This is the updated slideshow for the 2011 NFMBR presentation of Geriatrics. We apologize sincerely for the error in the manual, you can both view the slideshow online or download it to your computer and view with PowerPoint.

1. Geriatrics Geriatrics

82. UI: Cystometric Findings Geriatrics Urinary Incontinence Cystometric Findings Stress Normal Overflow Little or no detrusor contractions despite high bladder volume Urge Involuntary detrusor contracitons that cannot be suppressed Functional Normal

89. Staging System – 6 options Geriatrics Staging Option Description Stage I Pressure related change of intact skin, usually appearing as a persistent, non-blanchable redness for 1 hour after pressure relief Stage II Skin loss involving epidermis and dermis; superficial abrasion, blister, or shallow crater Stage III : Full thickness tissue loss, including subcutaneous tissue down to, but not through, fascia Stage IV Full thickness damage including muscle, bone and supporting tissues

90. Staging System – 6 options Geriatrics Staging Option Description Unstageable Covered by slough and/or eschar Suspected deep tissue injury Purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying tissue from pressure or shear

109. Clinical Features of Cognitive Disorders Geriatrics Age-Related Cognitive Decline (ARCD) Subjective Memory Impairment (SMI) Mild Cognitive Impairment (MCI) Dementia Patient Concerns Often present Present May be absent May be absent Observer Concerns Typically not present Typically not present Present Present Memory Impairment Recall of experiences, events, names – mild impairment Subjectively present not demonstrated on testing Present Present sufficiently to impair function Non-memory Impairment Mild decline processing speech, preserved language and attention span, conceptual and factual knowledge intact Complaints on individual tasks of daily living Present, but intact function Present sufficiently to impair function Functional impairment No No Mild, if present Present Behavioral abnormalities No May be present– depression/anxiety Often present- depression, anxiety, apathy Often present-depression, anxiety, apathy, agitation

120. Sensitivity and Specificity of Diagnostic Tests for Dementia Geriatrics * Diagnosis of dementia ** Diagnosis of Alzheimer’s Disease Diagnostic Test Sensitivity Specificity Mini-Mental Status Exam 87% 82% Short Portable Mental Status Questionnaire* Any Dementia Mild Dementia 82% 55% 92% 96% NINCDS Criteria** 92% 65% DSM-IV Criteria** 76% 80% Clinical Judgment** 85% 82%

130. Protocol for the Treatment of Psychiatric and Behavioral symptoms of Dementia Geriatrics

131. Palliative and End-of-Life Care

156. Syllabus Extras Approach to Fever and Infection in the Nursing Home Sexuality and the Aging Approach to the Older Driver

192. Geriatrics Score 1 point for each “depressed” answer (no on 1, 5, 7, 11, 13; yes no others) Normal: 3 + 2 Mildly Depressed: 7 + 3 Very Depressed: 12 + 2 *Adapted from Sheikl, Jl, Yesavage, JA, Brooks, JO 3d, et al. Int Psycogeriatr 1991; 3:23.

193. Geriatrics Positive answers for depression are “no” to the first question and “yes” to the other questions. Two or more positive answers are indicative of depression. *Adapted from Rinaldi, P, Mecocci, P, Benedetti, C, et al. J AM Geriatr Soc 2003; 51:694.

194. Geriatrics Appendix B - Mini-Mental State Examination