Geriatric Medicine Flashcards

A 79-year-old woman asks for an over-the-counter sleep aid. Which agent is listed in the AGS Beers Criteria as strongly anticholinergic and should be avoided?

Answer: Diphenhydramine

First-generation antihistamines like diphenhydramine are highly anticholinergic and raise the risk of confusion, constipation, urinary retention and falls in older adults.

In the Confusion Assessment Method (CAM), which feature must be present, along with acute onset or fluctuating course, to diagnose delirium?

Answer: Inattention

CAM requires acute onset/fluctuating course plus inattention, plus either disorganized thinking or altered level of consciousness.

Using the CDC STEADI approach, a Timed Up and Go test result of what duration indicates increased fall risk in an older adult?

Answer: 12 seconds or more

STEADI uses a TUG time of 12 seconds or longer as a marker of increased fall risk.

A nursing home resident has a sacral wound with full-thickness skin loss and visible subcutaneous fat, but no exposed bone, tendon, or muscle. What is the pressure injury stage?

Answer: Stage 3

Stage 3 involves full-thickness skin loss into adipose tissue without exposure of fascia, muscle, tendon, ligament, cartilage, or bone.

In a patient with suspected normal pressure hydrocephalus, which feature of the classic triad is most likely to improve after ventriculoperitoneal shunting?

Answer: Gait disturbance

Gait disturbance is usually the earliest feature and the one most responsive to CSF diversion.

An 81-year-old cognitively intact woman reports sudden urges and leakage before reaching the toilet. What is the most appropriate first-line treatment?

Answer: Bladder training and pelvic floor exercises

Behavioral therapies are first-line for urge incontinence and avoid anticholinergic adverse effects.

An 84-year-old woman with osteoporosis and a creatinine clearance of 25 mL/min needs pharmacologic therapy. Which is the most appropriate choice?

Answer: Denosumab

Bisphosphonates are not recommended when CrCl is below about 30-35 mL/min, while denosumab is not renally cleared.