Rural Aging Health | Bilingual AI Tools in 1-2-3 Steps | Personalized Training
Designed for “Barefoot Doctors” and Rural Families： Personalize your own AppBinder with these 60 adaptable AI toolkits.
Disclaimer: This information is for educational purposes only and does not constitute medical advice. Consult a healthcare professional for personalized guidance.
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<aside> <img src="/icons/potted-plant_green.svg" alt="/icons/potted-plant_green.svg" width="40px" /> Health Screening
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<aside> <img src="/icons/home_blue.svg" alt="/icons/home_blue.svg" width="40px" /> Neighbors
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<aside> <img src="/icons/hourglass_pink.svg" alt="/icons/hourglass_pink.svg" width="40px" /> Daily Reminders
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<aside> <img src="/icons/dining_orange.svg" alt="/icons/dining_orange.svg" width="40px" /> Meal Planner
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https://raindrop.io/cheernurse/most-complained-health-problems-52155742
https://raindrop.io/cheernurse/healthy-aging-geriatric-issues-52152365
https://raindrop.io/cheernurse/chronic-diseases-management-52105173
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most commonly used to treat depression in the elderly are in the category of an SSRI (Seratonin selective reuptake inhibitors). A known adverse effect of these medications is hyponatremia (low sodium) and usually develops within the first few weeks to few months after initiation of treatment. So, be vigilant and cautious when starting these medications.
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(diphenhydramine) is not a good sleeping agent in the elderly. This drug is in the class of first generation antihistamines and can cause acute delerium (confusion) in the elderly. It can also commonly cause dry mouth, urinary retention and constipation. I have had many inpatient geriatric consults for acute delirium secondary to Benadryl being given as a sleeping aide the night before. In addition, always take a good clinical history and exam before prescribing any medication. Determine the likely cause for the sleep loss and based on your working diagnosis create a plan that may or may not include prescribing medication.
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Alcohol related risks increase with age due in part to age-related physiologic changes. As we age the volume of distribution for gastric alcohol dehydrogenase (ADH) levels decreases. ADH is the major enzyme responsible for alcohol (ethanol) metabolism in humans. This results in a higher blood alcohol level in older adults than in younger adults with the same alcohol consumption. Thus, current guidelines recommend no more than 1 drink per day for people over the age of 65. In addition, we should be aware of our patient’s alcohol consumption and it’s relationship with their current medications as many times alcohol will interfere with the metabolism of other medications or interact negatively with their current medications (such as a patient on a benzodiazepine regimen). Addressing a patient’s at risk alcohol consumption can lead to substantial and sustained reduction in alcohol consumption and therefore reduce alcohol related adverse events. Lastly, elimination of alcohol should be done in a stepwise manner. An immediate abstinence of alcohol is not recommended. In fact, immediate abstinence is dangerous to a patient due to alcohol withdrawal symptoms that can include cardiovascular collapse.
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is a major part of aging gracefully. Hearing impairment is strongly correlated with depression, decreased quality of life, poor memory and executive function and a higher incident of dementia. Hearing loss is the most common sensory impairment in older individuals known as age-related presbycusis. Screening individuals over the age of 65 for hearing loss is recommended at least annually. A screening exam can be done with taking an appropriate history and completing a whisper test followed by otoscope examination. If hearing loss is suspected a referral to an Audiologist is recommended.
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is a common cause of syncope and fall with sustained injury in the elderly population. The usual symptoms occur after standing and can include: lightheadedness, dizziness, syncope, blurred vision, diaphoresis and decreasing hearing. The diagnosis is made by checking accurate blood pressure and heart rate changes from lying to standing after 3 minutes and can be done by a health professional with a blood pressure cuff and the ability to check your pulse. Common causes of postural hypotension are hypovolemia (dehydration), anemia and medications. Evidence to date suggests that the ability to detect thirst reduces in an aging brain and therefore dehydration can occur more often in older individuals. A common class of medications that can cause postural hypotension are anti hypertensive medications and a medication review should be done weighing the risks and benefits of the medication.
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as we age is important to reduce the risk of fall and sustained injury. Balance issues are typically multi factorial and require a good balance exam including a neurological exam with testing of peripheral sensation and proprioception. If clinical history warrants would include vertiginous testing. A gait exam such as the timed get up and go test will help to establish any obvious ambulatory dysfunction, muscle weakness and the potential need for an assist device. In addition, a good foot exam (take off their shoes and socks) including evaluation of the patient’s choice of foot wear and checking for leg length discrepancy is recommended. Lastly a medical history including analysis of recent falls and review of medications is important. Treatment of a balance disorder will depend on the underlying etiology. Happy Friday!
Ps- If you have access to a balance clinic then don’t hesitate to refer older individuals that could benefit from this service. A balance clinic, such as the one I had the pleasure of participating in at the VA, is typically a Geriatrician paired with a Neurologist, pharmacist, PT, OT and vestibular specialist and is very beneficial to the patient.
Add looking at labs to rule out Anemia, Thyroid or electrolyte abnormalities. There was a lot of controversy over the last couple of years concerning the role of Vitamin D in fall prevention but it appears there is a paucity of great research data in support.
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is a common problem in aging individuals that leads to pain and functional debility. Many patients are taking over-the-counter non-steroidal anti-inflammatory medications (NSAIDs) to reduce arthritic pain — such as Ibuprofen, Advil, Naproxen just to name a few of them. These medications often provide pain relief but when taken consistently for greater than 1-2 weeks they have a higher incidence of stomach ulcers leading to GI bleeds and can induce renal dysfunction in the elderly. In addition, NSAIDs are to be avoided in patients with congestive heart failure as they can exacerbate the disease state.
Therefore, a better option for osteoarthritic pain in the elderly is non-pharmacological options such as applied heat, acupuncture, water-based exercises, assist device, weight loss and if appropriate surgical intervention. Alternative pharmacological options would be Tylenol dosed appropriately, topical analgesics, topical NSAIDs that don’t have the same systemic absorption and can be effective with small joints and intra-articular injections. So, remember to always ask your patient what medications they are taking over-the-counter as they could have serious adverse effects.
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In dementia many patients will develop oropharyngeal dysphagia (swallowing difficulties) as the disease progresses. This type of dysphagia secondary to advanced dementia should not be treated with a gastrostomy tube placement. The gastrostomy tube will not prevent aspiration as the patient can still aspirate on oral secretions as well as enteral feedings. In addition, a dementia patient often will pick or pull at the G-tube not realizing what it is and why it is present. This can lead to many accidental G-tube removals, displacement of the G-tube and or infection around the G-tube site. Lastly, G-tube enteral feedings are not as pleasurable as eating by mouth. A better approach to dysphagia secondary to dementia is to modify the patient’s diet, encourage chin tuck swallowing methods, cueing with meals and one-to-one feedings if required.
The American Geriatric Society (AGS) is a great resource for more information about the recommendation against gastrostomy tube placement as a treatment for dysphagia secondary to advanced dementia.
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