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

There's nothing more overrated than SEX, and nothing more underrated than a good BM.

OBSTIPATION / IMPACTION

SCENARIO #1

SCENARIO #2

SCENARIO #3

Henderson-Hasselbalch equation

“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

“Doc, can you call in something?”

Chemical restraints

Antipsychotics

Benzodiazepines

Physical restraints

4-point restraints

Posey vests

Side rails

Behavioral interventions

ANTIPSYCHOTICS

Extra-pyramidal movements

Neuroleptic malignant syndrome

Confusion

Nausea / vomiting

Difficulty urinating

Tremor

Mood changes

Granny's upset. Give her some gin!

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 >>>>>>

BEHAVIOR

A key form of communication

Assess for mediators

ENVIRONMENTAL MEDIATORS

TV

Restraints

Lights

Noise

People

Timing of health care

PSYCHOLOGICAL MEDIATORS

Depression

Anxiety

SOCIAL MEDIATORS

Love

Touch

Belonging

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

CARRY ON

FINAL INNING

WHY IS THIS IMPORTANT?

Health department

Family

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

STAGES OF EUTHANASIA TALK

Initial requests (must be repeated)

Written declaration

Second (MD) opinion

Date set

Euthanasia death

DEATH DISTINCTIONS

Clinical death Appearance of death “signs” upon examination

Biological death Cessation of cellular activity

Social death

SOCIAL DEATH

Pre-death treatment Start with relationships and rights End up with hardly any of either

I Don't Remember

56 Ways to Say I Don't Remember

http://nyti.ms/14cBTkGhttp://nyti.ms/14cBTkG

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!