Geriatrics OSCE – the Falls Risk Assesement Checklist

Patient factors

  • Cardiovascular/Neurogenic
    • Dizziness
    • Unsteadiness on first standing
    • Weakness or reduced sensation in lower limbs
  • Gastrointestinal
    • Nutrition
    • LOA, LOW
  • Movement
    • Transfers
    • Use of aids
    • Sways or furniture walks
    • Footwear
    • Trips
    • Weakness
  • Vision
    • Seeing steps and obstacles
    • Last vision assessment?
  • Cognition
    • Confusion
    • Memory
  • Falls history
    • Falls or near falls of unknown cause
    • Last few falls and consequences thereof
  • Medications
    • Difficulty managing medications?
    • Antidepressants
    • PD drugs
    • Diuretics
    • Sedatives
    • Antihypertensives
    • Psychotropics
    • Continence
  • Impact
  • Attitude of patients

 

Environmental factors

  • Indoor hazards
  • Outdoor hazards
  • Restricted traffic ways indoors
  • Poor lighting
  • Steps

 

ADLS

  • Any activities patients feels unsafe performing
  • Activity – how often leave the residence
  • Exercise
  • Risky behaviour
  • Home services
Advertisements

Continence – A Syndromes Approach for the Geris OSCE

General questions

  • Quantity of urine lost
  • Frequency of episodes
  • Duration of incontinence and progress to date
  • Precipitating factors
  • Functional impact and coping strategies
  • Haematuria

Stress syndrome

  • Leakage with increased abdominal pressure – cough, sneeze, bending, sports
  • More common when erects than supine
  • Little urine is lost
  • Cough test

Urge / overactive baldder

  • Urgency +/- triggering cues
  • Loss of entirety of bladder contents
  • Nocturia

Neurogenic

  • Faecal incontinence
  • Saddle numbness or paraesthesia
  • Focal neurology

Infective

  • Frequency, urgency, dysuria, pain
  • PMHx of frequent UTIs
  • Similarities to previous UTIs

Overflow

  • Incomplete emptying
  • Dribbling
  • Slow flow

Past medical History

  • Past surgical history – abdominal or pelvic floor
  • Neurological conditions or surgery
  • Parity and complications thereof
  • Prostatesa

Medications

  • Diuretics
  • (Anti)cholinergics

Social

  • Impact
  • EtOH
  • Caffeine
  • Daily H2O consumption
  • Smoking and illicit drugs

Misc

  • Reversibule causes
    • Delirium
    • Infection
    • Atrophic vaginitis
    • Phamaceuticals
    • Psychological
    • Excess fluid in
    • Restricted mobility
    • Stool impaction

Workup

  • Urine diary
  • Urinalysis
  • Urodynamics
  • Cystoscopy

Management

  • Kegel exercises
  • Lifestyle modification
  • Timed voiding
  • Pads
  • Stress
    • Electrostimulation
    • Vaginal cone
    • Pseudoephidrine
    • Duloxetine
  • Urge
    • Oxybutinin – anticholinergic
    • Botulinum A
  • Obstruction
    • 5alpha reductase inhibitor (finasteride)
    • alpha blockade (prazosin, tamsulosin)

 

 

Geriatrics OSCE Prep – My Way of Remember Things For The Functional Assessment

 Go for the money: Barthel’s Index

Toilet cluster

  1. Toileting
  2. Grooming
  3. Urinary incontinence
  4. Faecal incontinence
  5. Bathing

Movement cluster

  1. Transfers
  2. Walking
  3. Climbing steps and stairs

Miscellaneous

  1. Dressing
  2. Feeding

Fill in the gaps by asking about the 7 Cs

  1. Cooking
  2. Cleaning
  3. Cash
  4. Computers (technology)
  5. Cars (transport)
  6. Companions
  7. Coles (shopping)

Take the rest of a standard comprehensive medical history

  1. PMHx
  2. Meds and allergies
  3. FHx
  4. SHx
    1. EtOH
    2. Drugs and tobacco
    3. Caffeine!
    4. Social supports
    5. Level of care

Conduct a sneaky quick  up and go test