1 - Intro to Geriatrics Flashcards
Define Geriatrics.
Old age or being a “geriatric” is defined as 65 years and over.
Assignment is arbitrary and formerly linked to retirement at age 65.
Medicare coverage may begin at 65 – but, medical care does not dramatically rise until after __?__ .
75 yrs of age
What is the average lifespan for a woman? Man?
Woman - 79 yrs
Man - 74 yrs
By 2050, the population > 65 will approach __?__.
90 million
True/False
Most older men are married & cared for by their spouses (if needed).
True
Describe how the older population is becoming ethnically diverse.
What does this mean for us as medical providers?
By 2050, % of “white” elders will drop by >20%, “blacks” will increase >50% and Asians & Hispanics will triple.
Cultural competency will become a major consideration.
Geriatrics = ____ + ____
pediatrics + time
What are key reasons for the increase in obesity?
Nutrition and Sedentary Lifestyle
“OVERFED & UNDER-NOURISHED”
True/False
Better healthcare is extending lives.
FALSE
*Public health initiatives (clean water, sanitation, etc.) and immunizations are key factors.
What are major factors involved in human aging?
- Gender and genetics
- Lifestyle and genetic expression
- Various theories of aging attempt to explain the process - bottom line, there is disruption of homeostasis.
How do we assess aging in our general survey?
“….patient appears his/her stated age.”
Since the 1940s, chronic diseases are the major causes of death.
What are some of these diseases?
CVD
CA
CVA
DM
What are some common sensory impairments in elderly patients?
Presbycusis
Presbyopia
Memory Impairment
No natural teeth
What are some common geriatric syndromes?
Falls Urinary Incontinence Confusion Immobility Sleep disorders Fatigue Weight loss
True/False
Generally minority group members die earlier from preventable causes.
True
What is the goal in the treatment of the geriatric patient?
Goal: Older adults will maintain full function and live active lives in their homes and communities.
Not just to increase the life span, but also the “health span” of the older population.
True/False
Only 37% of Americans over 65 live in the community.
FALSE
95% of Americans over 65 live in the community
Only 5% reside in long-term care facilities.
What are the 2 foundations of geriatric medicine?
- Ethical decision making
2. Patient-centered care
Describe “ethical decision making”.
“Can versus Should”
Given choices, ask the patient for their decision.
Give elders the right to control their destiny.
Describe “patient-centered care”.
F.I.F.E.
F = Feelings (hopes and fears) I = Ideas about what’s going on F = Function (“How is the illness affecting their life?”) E = Expectations
What are the unique considerations that need to be made when assessing older adults?
- Focus is on healthy or “successful” aging (“quality of life”)
- Understand and mobilize family, social, and community supports.
- Importance of skill directed to functional assessment
- Look for opportunities for promoting older adult’s long-term health and safety.
How do vitals change in the elderly patient?
BP, HR, RR, Temp
BP - widened pulse pressure (high sys./lower dia.)
HR - max rate decreases
RR - unchanged
Temp - often lower basal temp
How does the integumentary system change with aging?
Thin Skin
Grey Hair
Thick nails
Sun damage - catches up!
How do the eyes and ears change with aging?
Eyes:
Increased incidence of degenerative diseases
Presbyopia - lens is not as flexible
Ears:
HEARING - Presbycusis - afflicted person fails to catch upper tones of words while hearing lower ones.
How does the thorax and respiratory system change with aging?
Increased chest wall stiffness!
Osteoporosis and kyphosis can reduce the thoracic capacity.
Osteoporosis, kyphosis and alveolar stiffness leads to “senile emphysema” with an FEV1/FVC < 70% of the predicted for age and gender.
How does the respiratory system change with aging?
Respiratory problems are associated with all cause mortality and specifically with:
CVD
COPD
Lung cancer
True/False
Problems with the respiratory system contribute significantly to cause of death for both elderly men and women.
True
43% cause of death in women
60% cause of death in men
How does the cardio system change with aging?
- Reduced cardiac output
2. Increased BP and peripheral vascular resistance
How do the male and female genitalia and prostate change with aging?
Female genitalia:
Menopause usually between ages 48 and 55.
Male genitalia:
ED – common beyond 4th decade.
-> Important marker for CVD!
Prostate:
BPH
How does the MS system change with aging?
- Loss of height – loss of muscle mass.
- > Makes it harder to get a full breath. - Osteoarthritis
- Osteoporosis
How does the neuro system change with aging?
Neuronal loss is normal in the aging brain but the ability to learn remains generally unchanged.
- Recall memory declines.
- Increased incidence of dementias.
How does the renal system change with aging?
- Decreased renal mass and size:
Kidneys get smaller.
Mostly loss of renal cortex - 40% less glomeruli by age 80. - Reduced Renal Blood Flow
10% reduction per decade after age 20.
Age 70 = 50% less blood flow!
Less urine concentration
How does the GI system change with aging?
Decreased global functions – secretion/absorbtion.
How does the endocrine system change with aging?
Hypothyroidism more common.
DM increased incidence.
Vitamin D absorbtion – parathyroid issues
Androgen/Estrogen lessens.
How does the immune system change with aging?
Global decrease in immune function and response to antigens
What are some treatment implications for aging adults?
Treat infections aggressively!
Mental status changes = urgent/emergent disease!
True/False
Elderly can undergo most surgical procedures as well as younger patients.
True
What is an example of an infection that can cause mental status changes and early death in the elderly, but is usually a simple infection in younger people?
UTI
What are some things to consider when obtaining a health hx for an older patient?
Demeanor should convey respect and PATIENCE.
KEEP IT WARM
KEEP THE PACE S - L - O - W
ALWAYS “WRITE IT DOWN.”
What are some areas of concern when assessing an older patient that may not be as crucial in a young adult?
Physical activities of daily living –
Basic self-care: bathing, dressing, toileting, transferring, continence, feeding.
Instrumental activities of daily living –
Higher-level functions: using the telephone, shopping, preparing food, housekeeping, laundry, transportation, taking medications.
Medication history
Nutrition – diet history
Acute and persistent pain – account for 80% of visits
Smoking and alcohol (EtOH – CAGE questionnaire )
Advance directive and palliative care
What are important health counseling areas for older adults?
1. Screenings & Shots: Encourage regular health screening exams Assess vision and hearing Encourage cancer screening Encourage immunizations Influenza: ANNUALLY Pneumococcal: Now SINGLE DOSE at age 65.
- Encourage exercise
- Encourage household safety
- Assess for Neuro/Psych problems & Abuse
Assess for depression
Assess for dementia and mild cognitive impairment
Assess for elder mistreatment
What are some recommendations you can make to your elderly patients and ways you can help them thrive in later life?
- Maintain a maximal muscle mass. Exercise of some form is ALWAYS better than less exercise of any kind at any age and in any condition.
- Develop and nurture a close relationship between the physician, elderly patient and the family. This allows the practitioner to pick up on any subtle changes early in any disease process.
- Maintain careful hydration and nutritional status.
- Avoid excess weight gain BUT protect against weight loss, unless morbidly obese. Dropping LDL, triglycerides, albumin are all red flags for senescence and decline.
Awesome sauce! You’re done!!
Don’t forget to read through Bate’s again - as much of this material is probably in the geriatrics chapter!
=)
