II. Epidemiology: Incidence
- Community adults: >5%
- Nursing Home: >25%
- Hosptalized: >50%
III. Pathophysiology: Contributing Factors
- Physical function decline: Weakness, falls, ADL decline
- Malnutrition: Weight loss, Anorexia, decreased Immunity
- Depression
- Cognitive Impairment (Delirium, Dementia)
IV. Causes
- Medications
- See Medications to Avoid in Older Adults
- See Polypharmacy
- Most common medication culprits
- Psychotropic medications
- Anticholinergic Medications
- Recently added medications
- Consider non-prescription drug use, Herbals
- Missed dose and non-compliance
- Medication Overdosage (or with Renal Insufficiency)
- Acute
- Infection: Pneumonia, UTI, Cellulitis
- CHF exacerbation
- COPD exacerbation
- Diabetes Mellitus
- Elecrolyte disrders
- Acute gastrointestinal bleeeing
- See Medications above
- Subacute
- Anemia
- Cirrhosis
- Chronic Kidney Disease
- Infection
- Diabetes Mellitus
- See Medications above
- Acute
- Cancer
- Dementia
- Endocrine conditions (Thyroid, Parathyroid disease)
- Tuberculosis
- HIV Infection
- Chronic Obstructive Pulmonary Disease
- Cardiomyopathy
- Valvular heart disease
- Chronic Kidney Disease
- Chronic Liver Disease
- Polymyalgia Rheumatica
V. Labs
- Complete Blood Count
- Chemistry panel including Renal Functions, Electrolytes
- Serum Glucose
- Thyroid Stimulating Hormone
- Urinalysis (consider chronic colonization vs UTI)
- Liver Function Tests
- Erythrocte sedimentation rate or C-Reactive Protein
-
Malnutrition Labs
- See Lab Markers of Malnutrition
- Albumin
- Total Cholesterol
VI. Imaging
- Chest XRay
- Consider Echocardiogram
- Consider anatomic imaging (CT, MRI)
- Consider Pulmonary Function Tests
VII. Evaluation
- Consider causes above
- Focus on medications
- What medications can be stopped?
- Are medications dosed correctly?
- Interpret doses in light of Renal Function
- Are medication side effects resulting in failure?
- Consider Drug Interactions
VIII. Management: General
- Treat acute illness
- Optimize chronic disease management
- Manage medications as above (stop those not needed)
- Address Advanced Directives
- See Depression in the Elderly
IX. Management: Physical Impairment
- Avoid bed rest
- Up in chair for all meals
- Walk twice daily in hallway if able
- Physical Therapy
- Avoid restraints including Foley Catheter
- Bathroom use (up with assistance)
X. Management: Malnourishment
- Use oral nutrition supplements
- Sample protocol
- Split one can supplement into four doses
- Take interspersed as snacks
- Take with medications
- Make more palatable by mixing with ice cream
XI. Prognosis
- Nearly 16% mortality rate