Adult-Gerontology CNS Test Gerontological Care & Age-Related Changes 1 — Questions and Answers
Question 1: The principle of "start low and go slow" in prescribing for older adults reflects which age-related pharmacokinetic change?
- Increased receptor sensitivity requiring higher doses
- Decreased hepatic and renal drug clearance causing drug accumulation at standard doses (Correct answer)
- Faster GI absorption increasing peak drug levels
- Increased plasma protein binding reducing free drug
Correct answer: Decreased hepatic and renal drug clearance causing drug accumulation at standard doses
Reduced hepatic metabolism and renal excretion prolong drug half-lives in older adults, making standard doses more likely to accumulate to toxic levels.
Question 2: Age-related changes in the cardiovascular system that affect older adults include:
- Increased heart rate reserve and decreased afterload
- Decreased maximal heart rate, increased arterial stiffness, and diastolic dysfunction (Correct answer)
- Reduced resting blood pressure from vasodilation
- Hyperresponsive baroreceptors preventing orthostatic hypotension
Correct answer: Decreased maximal heart rate, increased arterial stiffness, and diastolic dysfunction
Aging reduces maximal heart rate and cardiac reserve, stiffens arteries, impairs baroreceptor reflex, and causes ventricular diastolic stiffening affecting exercise tolerance and orthostatic compensation.
Question 3: Falls in older adults are best understood as:
- Inevitable consequences of aging that cannot be prevented
- Multifactorial events involving intrinsic risk factors, environmental hazards, and medication effects (Correct answer)
- Primarily caused by neurological disease alone
- Largely caused by patient non-compliance with safety advice
Correct answer: Multifactorial events involving intrinsic risk factors, environmental hazards, and medication effects
Falls result from the interaction of intrinsic factors (gait impairment, visual loss, cognitive decline) with extrinsic hazards (poor lighting, slippery floors) and medication side effects.
Question 4: The AGS/BGS clinical practice guideline recommends comprehensive fall risk assessment for older adults who:
- Are over age 80 regardless of history
- Report any fall in the past year, have gait or balance problems, or present after a fall (Correct answer)
- Only have a history of two or more falls in the past 6 months
- Are on more than 3 medications
Correct answer: Report any fall in the past year, have gait or balance problems, or present after a fall
Guidelines recommend fall risk evaluation for anyone reporting a fall, demonstrating gait or balance abnormalities, or presenting after a fall event to identify modifiable risk factors.
Question 5: Urinary incontinence in older adults is most commonly:
- A normal and unavoidable part of aging requiring no assessment
- A treatable condition with identifiable underlying causes warranting comprehensive evaluation (Correct answer)
- Exclusively caused by prostate enlargement in men and pelvic floor weakness in women
- Only amenable to surgical repair
Correct answer: A treatable condition with identifiable underlying causes warranting comprehensive evaluation
Most urinary incontinence has treatable causes including medications, infection, restricted mobility, or detrusor instability, and comprehensive geriatric assessment identifies reversible factors.
Question 6: Elder mistreatment screening should be incorporated into routine assessments because:
- It occurs only in nursing homes and is reported by staff
- It is underreported and affects approximately 10% of older adults, with perpetrators often being family members (Correct answer)
- Victims reliably self-disclose abuse during routine visits
- Only financial abuse is clinically significant
Correct answer: It is underreported and affects approximately 10% of older adults, with perpetrators often being family members
Elder abuse affects up to 10% of older Americans and is significantly underreported; perpetrators are commonly family caregivers, making routine screening by healthcare providers essential.
Adult-Gerontology CNS Test Gerontological Care & Age-Related Changes 1
The principle of "start low and go slow" in prescribing for older adults reflects which age-related pharmacokinetic change?