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    Care of The Older Adults-5Ms of Geriatrics: Ria Paul MD

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    Renata Mara Geriatra
    This document discusses the Geriatrics 5Ms framework for caring for older adults. It covers Mobility, focusing on fall risk factors and the Timed Up and Go test. It discusses Medications, including polypharmacy, deprescribing tools like the Beers Criteria, and medication assessment tools. It covers Mind, applying the Mini-Cog dementia screening tool and evaluating cognitive impairment. It also discusses Multicomplexity in older patients and how Matters Most is focusing care on patient priorities and preferences.

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    Care of The Older Adults-5Ms of Geriatrics: Ria Paul MD

    Uploaded by

    Renata Mara Geriatra
    24 views33 pages
    This document discusses the Geriatrics 5Ms framework for caring for older adults. It covers Mobility, focusing on fall risk factors and the Timed Up and Go test. It discusses Medications, including polypharmacy, deprescribing tools like the Beers Criteria, and medication assessment tools. It covers Mind, applying the Mini-Cog dementia screening tool and evaluating cognitive impairment. It also discusses Multicomplexity in older patients and how Matters Most is focusing care on patient priorities and preferences.

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    This document discusses the Geriatrics 5Ms framework for caring for older adults. It covers Mobility, focusing on fall risk factors and the Timed Up and Go test. It discusses Medications, including polypharmacy, deprescribing tools like the Beers Criteria, and medication assessment tools. It covers Mind, applying the Mini-Cog dementia screening tool and evaluating cognitive impairment. It also discusses Multicomplexity in older patients and how Matters Most is focusing care on patient priorities and preferences.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    24 views33 pages

    Care of The Older Adults-5Ms of Geriatrics: Ria Paul MD

    Uploaded by

    Renata Mara Geriatra
    This document discusses the Geriatrics 5Ms framework for caring for older adults. It covers Mobility, focusing on fall risk factors and the Timed Up and Go test. It discusses Medications, including polypharmacy, deprescribing tools like the Beers Criteria, and medication assessment tools. It covers Mind, applying the Mini-Cog dementia screening tool and evaluating cognitive impairment. It also discusses Multicomplexity in older patients and how Matters Most is focusing care on patient priorities and preferences.

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    Care of the Older

    Adults- 5Ms of
    Geriatrics
    Ria Paul MD

    Confidential – For Discussion Purposes Only


    Objectives

     To understand Geriatric Principles in Primary Care

     To increase understanding of 5 Ms of Geriatrics

    Confidential – For Discussion Purposes Only


    What are the Geriatrics 5Ms?

    Mobility Mind Medications Multicomplexity Matters Most

    Created by: Sarah C. Phillips, MD; Chelsea Hawley, PharmD;


    Laura Triantafylidis, PharmD; Andrea Wershof Schwartz, MD MPH
    Modifications by: Ria Paul MD Tinetti et al, JAGS 2017
    Module 1: Mobility

    Geriatrics 5M’s: Tinetti, Molnar and Huang, JAGS 2017


    Fall Prevalence

    CDC, 2017; Hafner, 2014

    Confidential – For Discussion Purposes Only


    Objectives

     Differenti

     Differentiate between intrinsic and extrinsic fall risk factors

     Become familiar with Timed Up and Go (TUG) Test

    Confidential – For Discussion Purposes Only


    Fall Risk Factor Modification
    Intrinsic Fall Risk Factors Extrinsic Fall Risk Factors
    Advanced age Footwear or foot problems
    Cardiovascular abnormalities Home hazards
    Chronic conditions Improper use of assistive device
    Cognitive impairment Multifocal eyeglasses
    Functional limitations New glasses prescription
    Gait and balance problems Substance use
    Medications
    Orthostatic hypotension
    Vision problems
    M. E. Tinetti & Kumar, 2010; STEADI, CDC 2017.

    Confidential – For Discussion Purposes Only


    Toe to Head Approach
    Socks,
    shoes,
    toenail Musculoskeletal

    Bowel
    Cardiovascular Bladder
    Extrinsic
    Factors

    Medications,
    Sensory

    Cognition

    Confidential – For Discussion Purposes Only


    Timed up and go test

    Confidential – For Discussion Purposes Only


    CDC Home Safety Checklist

    STEADI, CDC 2017.

