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GERIATRIC PEARLS

GERIATRIC PEARLS. GOOD NEWS. Medicine is getting better and we are living longer. BAD NEWS. Medicine is getting better and we are living longer. Thus the need for geriatric pearls. Pearl #1 - A Father's Wisdom.

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GERIATRIC PEARLS

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  1. GERIATRIC PEARLS

  2. GOOD NEWS Medicine is getting better and we are living longer.

  3. BAD NEWS Medicine is getting better and we are living longer.

  4. Thus the need for geriatric pearls

  5. Pearl #1 - A Father's Wisdom • There's nothing more overrated than SEX, and nothing more underrated than a good BM.

  6. OBSTIPATION / IMPACTION

  7. SCENARIO #1

  8. SCENARIO #2

  9. SCENARIO #3

  10. Henderson-Hasselbalch equation

  11. “Mrs. Jones is 'AGITATED'” • My least favorite word • Coverup • Ignorance (naivete) • Looks at the caregiver, not the patient • Distractor from the true problem • Think of the onion • Think of what's being communicated • Stop, look, and listen

  12. “Doc, can you call in something?” • Chemical restraints • Antipsychotics • Benzodiazepines • Physical restraints • 4-point restraints • Posey vests • Side rails • Behavioral interventions

  13. ANTIPSYCHOTICS • Extra-pyramidal movements • Neuroleptic malignant syndrome • Confusion • Nausea / vomiting • Difficulty urinating • Tremor • Mood changes

  14. Granny's upset. Give her some gin!

  15. BENZODIAZEPINES • Behavioral abnormalities • ST memory loss • Fatigue • Ataxia → falls → hip fracture → pain / suffering / death • Confusion • Hyperactivity • Hostility • Insomnia • <<<<<< THINK OF FIVE POINTS ON SATURDAY NIGHT >>>>>>

  16. BEHAVIOR • A key form of communication • Assess for mediators

  17. ENVIRONMENTAL MEDIATORS • TV • Restraints • Lights • Noise • People • Timing of health care

  18. PSYCHOLOGICAL MEDIATORS • Depression • Anxiety

  19. SOCIAL MEDIATORS • Love • Touch • Belonging

  20. IF IT'S THE LAST THING YOU DO...

  21. CARRY ON

  22. FINAL INNING

  23. WHY IS THIS IMPORTANT? • Health department • Family

  24. SOCIAL DEATH • The Maintenance of Life, by Frances Norwood • Subtitled Preventing Social Death throught Euthanasia Talk • and End-of-Life Care – Lessons from The Netherlands

  25. STAGES OF EUTHANASIA TALK • Initial requests (must be repeated) • Written declaration • Second (MD) opinion • Date set • Euthanasia death

  26. DEATH DISTINCTIONS • Clinical death • Appearance of death “signs” upon examination • Biological death • Cessation of cellular activity • Social death

  27. SOCIAL DEATH • Pre-death treatment • Start with relationships and rights • End up with hardly any of either

  28. I Don't Remember http://nyti.ms/14cBTkG http://nyti.ms/14cBTkG 56 Ways to Say I Don't Remember

  29. ATTITUDE • The most important pearl to learn • 92 yo man with OA and CHF and dementia • 32 yo woman with terminal breast cancer • 6 yo with inoperable brain tumor • THERE’S NO DIFFERENCE!

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