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NURS 5461 GERIATRIC SYNDROMES EXAM QUESTIONS AND ANSWERS WITH COMPLETE SOLUTIONS VERIFIED LATEST UPDATE
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NURS 5461 GERIATRIC SYNDROMES EXAM QUESTIONS AND ANSWERS WITH COMPLETE SOLUTIONS VERIFIED LATEST UPDATE FALLS 1 in 3 adults ≥ 65 years reports falling each year One-half of those > 80 years • One-half of nursing-home residents • Nearly 60% of those with history of falls • Complicati...

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  • November 2, 2024
  • 20
  • 2024/2025
  • Exam (elaborations)
  • Questions & answers

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  • nurs 5461 geriatric syndromes exam questions and a

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NURS 5461 GERIATRIC SYNDROMES EXAM QUESTIONS AND

ANSWERS WITH COMPLETE SOLUTIONS VERIFIED LATEST

UPDATE


FALLS

1 in 3 adults ≥ 65 years reports falling each year

One-half of those > 80 years • One-half of nursing-home residents • Nearly 60% of

those with history of falls • Complications of falls are the leading cause of death from

injury in people aged ≥65 years

MORBIDITY AND MORTALITY

Most falls by older adults result in some injury • 5%-10% of falls by older adults result in

fracture or more serious soft-tissue injury or head trauma • The death rate attributable to

falls increases with age • Mortality highest in white men aged ≥85: >180 deaths/100,000

population

Associated with:

Decline in functional status Nursing home placement Increased use of medical services

Fear of falling • Half of those who fall are unable to get up without help ("long lie") • A

"long lie" predicts lasting decline in functional status

CAUSES OF FALLS BY OLDER ADULTS

Rarely due to a single cause • May be due to the accumulated effect of multiple

impairments (similar to other geriatric syndromes) • Complex interaction of: Intrinsic

,factors (e.g., chronic disease) Challenges to postural control (e.g., changing position)

Mediating factors (e.g., risk taking, situational hazards

INTRINSIC RISK FACTORS

• Older age • Cognitive impairment • Female gender • Past history of a fall • Leg

weakness or gait problems • Foot disorders • Balance problems • Hypovitaminosis D •

Pain • Parkinson's disease • Stroke • Arthritis

Age-related decline

Changes in visual function Proprioceptive system, vestibular system Regulation of

systolic blood pressure Reduced total body water, risk of dehydration with stressors

Chronic disease

Parkinson's disease Strokes Osteoarthritis, chronic pain

CAUSES: MEDICATION USE

Benzodiazepines Other sedatives Antidepressants Antipsychotic drugs Cardiac

medications Hypoglycemic agents • Recent medication dosage adjustments • Total

number of medications

CLINICAL GUIDELINES

Ask all older adults about falls in past year • Single fall: check for balance or gait

disturbance • Recurrent falls or gait or balance disturbance: Pursue a multifactorial falls

risk assessment

FALL HISTORY

History of falls Activity at time of fall(s) Prodromal symptoms Location and time of fall(s)

Medication history (new, changed, high-risk meds)

• Lighting • Floor coverings • Railings • Furniture • Door thresholds • Footwear

, PHYSICAL EXAMINATION

The most important part includes an assessment of integrated musculoskeletal function

Functional reach test

yardstick test <6in =high risk

Up and Go test (with or without timing)

get up s arm support walk 3m, then sit back down without using arms if >15s =in risk

Berg Balance Test

15 measures incl picking anoject up off the floor

Performance-Oriented Mobility Assessment (POMA)

abnl if 1 pt off for two or more items, or 1.5 off for a single item.

LABORATORY & DIAGNOSTIC TESTING

Tests and procedures should be guided by the history & physical exam:

echocardiography, brain imaging, radiographic studies of spine • Hemoglobin, BUN,

creatinine, glucose: can exclude anemia, dehydration, or hyperglycemia • Holter

monitoring: no proven value for routine evaluation • Carotid sinus massage with

continuous heart rate and BP monitoring is advocated by some for pts with unexplained

falls: can uncover carotid sinus hypersensitivity

FALLS PREVENTION GUIDELINES

Prescribe exercise, particularly balance, strength, and gait training Discontinue or

minimize psychoactive and other medications Manage postural hypotension Manage

foot problems and footwear Supplement vitamin D Treat vision impairment Manage

heart rate and rhythm abnormalities Modify the home environment

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