2 - Principles Of Geriatric Care Flashcards
Age and cost of care?
25% of medicare costs are last year of life
50% of costs incurred during last 60 days of life
Causes of death for the elderly?
- Heart disease
- Cancer
- COPD
- CVD(stroke)
- Alzheimers
- DM
- Pheumonia and influenza
- Accidents
MC chronic disease afflicting the elderly are?
Adult onset DM Arthritis Kidney/bladder Dementia Parkinson’s Glaucoma Lung disease Cataracts
Multimorbidity definition?
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
Factors that affect the rate of aging?
Genetic = 1/3 Environmental = 2/3
Who has the highest rate of ETOH related deaths?
Adults 65+
- go grandma!!
Generalized body changes
test q slide
- Decreased lean body mass
- Decreased body water content
- Increase fat per unit of body weight
The elderly have a consistent decline in all organ reserves, this means?
(Test q slide)
Reduces ability to respond adaptively to environmental changes and new illness
Stratum corneum layer changes?
Epidermis has a lower moisture content, slower rate of cell renewal and decreased cellular cohesion
- dry, rough, brittle skin
- slower rate of wound healing
Why do old people not smell as bad as they would otherwise (2/2 their inability to do hygiene as they get older)
Decreased number of eccrine and apocrine sweat glands Decreased number of sebaceous glands - diminished sweating - decreased body odor - dry skin
Melanocyte changes in old people?
Hair bulb melanocytes
- gray hair
Melanocyte enlargement
- liver spots (lentigo) in sun-exposed areas
General hair, nail and adipose changes of old people?
Loss of body hair in men Nails - dry and flattened - more onchomycosis SubQ adipose - decrease tissue on hands, face - increase on abdomen, thighs
Mouth hole changes?
Decrease in
- mastication strength
- mandibular bone density
- peridontal tissue
- salivary flow
- taste sensation
- appetite (2/2 taste)
Increase
- dental disease
- malnutrition
Lung compliance changes?
Decreased lung compliance
- loss/damage of elastic fibers w/in alveoli
- ossification of rib-cartilage articulations
Why does air flow rate diminish?
Diminished elastic recoil collapses peripheral airways
Decreased muscle strenght of rib cage
- decreased FVC, max expiratory flow rate
Because of the collapsed alveoli you can often osculate?
Basilar crackles
Why does the lung diffusing capacity diminish?
Decreased total surface area
Thickening of alveolar-capillary membrane
Age and PaO2?
Gradual reduction
<60 : >85 60 : >80 70 : >70 80 : >60 90 : >50
Marked decrease in pulmonary immunocompetence, why?
- Decreased mucociliary transport
- Loss of effective cough reflex
- Diminished cellular immunity
(Increased risk of bacterial pathogens, TB, legionella)
Cardiac changes?
Sick sinus syndrome
- Atrial dysrhythmias
LV < compliant
- preload decreases (CHF)
Increased afterload
- atherosclerosis and increased pulm vascular resistance
Endothelial dysfunction = increased risk of atherosclerosis
The elderly heart and exercise?
Decreased cardiac reserve
- they have a less responsive heart response to exercise
GI changes
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
Liver function test in elderly?
No age-related change in LFT
Renal changes in elderly?
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
Drug doses and the elderly?
Adjustments for kidney function based on GFR
Best way to assess renal function in elderly?
Creatinine clearance test
- >1.5mg/dl in a geriatric pt indicates renal pathology
Heme system changes?
Progressive decline in hematopoietic tissue in bone marrow
Normal platelets
Minimal/no change in granulocyte/lymphocyte
Diminished responsiveness of WBC to infection or stress
Immune function changes?
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
Old people and vaccines?
General decline in maximal antibody response to vaccinations and time for max antibody response increase
- high dose flu shot is given
What lab values increase w aging?
ESR
Alkaline phosphatase
Autoantibodies
Lab values that decrease w aging?
PaO2
Albumin
B12
Lav values that dont change w aging?
PH PaCO2 LFT (other than alk phos) Thyroid function Coag test Platelets
Did you hear about the semicolon that broke the law?
He was given two consecutive sentences
