Source / episode info
- **Episode:**207
- **Title:**Divine Intervention Episode 207 – The USMLE And Geriatrics Part 1.
- **Published:**2020-01-30
- Source:Episode page
One-liner
This episode provides a comprehensive overview of geriatric care for the USMLE, emphasizing functional assessment via Basic/Instrumental ADLs, cognitive screening tools like MiniCog and MMSC, managing polypharmacy using Beers Criteria, diagnosing various types of incontinence, assessing fall risk, and establishing end-of-life directives (POLST).
High-yield summary
- Comprehensive Geriatric Assessment (CGA): This holistic evaluation is paramount in the elderly, covering physical function, cognitive status, sensory deficits (vision/hearing), nutritional status, and psychosocial risks.
- Functional Status: Differentiate between Basic ADLs (self-care: bathing, dressing) required for independent living at home, and Instrumental ADLs (IADLs: managing finances, shopping, taking meds) necessary for community function.
- Cognitive Screening: Use the MiniCog or MMSC; a score below 24 on the MMSC suggests cognitive dysfunction. Initial workup must rule out reversible causes (e.g., B12 deficiency, hypothyroidism, hyponatremia).
- Fall Prevention: Screen for falls within the past year and perform the Get Up and Go Test (normal time: 10–12 seconds; abnormal >20 seconds). Interventions include exercise, physical therapy, and Vitamin D supplementation.
- Incontinence Management: Recognize the distinct types (Urgency/Stress/Overflow/Functional) and avoid anticholinergic medications in urgency incontinence due to high risk of delirium.
- End-of-Life Care: Understand the difference between a Durable Power of Attorney (full decision-making power) and a Healthcare Proxy (limited to healthcare decisions). POLST is a physician order for life-sustaining treatment.
Learning objectives
- Differentiate between Basic Activities of Daily Living (ADLs) and Instrumental ADLs (IADLs) in the geriatric population.
- Apply appropriate cognitive screening tools (MiniCog, MMSC) and interpret results while considering reversible causes.
- Identify risk factors for falls and implement multi-modal preventative strategies (e.g., Vitamin D, PT).
- Classify different types of urinary incontinence (Urgency, Stress, Overflow, Functional) and select appropriate non-pharmacological management.
- Understand the legal and medical implications of end-of-life care planning, including POLST and Advanced Directives.