Geripardy

1. Geripardy Developed byBree Johnston MD MPHEric Widera MDMike Harper MDUC San FranciscoBased on The Game Show Jeopardy! & Geriatric Jeopardy from our colleagues at UCLA and other institutions

2. Geripardy Click Here to Start Click here for Double Geripardy Click here for Final Geripardy

3. Delirium Aging* Rock Stars AARP definition Falls Incon- tinence Medicare & MediCaid $10 $10 $10 $10 $10 $20 $20 $20 $20 $20 $30 $30 $30 $30 $30 $40 $40 $40 $40 $40 $50 $50 $50 $50 $50

4. Fat emboli may be one explanation for the high prevalence of delirium with this condition

5. What is hip fracture? Robertson BD and TJ The Journal of Bone & Joint Surgery 2006; 88: 2060-68.

6. This commonly used sleeper will increase the risk of of delirium by about 70%

7. What is diphenhydramine? (benadryl) Agostini JV, Leo-Summers LS, Inouye SK. Arch Intern Med. 2001 Sep 24;161(17):2091-7

8. Sleep promotion Activity Hydration Vision and Hearing Aids Re-orientation

9. Targeting what conditions can reduce the incidence of delirium? Inouye S et al N Engl J Med. 1999 Mar 4;340(9):669-76

10. The Confusion Assessment Method (CAM) requires these two elements plus EITHER disorganized thinking OR altered level of consciousness

11. What are Acute Change in Mental Status AND Inattention? Inouye SK et al. The confusion assessment method. A new method for detection of delirium. Ann Intern Med. 1990 Dec 15; 113(12):941-8.

12. The use of this class of medications as first line treatment for agitated delirium is based more on expert opinion than RCTs

13. Inouye SK. Delirium in older persons.N Engl J Med. 2006 Mar 16;354(11):1157-65. What are antipsychotics?

14. He was born Robert Zimmerman on May, 24th, 1941, in Duluth, Minnesota

15. Who is Bob Dylan?

16. In the 1960’s this guitarist was often referred to as “God”

17. Who is Eric Clapton?(age 61)

18. Though not well known for this, this aged Rocker attended the London School of Economics

19. Who is Mick Jagger?

20. This band did its first tour in over 20 years in 2006, “Uncut. Uncensored. Unrepentant.”

21. Who is the “Who”?

22. Sometimes known as “Shaky”, this Rocker does a major benefit for a Bay Area School for physically challenged children every fall

23. Who is Neil Young? (age 61)

24. These can reduce hip fractures dramatically….but patients don’t like to use them

25. What are hip protectors? Kannus et al.NEJM 2000 343; 1506-1513

26. This exercise has been associated with reduced fall risk, improved balance, and reduced fear of falling

27. What isTai Chi? Wolf SL, Barnhart HX, Kutner NG, McNeely E, Coogler C, Xu T.Atlanta FICSIT Group.J Am Geriatr Soc. 1996 May;44(5):489-97. Li F, Tai Chi and fall reductions in older adults: a randomized controlled trial.J Gerontol A Biol Sci Med Sci. 2005 Feb;60(2):187-94.

28. Antidepressants, diuretics, and sedative-hypnotics, based on this meta-analysis

29. What medications are associated with an increased risk of falls? Leipzig RM, Cumming RG, Tinetti ME. J Am Geriatr Soc. 1999 Jan;47(1):40-50. Leipzig RM, Cumming RG, Tinetti ME. J Am Geriatr Soc. 1999 Jan;47(1):30-9.

30. A meta-analysis published in JAMA suggests that this intervention is associated with a decreased risk of FALLS and FRACTURES

31. What is ingestion of Vitamin D? Bischoff-Ferrari HA et al; JAMA 2004; 291(16):1999-2006

32. Of the following interventions, the one that has been most strongly associated with a decreased risk of falls in an RCT: • A multifactorial intervention targeting risk factors for falls • Prescription of a walker • Prescription of thick soled athletic shoes • Aerobic exercise training

33. What is “A multifactorial intervention targeting risk factors for falls”? Tinetti M, et. al. New England Journal of Med. 1994;331:821-827.

34. 45-60 a day of these daily may help reduce stress episodes

35. What are pelvic floor (“Kegel”) exercises? Cochrane Database Syst Rev. 2001;(1):CD001407..Hay-Smith EJ, Bo Berghmans LC, Hendriks HJ, de Bie RA, van Waalwijk van Doorn ES.

36. Refractory retention • Recurrent UTI’s • Hematuria • Bladder stones • Renal impairment due to BPH

37. What are indications for TURP with BPH? McConnell JD, Barry MJ, Bruskewitz RC. Agency for Health Care Policy and Research.Clin Pract Guidel Quick Ref Guide Clin. 1994 Feb;(8):1-17.

38. Oxybutinin & tolteridine, to name 2

39. What are medications used to treat urge incontinence? Ouslander J. Management of overactive bladder. N Engl J Med. 2004 19;350(8):786-99.

40. The mnemonics DRIP & DIAPPRERS are two ways to remember these

41. D –delirium, diabetes R – Restricted mobility I – Infection, impaction P - pharmeceuticals D – Delirium I – Infection A – Atrophy (urethrovaginal) P – Pharmaceuticals P – Psychiatric E – Endocrine (DM, Calcium, DI) R – Restricted mobility S – Stool Impaction What are potentially reversible causes of incontinence? Adapted From Joe Ouslander (DRIP) and Neil Resnick (DIAPPERS)

42. Symptoms of urgency with an elevated post void residual volume

43. What is DHIC? (detrusor hyperactivity with impaired contractile function) Resnick NM, Yalla SV. Detrusor hyperactivity with impaired contractile function. An unrecognized but common cause of incontinence in elderly patients. JAMA. 1987 Jun 12;257(22):3076-81.

44. Medicare will only pay for a home health aid while this condition is met

45. What is receiving skilled services at home?

46. The vast majority of patients in this innovative program for frail elders have both MediCaid and Medicare

47. What is PACE? (in San Francisco, On Lok) Bodenheimer T: Long-term care for frail elderly people--the On Lok model. N Engl J Med. 1999 Oct 21;341(17):1324-8.

48. It pays for about 50% of nursing home care

49. What is MediCaid? http://.cms.hhs.gov/statistics/nhe

50. Between $2250 and $5100