<p>3. Why should catheter use be minimized? a. Infection Risk:  Cause of 40% of nosocomial infections </p><p> b. Morbidity  Internal Catheters Geriatrics Educational Tools for the o Associated with delirium o Urethral & meatal injury Surgical Resident o Bladder & renal stones o Fever TOOLS FOR ASSESSMENT o Polymicrobial bacteriuria  External (condom) Catheters GAIT: “HAVE YOU FALLEN IN THE PAST YEAR?” o Penile cellulitis / necrosis o Urinary retention TIMED ‘GET UP AND GO’ TEST (Normal < 10 sec) o Bacteriuria & infection To test the subject, give the following instructions: c. Foleys are Uncomfortable / Painful  Rise from the chair without hands  Walk 10 feet across the floor d. Foleys are Restrictive  Falls & Delirium  Turn e. Cost  Return to the chair  Sit down again</p><p>Prepared by: MINI-COG (SCORE 0-5) Consisting of two parts: 3-item recall plus clock draw test (CDT). Keerti Sharma, MD Arnold Berlin, MD 1. Instruct the patient to listen carefully as you name 3 unrelated objects Amy Ehrlich, MD Department of Surgery (apple, penny, table) and then ask them to repeat the object names. Division of Geriatrics 2. Instruct the patient to draw the face of a clock, either on a blank sheet of paper, or on a circle already drawn on the page. After the patient Contributions: puts the numbers on the clock face, ask him/her to draw the hands of the clock to read a specific time, such as 8:20 or 11:10. These Don Scott, MD Catherine DuBeau, MD instructions can be repeated, but no additional instructions should be University of Chicago Geriatrics, Univ. of Chicago given. Give the patient as much time as needed to complete the task. Score 2 if numbers sequenced and placed correctly, and hands in Brochure design & layout: correct place; Score 0 if either is incorrect. 3. Ask the patient to repeat the 3 previously presented object names. Kim Freeman, MPH (Score 0 – 3) Division of Geriatrics Likelihood of cognitive impairment is high with scores of 0 – 2 (76% sensitivity; 89% specificity for dementia). Support provided by a grant from the American Geriatrics Society Scanlon J. Int J geriatr Psychiatry 2001;16:216-222. METABOLIC EQUIVALENTS (METS) IN THE ELDERLY Diagnosis: Confusion Assessment Method (CAM) A tool to estimate perioperative risk based on functional status Diagnosis requires: 1 + 2 + (3 or 4) 1= Acute Onset & Fluctuating Course </p><p>1 MET = the basal O2 consumption for a 40 year old, 70 kg person at rest 2= Inattention =3.5cc/kg/min 3= Disorganized Thinking </p><p>METS are then expressed as multiples of the basal O2 consumption for 4= Altered l Level of Consciousness various activities (Most Common = HYPOACTIVE Form) </p><p>1-Sitting Delirium – versus – Dementia 2-Walking slow pace, light housework, ADLs Feature Delirium Dementia 3-Walking average pace, carrying light objects Onset Acute Insidious 4-Walking brisk pace, climbing a flight of stairs Course Fluctuating Constant 5-Walking very brisk pace, slow swimming Attention Disordered Generally Preserved* 6-10 Strenuous sports Consciousness Disordered Generally Preserved* Hallucinations Often Present Generally Absent* Inability to meet a 4 MET demand places the patient at increased Involuntary Movement Often Present Generally Absent* perioperative cardiac and long term risk. * = Variable in Advanced Dementia</p><p>TOOLS FOR CLINICAL CARE FOLEY CATHETERS Catherine DuBeau, MD, Geriatrics, University of Chicago </p><p>DELIRIUM IN SENIORS 1. Does this patient have a catheter? Don Scott, MD, University of Chicago Incorporate regular catheter checks on rounds as a Practice-Based Learning and Improvement Exercise. Risk Assessment at Admission 1.  Vision (<20/70) 2. Does this patient need a catheter? 2. Severe Illness Only FOUR Indications 3.  Cognition (< 24 MMSE) 1. Inability to Void 4. Dehydration (BUN/Cr > 18) 2. Urinary Incontinence and 1-2 = Intermediate Risk  OR 2.5  Open Sacral or Perineal wound 3-4 = High Risk  OR 9.2  Palliative Care Precipitating Risk Factors 3. Urine Output Monitoring 1. Phys. Restraints  Critical Illness—frequent/urgent monitoring needed 2. Malnutrition  Pt unable/unwilling to collect urine 3. > 3 Med Classes added 4. After General or Spinal Anesthesia 4. Bladder Catheter (Continues on back panel) 5. Iatrogenic Event Intermediate Risk = 1-2  OR 7.1 High Risk = 3-5  OR 17.51 </p>