    Confidential – For Discussion Purposes Only


    Module 2: Medications

    Geriatrics 5M’s: Tinetti, Molnar and Huang, JAGS 2017


    Objectives
    −Identify when a patient is experiencing
    polypharmacy

    −Utilize evidence-based tools for deprescribing

    −Review the Beers Criteria

    Confidential – For Discussion Purposes Only


    POLYPHARMACY
    PROBLEM
    • Disability
    • Frailty
    • Drug-drug interactions
    • Impaired cognition
    • Slowed gait speed
    How many
    meds? >
    5

    Adverse drug events: 5th leading cause of Gnjidic D et al. J Clin Epidemiol 2012
    death Doan J et al. Ann Pharmacother 2013
    Langeard et al. Frontiers in Pharmacology 2016

    Confidential – For Discussion Purposes Only


    Deprescribing

    Planned or supervised process of


    dose reduction or stopping
    medication(s) that may be causing
    harm or no longer providing
    benefit

    Scott IA et al. JAMA. 2015; 175(5):827-834.

    Confidential – For Discussion Purposes Only


    Deprescribing Protocol

    1. Reconcile 2. Consider 5. Implement


    3. Assess
    all risks/benefits 4. Prioritize and monitor
    eligibility
    medications of use deprescribing

    Scott IA et al. JAMA. 2015; 175(5):827-834.

    Confidential – For Discussion Purposes Only


    Use Medication Assessment
    Tools!
    • American Geriatrics Society Beers
    Criteria
    • Medication Appropriateness Index
    • Anticholinergic Risk Scale
    • STOPP and START
    AGS Beers Criteria 2015
    Hanlon JT et al. J Clin Epidemiol.1992
    Gallagher P Int J Clin Pharmacol Ther 2008
    Ruldolph et al. Arch Intern Med 2008
    Phung E et al. Journal of Palliative Medicine 2018

    Confidential – For Discussion Purposes Only


    Module 3: Mind

    Geriatrics 5M’s: Tinetti, Molnar and Huang, JAGS 2017


    Objectives

     Apply the Mini-Cog as a screening tool for dementia

     Formulate the initial diagnostic evaluation for dementia

    Confidential – For Discussion Purposes Only


    Some Dementia Warning Signs

     Trouble remembering • Defers to family


    • Problems with self-care
     “Poor historian”
    • Unexplained weight
     Appointment mix-ups loss
    • Vague symptoms
     Can’t follow instructions

     Getting lost Alzheimer’s Association and National Chronic Care Consortium,


    2003.

    Confidential – For Discussion Purposes Only


    Normal Aging vs Dementia

    Preclinical

    ?
    Cognitive

    Mild
    Decline

    Cognitive
    Impairment

    Dementia

    Time (years)

    Confidential – For Discussion Purposes Only


    Primary Care Evaluation of Cognitive Impairment

    Screen Evaluate Manage

    GSA KAER Toolkit, 2017.

    Confidential – For Discussion Purposes Only


    Mini-Cog Test

    Confidential – For Discussion Purposes Only


    Screen Evaluate Manage

    Labs and
    History
    Imaging
    Function Mood

    Cognition
    GSA KAER Toolkit, 2017.

    Confidential – For Discussion Purposes Only


    Screen Evaluate Manage

     Neuropsychology (if available)


    - Can provide comprehensive, objective information about which cognitive functions are
    affected and establish a baseline for future re-evaluations
    - Most helpful for MOCA 19-27, SLUMS 18-27, MMSE 18-28

     Specialty physicians

    − Geriatrics

    − Neurology

     Resource referral

    GSA KAER Toolkit, 2017.

    Confidential – For Discussion Purposes Only


    Screen Evaluate Manage

     Medications for dementia


    − Acetylcholinesterase Inhibitors (AChI)
    − NMDA Antagonists

    Early/mild Middle/moderate Late/severe

    Start AChI
    Start ±
    AChI NMDA antagonist

    Confidential – For Discussion Purposes Only


    Module 4: Multicomplexity and
    Matters Most

    Geriatrics 5M’s: Tinetti, Molnar and Huang, JAGS 2017


    Multicomplexity

    Challenges in caring for older adults


     Multiple chronic diseases
     Limitations of current clinical guidelines
     Limited or no data on older adults
     Multifactorial nature of geriatric problems and
    syndromes
     Range of patient preferences
    JAGS 2012 patient-centered care for older ad

    Confidential – For Discussion Purposes Only


    Multicomplexity

    American Geriatrics Society


    Approach to Older Adults
    with Multimorbidity

    Patient Look at the Estimate What is Communicate


    preferences evidence prognosis feasible a plan

    American Geriatrics Society, 2012.

    Confidential – For Discussion Purposes Only


    What Matters Most?

    Tinetti et al, JAGS 2017


    What Matters Most?

    Confidential – 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


    Multicomplexity

    http://cancerscreening.eprognosis.org/

    Confidential – For Discussion Purposes Only


    Questions?

    Confidential – For Discussion Purposes Only 33

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