How To Treat An Elderly Patient

Transcription

1 1. Introduction/ Getting to know our Seniors a. Identify common concepts and key terms used when discussing geriatrics b. Distinguish between different venues of senior residence c. Advocate the necessity of geriatrics as a true specialty d. Compose an example of a prescribing cascade e. Explain Medicare Part D to a senior or a fellow senior- focused practitioner and help them find a drug plan using online tools 2. Geriatric Assessment 1 (& 2) a. Distinguish the ways in which clinical presentations of illness differ in the older patient b. Interpret common physical, laboratory, and functional findings when assessing the older patient c. Employ assessment tools validated for the older patient d. Incorporate Geriatric Assessment principles into the Drug Regimen Review e. Differentiate tools and standards for assessing Medication Appropriateness f. Formulate a structure for assessing Medication Related Problems and communicating interventions 3. Geriatric Assessment 2 4. Cognition Reversible Dementias a. Compare and contrast dementia and depression b. Identify the putative mechanisms of drug induced cognitive impairment for a variety of drug classes c. Apply the Anticholinergic Risk Scale d. Distinguish drug induced Parkinsonism from PD and identify common causative agents 5. Cognition Irreversible Dementias

2 a. Distinguish clinical presentations of the most prevalent dementia variants b. Recommend drug therapy interventions for patients with Dementia with Lewy Bodies c. Evaluate the literature describing the cognitive outcomes associated with the treatment of vascular risk factors d. Discuss the literature evaluating duration of therapy for cholinesterase inhibitors or memantine 6. Affective Depression a. Recognize key features of depression presentation and diagnosis in the elderly b. Describe the associations between depression and common comorbidities in the elderly c. Compare and contrast assessment tools used in geriatric depression d. Determine an appropriate antidepressant for a senior with depression based on efficacy and side effect profiles 7. Affective Anxiety a. Describe the prevalence of, and diagnostic procedures for, late- life generalized anxiety disorder (GAD) and panic disorder (PD) b. List medication/disease causes of late- life GAD and PD c. Select an appropriate treatment regimen for GAD or PD in the elderly population d. Identify key characteristics of individual medications within a drug class that make it preferred for use in elders with GAD or PD 8. Affective Insomnia/Behavioral Disturbances a. Identify key characteristics of the available insomnia assessment tools b. Identify medications and disease states that are associated with insomnia in the elderly c. Appropriately recommend non- pharmacological and medication therapy for an elder with insomnia

3 d. Evaluate the necessity for pharmacologic treatment of a patient with dementia and behavioral symptoms e. Given a patient case, recommend a non- pharmacologic or pharmacologic treatment for a patient with behavioral disturbances associated with dementia. 9. Affective Substance abuse a. Identify the risk factors, prevalence and warning signs of substance abuse in the elderly population. b. List the main pharmacokinetic/pharmacodynamic differences of alcohol and illicit drug use between elderly and younger patients c. Given a patient case, discuss the acute treatment of alcohol withdrawal and long term treatment of alcohol abuse/dependence in elderly patients d. Describe the optimal treatment of prescription drug abuse and/or dependence in the elderly 10. Geriatric Pain a. Describe key difficulties in the diagnosis and treatment of persistent pain in older persons b. Choose an appropriate pain assessment tool to use, given patient- related variables c. Educate a provider or patient on the prevention and treatment of post- herpatic neuralgia or diabetic peripheral neuropathy d. Compare and contrast agents used for nociceptive or neuropathic pain in elderly patients 11. Palliative Care and End- of- life a. Understand the terms used in advanced care planning b. Educate a patient or caregiver on the concepts of palliative care and hospice

4 c. Recognize medications typically useful in those patients facing death, as well as those medications which have little utility at the end of life 12. Cardio HTN/Lipids/Syncope/Dizziness a. Identify limitations of current literature evaluating hypertension and dyslipidemia treatment among elderly patients and where further research is needed b. Where possible, apply the evidence to support hypertension and hyperlipidemia treatment recommendations in each elderly subgroup c. Differentiate pathophysiology of vertigo, orthostatic hypotension, and other etiologies of dizziness d. Develop a pharmaceutical care plan for a patient with syncope and/or dizziness 13. Cardio ACS/MI/CHF/CAD/PAD in the Elderly a. Compare and contrast the epidemiology and clinical presentations of cardiovascular events across subgroups of older patients b. Evaluate the representation of older cohorts in cardiovascular literature c. Differentiate which treatment interventions have the best data support in older patients d. Provide counsel about special considerations for older patients with cardiovascular disease 14. Cardio Arrhythmias/Anticoagulation in the elderly/stroke a. Identify medications which can put the elderly cohort at an increased risk of arrhythmias, as well as how elderly patients may present differently with arrhythmias. b. Compare and contrast the commercially available anticoagulants in regards to their literature support and safety in the elderly cohort. c. Compose an appropriate treatment plan for an elderly patient with stroke, using the best available literature support and patient- related variables

