2 - Principles Of Geriatric Care

Question 1

Age and cost of care?

Answer 1

25% of medicare costs are last year of life

50% of costs incurred during last 60 days of life

Question 2

Causes of death for the elderly?

Answer 2

1. Heart disease
2. Cancer
3. COPD
4. CVD(stroke)
5. Alzheimers
6. DM
7. Pheumonia and influenza
8. Accidents

Question 3

MC chronic disease afflicting the elderly are?

Answer 3

Adult onset DM
Arthritis
Kidney/bladder
Dementia
Parkinson’s 
Glaucoma
Lung disease
Cataracts

Question 4

Multimorbidity definition?

Answer 4

Co-occurrence of 2+ med/psych conditions

More than 1/2 of older adults have 3+ conditions
- then again cigarette used disorder is a thing so i think its pretty easy to rack up some serious numbers

Question 5

Factors that affect the rate of aging?

Answer 5

Genetic = 1/3
Environmental = 2/3

Question 6

Who has the highest rate of ETOH related deaths?

Answer 6

Adults 65+

- go grandma!!

Question 7

Generalized body changes

test q slide

Answer 7

• Decreased lean body mass
• Decreased body water content
• Increase fat per unit of body weight

Question 8

The elderly have a consistent decline in all organ reserves, this means?

(Test q slide)

Answer 8

Reduces ability to respond adaptively to environmental changes and new illness

Question 9

Stratum corneum layer changes?

Answer 9

Epidermis has a lower moisture content, slower rate of cell renewal and decreased cellular cohesion

• dry, rough, brittle skin
• slower rate of wound healing

Question 10

Why do old people not smell as bad as they would otherwise (2/2 their inability to do hygiene as they get older)

Answer 10

Decreased number of eccrine and apocrine sweat glands
Decreased number of sebaceous glands
- diminished sweating
- decreased body odor
- dry skin

Question 11

Melanocyte changes in old people?

Answer 11

Hair bulb melanocytes
- gray hair

Melanocyte enlargement
- liver spots (lentigo) in sun-exposed areas

Question 12

General hair, nail and adipose changes of old people?

Answer 12

Loss of body hair in men
Nails - dry and flattened
- more onchomycosis
SubQ adipose 
- decrease tissue on hands, face
- increase on abdomen, thighs

Question 13

Mouth hole changes?

Answer 13

Decrease in

• mastication strength
• mandibular bone density
• peridontal tissue
• salivary flow
• taste sensation
• appetite (2/2 taste)

Increase

• dental disease
• malnutrition

Question 14

Lung compliance changes?

Answer 14

Decreased lung compliance

• loss/damage of elastic fibers w/in alveoli
• ossification of rib-cartilage articulations

Question 15

Why does air flow rate diminish?

Answer 15

Diminished elastic recoil collapses peripheral airways

Decreased muscle strenght of rib cage
- decreased FVC, max expiratory flow rate

Question 16

Because of the collapsed alveoli you can often osculate?

Answer 16

Basilar crackles

Question 17

Why does the lung diffusing capacity diminish?

Answer 17

Decreased total surface area

Thickening of alveolar-capillary membrane

Question 18

Age and PaO2?

Answer 18

Gradual reduction

<60 : >85
  60 : >80
  70 : >70
  80 : >60
  90 : >50

Question 19

Marked decrease in pulmonary immunocompetence, why?

Answer 19

• Decreased mucociliary transport
• Loss of effective cough reflex
• Diminished cellular immunity

(Increased risk of bacterial pathogens, TB, legionella)

Question 20

Cardiac changes?

Answer 20

Sick sinus syndrome
- Atrial dysrhythmias

LV < compliant
- preload decreases (CHF)

Increased afterload
- atherosclerosis and increased pulm vascular resistance

Endothelial dysfunction = increased risk of atherosclerosis

Question 21

The elderly heart and exercise?

Answer 21

Decreased cardiac reserve

- they have a less responsive heart response to exercise

Question 22

GI changes

Answer 22

Tummy/intestines

• more ulcers
• lactose intolerance
• < vit D, calcium, iron absorption

Liver

• size decrease
• capsular and parenchymal fibrosis
• decrease microsomal enzyme activity

Biliary tract

• more gallstone obstruction
• pre-ampule bile duct narrows
• more lipids in bile (more gallstone)

Colon and rectum

• increase stool transit time
• constipation (more time=more water)
• incontinence and fecal impaction

Question 23

Liver function test in elderly?

Answer 23

No age-related change in LFT

Question 24

Renal changes in elderly?

Answer 24

Decrease in GFR

• age 30 CrCL 140ml/min
• age 80 CrCl 97ml/min

Ras changes - more water/Na loss
- compounded by decreased thirst

dilutional hyponatremia

Question 25

Drug doses and the elderly?

Answer 25

Adjustments for kidney function based on GFR

Question 26

Best way to assess renal function in elderly?

Answer 26

Creatinine clearance test

- >1.5mg/dl in a geriatric pt indicates renal pathology

Question 27

Heme system changes?

Answer 27

Progressive decline in hematopoietic tissue in bone marrow

Normal platelets

Minimal/no change in granulocyte/lymphocyte

Diminished responsiveness of WBC to infection or stress

Question 28

Immune function changes?

Answer 28

Total T and B lymph - normal

Loss of Functional capacity/activity of t lymph occurs

Diminished cell-mediated immunity
- more infections

Host factor (more disease/implants etc)

Humoral immunity - no drop in IgE

Question 29

Old people and vaccines?

Answer 29

General decline in maximal antibody response to vaccinations and time for max antibody response increase
- high dose flu shot is given

Question 30

What lab values increase w aging?

Answer 30

ESR
Alkaline phosphatase
Autoantibodies

Question 31

Lab values that decrease w aging?

Answer 31

PaO2
Albumin
B12

Question 32

Lav values that dont change w aging?

Answer 32

PH
PaCO2
LFT (other than alk phos)
Thyroid function
Coag test 
Platelets

Question 33

Did you hear about the semicolon that broke the law?

Answer 33

He was given two consecutive sentences