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Confidential For Discussion Purposes Only Care of the Older Adults5Ms of GeriatricsRia Paul MD Confidential For Discussion Purposes Only To understand Geriatric Principles in

Primary CareTo increase understanding of 5 of GeriatricsObjectives Tinettiet al, JAGS 2017 What are the Geriatrics 5Ms?MobilityMindMedicationsMulticomplexityMatters MostCreate

d by: Sarah C. Phillips, MD; Chelsea Hawley, PharmDLaura Triantafylidis, PharmD; Andrea WershofSchwartz, MD MPHModifications by: Ria Paul MD Module 1: Mobility Geriatrics 5M&#

146;s: Tinetti, Molnar and Huang, JAGS 2017 Confidential For Discussion Purposes Only Fall PrevalenceCDC, 2017; Hafner, 2014 Confidential For Discussion Purposes Only Objectiv

esDifferentiDifferentiate between intrinsic and extrinsic fall risk factorsBecome familiar with Timed Up and Go (TUG) Test Confidential For Discussion Purposes Only Fall Risk

Factor Modification IntrinsicFallRisk FactorsExtrinsic Fall Risk FactorsAdvanced age Footwearor foot problemsCardiovascularabnormalitiesHome hazardsChronic conditionsImproperu

se of assistive deviceCognitiveimpairmentMultifocal eyeglassesFunctionallimitations Newglasses prescriptionGait and balance problemsSubstance useMedicationsOrthostatichypotens

ionVision problemsM. E. Tinetti& Kumar, 2010; STEADI, CDC 2017. Confidential For Discussion Purposes Only Socks, shoes, toenailMusculoskeletalBowelBladderCardiovascularMedica

tions, SensoryCognitionExtrinsic FactorsToe to Head Approach Confidential For Discussion Purposes Only Timed up and go test Confidential For Discussion Purposes Only CDC Home

Safety Checklist STEADI, CDC 2017. Geriatrics 5M’s: Tinetti, Molnar and Huang, JAGS 2017 Module 2: Medications Confidential For Discussion Purposes Only ObjectivesIdentif

y when a patient is experiencing polypharmacyUtilize evidencebased tools for deprescribingReview the Beers Criteria Confidential For Discussion Purposes Only GnjidicD et al. J

ClinEpidemiolDoan J et al. Ann PharmacotherLangeardet al. Frontiers in Pharmacology POLYPHARMACY PROBLEM DisabilityFrailtyDrugdrug interactionsImpaired cognitionSlowed gait s

peed How many meds? � Adverse drug events: 5leading cause of death Confidential For Discussion Purposes Only DeprescribingPlanned or supervised process of dose reducti

on or stopping medication(s)that may be causing harmor no longer providing benefitScott IA et al. JAMA. 2015; 175(5):827834. Confidential For Discussion Purposes Only Depresc

ribing Protocol 1. Reconcile all medications 2. Consider risks/benefits of use 3. Assess eligibility 4. Prioritize 5. Implement and monitor deprescribingScott IA et al. JAMA.

2015; 175(5):827834. Confidential For Discussion Purposes Only AGS Beers Criteria 2015Hanlon JT et al. ClinEpidemiol.Gallagher P IntClinPharmacolTherRuldolphet al. Arch Inter

n MedPhung E et al. Journal of Palliative MedicineAmerican Geriatrics Society Beers CriteriaMedication Appropriateness IndexAnticholinergic Risk ScaleSTOPP and START Use Medic

ation Assessment Tools! Module 3: Mind Geriatrics 5M’s: Tinetti, Molnar and Huang, JAGS 2017 Confidential For Discussion Purposes Only ObjectivesApply the MiniCog as a

screening tool for dementia Formulate the initial diagnostic evaluation for dementia Confidential For Discussion Purposes Only Some Dementia Warning SignsTrouble remembering &

#147;Poor historian”Appointment mixupsCan’t follow instructionsGetting lost Alzheimer’s Association and National Chronic Care Consortium, 2003. Defers to famil

yProblems with selfcareUnexplained weight lossVague symptoms Confidential For Discussion Purposes Only Normal Aging vs Dementia Cognitive DeclineTime (years) PreclinicalMild C

ognitive ImpairmentDementia ? Confidential For Discussion Purposes Only Primary Care Evaluation of Cognitive Impairment Screen Evaluate Manage GSA KAER Toolkit, 2017. Confiden

tial For Discussion Purposes Only MiniCog Test Confidential For Discussion Purposes Only HistoryFunctionCognitionLabs and Imaging Screen Evaluate ManageGSA KAER Toolkit, 2017.

Confidential For Discussion Purposes Only Neuropsychology (if available) Can provide comprehensive, objective information about which cognitive functions are affected and est

ablish a baseline for future reevaluations Most helpful for MOCA 1927, SLUMS 1827, MMSE 18Specialty physiciansGeriatricsNeurologyResource referral Screen Evaluate ManageGSA KA

ER Toolkit, 2017. Confidential For Discussion Purposes Only Screen Evaluate ManageMedications for dementia Acetylcholinesterase Inhibitors (AChINMDA Antagonists Early/mildMid

dle/moderateLate/severeStart AChIStart AChINMDA antagonist Module 4: Multicomplexity and Matters Most Geriatrics 5M’s: Tinetti, Molnar and Huang, JAGS 2017 Confidential

For Discussion Purposes Only Challenges in caring for older adultsMultiple chronic diseasesLimitations of current clinical guidelinesLimited or no data on older adultsMultifac

torial nature of geriatric problems and syndromes Range of patient preferences JAGS 2012 patient centered care for older ad Multi complexity Confidential For Discussion

Purposes Only American Geriatrics Society Approach to Older Adults with Multimorbidity Patient preferences Look at the evidence Estimate prognosis What is feasible Communicat

e a plan American Geriatrics Society, 2012. Multi complexity Tinettiet al, JAGS 2017 What Matters Most Confidential For Discussion Purposes Only What Matters Most Conf

idential For Discussion Purposes Only What Matters Most Resources for patients www.prepareforyourcare.org www.theconversationproject.org Resources for providers www.vitaltalk.

org https://eprognosis.ucsf.edu/communication/ Confidential For Discussion Purposes Only http://cancerscreening.eprognosis.org/ Multi complexity Confidential For Discuss