5 d. Evaluate the appropriateness of the care plan for a patient who is experiencing post- stroke sequelae 15. Respiratory COPD a. Differentiate between the presentation of COPD or COPD exacerbation in a general adult population and an elderly cohort b. Understand the limitations of the GOLD guidelines when treating an elderly patient with COPD c. Recognize the aspects of certain therapies for COPD which may make them a poor choice for an elderly patient d. Recommend an appropriate therapy for a senior patient with COPD, given a patient case 16. Respiratory Influenza/Pneumonia a. Describe risk factors, typical presentation and diagnostic criteria for influenza or pneumonia in older patients b. Discuss the benefits and drawbacks associated with pneumococcal and influenza immunization in the elderly, and a make a recommendation for immunization given a patient case c. Recognize those factors which can impact diagnosis and treatment of pneumonia or influenza in a nursing home patient. d. Given a patient case, recommend medication treatment for an elderly patient with pneumonia or influenza 17. Musculoskeletal Osteoporosis a. Differentiate between the two types of osteoporosis b. Identify a senior patient at risk for vitamin D deficiency and provide a treatment plan for that patient given lab results and clinical data

6 c. Utilize best available data, patient- related and agent- related variables to provide a treatment plan for a senior patient diagnosed with osteoporosis 18. GU Incontinence/UTI a. Differentiate between the different types of urinary and fecal incontinence and their treatments b. Given a patient case, develop a basic plan for management of urinary incontinence in an elderly patient c. Given a patient case, correctly differentiate between asymptomatic bacteriuria and a urinary tract infection (UTI) d. Recommend treatment adjustments for antibiotics used to treat UTI in the elderly 19. GI Upper GI a. Distinguish medications and conditions which can make eating difficult in a senior patient b. Identify nutritional deficiencies typically seen in the elderly and their most common causes c. Discuss common causes of weight loss in the elderly, and the ramifications of such weight loss d. Identify medications whose administration is made more complicated by the presence of alternative feeding strategies (e.g. NG tube, PEG) 20. GI Lower GI a. Identify common causes of constipation or diarrhea in the elderly. b. Given a patient case, recommend an appropriate bowel regimen to alleviate constipation or diarrhea

7 c. Recommend an appropriate medication regimen for an elderly patient with a Clostridium difficile infection. d. Compare and contrast the different types of ostomies, as well as educate a patient on their case 21. Muscular & Skin Integrity Issues a. Select appropriate antibiotic treatment for cellulitis b. Categorize pressure ulcers into appropriate Stage c. Recommend appropriate non- pharmacologic intervention for pressure ulcer prevention and treatment d. Evaluate the roles of various debridement methods, topical drug therapy and antibiotics in the treatment of pressure ulcers 22. Endocrine Diabetes a. Understand the rationale for the differing goals and medication regimens utilized in the treatment of diabetes in seniors b. Compare drugs available for the treatment of diabetes mellitus type 2 in a senior patient c. Recommend a plan of care for an elderly patient with diabetes mellitus type Endocrine Thyroid/Sexual health & dysfunction/menopause/andropause a. Apply principles of age- related changes in thyroid or parathyroid function to interpretation of laboratory tests and to the appropriate use of thyroid replacement therapy, or calcium and Vitamin D b. Interpret literature evaluating hormone replacement therapy for menopause and andropause c. Make drug therapy recommendations to treat symptoms associated with menopause or andropause

8 24. Preventative Medicine in the Elder a. Discuss the utility of preventative medicine in a senior cohort b. Make a recommendation for a senior patient inquiring about getting a pap smear or mammogram c. Recognize the role of the USPSTF and literature evaluation in recommending PSA screening 25. Neurosensory Vision, hearing, gait & balance, dehydration a. Recognize medications which can contribute to problems with gait and/or balance b. Identify the deficits commonly seen in regards to vision and hearing seen in a senior patient, including causes of those deficits c. Recommend a plan of care for a senior individual with glaucoma or macular degeneration or cataracts or hearing loss d. Construct an appropriate plan for a geriatric patient who is at risk for developing dehydration