decision-making with older adults.
What is a prescription cascade?
Presbycusis is age-related hearing loss that typically affects high-frequency sounds first and is associated with social withdrawal and cognitive decline. This simple bedside screening test can identify moderate hearing loss in older adults and requires no equipment.
What is the whisper test?
You consider neuroimaging to evaluate Alzheimer’s Disease as a possible cause of this person’s cognitive impairment. Which test is most sensitive in achieving this goal
What is an Amyloid PET scan?
This specific subtype of delirium, marked by lethargy and poor attention without agitation is often missed.
What is hypoactive delirium?
Your patient has isolated systolic hypertension with a BP of 168/72. What vascular change explains this pattern?
What is arterial stiffening?