25- Geriatrics (e.g. Madonna) Flashcards
What happens to the Body Size and Composition as you age?
- Relative increase in body fat.
- Relative decrease in muscle mass and body water.
- Decreasing weight (men older than 50 yrs and women older than 60 yrs)
What changes to the hematologic/immune systems as you age?
- Blood counts generally maintained.
- Changes in T-cell production, macrophage function, and cytokine secretion.
- Diminished Ab response w/ immunization.
- Reduced barrier functions of skin and mucous membranes.
- Reduced urine acidity and urine stagnation = predisposition to UTIs.
What changes to the MSK/neuro systems as you age?
- Common to have arthritis and osteoporosis
- Sarcopenia = impaired mobility and frailty
- Decrease in walking speed; increasing balance problems.
- Modest diminishment of deep tendon reflexes in lower extremities.
- Minimal cognitive changes (slower processing speeds).
- Reduced sleep efficiency; less time spent in restful sleep stages.
Why are stiches left in longer for geriatrics?
- Wound healing is impaired by age-related reduction in blood flow to the skin and reduced effectiveness of immune responses.
- Thinning of the dermis with age causes skin to become more susceptible to minor trauma.
- Incontinence can cause maceration (pruning/hyperhydration) of skin; long-term maceration can cause increased risk of bacterial and fungal infection.
- Pressure and shear forces are common during periods of bed rest, thereby increasing risk for skin breakdown.
- Poor nutrition (common among older persons who are ill) also impairs wound healing.
Why should you use lower doses of water-soluble drugs in the elderly?
b/c of (relative) reduced total body water and increased fat percentage.
Why should you use lower doses of fat-soluble drugs in the elderly?
prolonged retention of fat-soluble medications in the body due to increased fat percentage.
Why should you measure serum albumin prior to proper dosing?
• Aging causes decreased binding of protein-bound drugs due to lower serum albumin levels (esp in older adults who are ill) –> causes increased concentration of free, unbound, active drug.
Is metabolism of drugs increased or decreased in drugs?
Decreased hepatic blood flow causes decline in oxidation, reduction and hydrolysis of drugs.
What are some changes in the H&P with an elderly pt?
make take longer because they are frail, have a more complex medical Hx, hearing imparment is an issue, and the congnitively impared is an issue
What are some age-related changes typically found on the physical exam?
o Kyphosis secondary to osteoporosis
o Atelectatic basilar lung crackles from impaired chest wall expansion secondary to kyphosis.
o Lower ribs may rest on the pelvic brim from severe osteoporosis. (ouch!)
o Osteoporosis + increasing laxity of abd. mm. = flexed posture and protuberant abdomen.
o Decreased responsiveness of deep tendon reflexes in lower extremities.
o Slower gait.
What are ADL’s?
activities of daily living (e.g. essentials for maintaining independence and mobility)
• Mobility, bathing, dressing, grooming, eating, toileting, taking medication
What are IADL’s?
instrumental activities of daily living (requires a higher level of functioning)
• Getting out of the house, paying bills, answering the telephone, preparing meals
What are some causes to poor nutrition in geriatrics?
- Age-related physiologic changes
- Disease states or medications that impair appetite
- Deteriorating oral and dental health
- Functional impairment related to meal prep and eating
- Social isolation
- Economic hardship
What is the acronym for poor nutrition in the elderly?
DETERMINE • Disease • Eating poorly • Tooth loss/mouth pain • Economic hardship • Reduced social contact • Multiple medications • Involuntary weight loss/gain • Needs assistance in self-care • Elder years (>80)
What is polypharmy?
one person takes many drugs. (implication:more are in use than clinically warranted)
What happens when you use 5-7 or more drugs?
Use of 5-7 or more drugs daily is assoc. w/ adverse drug rxns, decreased med compliance, poorer quality of life, high rate of symptomatic adverse rxns, & potentially unnecessary expense.
What factors does falling assocaited with?
increased mortality, morbidity, reduced functioning, & premature nursing home admission.
What are some intrinsic risks to falls?
lower extremity weakness, disturbed balance, cognitive impairment, visual deficits.
What are some extrinsic risks to falls?
use of sedatives and environmental hazards.
What can the physician do to prevent falls?
- ) Conduct a medication review and modification, esp. for psychoactive drugs
- ) Treat cardiovascular disorders, including symptomatic dysrhythmias
- ) Treat orthostatic hypotension.
- ) Evaluate gait and train pts. w/ appropriate assistive devices.
- ) Recommend an exercise program that includes balance training.
- ) Treat visual impairments.
- ) Treat incontinence.
- ) Treat foot disorders affecting gait mechanics.
- ) Recommend that pts. modify environmental hazards (e.g. poor lighting, loose rugs, cords, etc.)
- ) Recommend that pts. equip bathroom w/ handrails, a raised toilet et, and bath chair as needed.
True or false: Restraints in nursing homes reduce the rate of fall-related injuries
False
What % of the elderly are abused every year?
~4% of adults > 65 yrs old are victims of elder neglect and abuse each year
Who are the most common perpetrators to elderly abuse?
spouses and adult children
What are some examples of physical abuse to the elderly?
striking, shoving, restraining, improper feeding (can result in musculoskeletal injury)
What are some examples of psychological abuse to the elderly?
threats (e.g. of institutionalization), insults, harsh commands, ignoring them
What are some examples of financial abuse to the elderly?
exploitation or neglect of a person’s possessions of funds
What is the most common degenerative joint disease and the leading cause of disability in persons older than 65 years?
Osteoarthritis
How do you treat asymptomatic OA?
YOU DON’T
What is the cognitive/behavioral therapy to OA?
directed toward enhancing coping skills or increasing confidence in performing activities safely.
How do you restore function in OA patients?
regimen of range-of-motion, strengthening, and endurance exercises
How can assistive aids help OA patients?
(braces, canes, and devices to increase hand function) may help restore function and improve independence.
How can weight loss help OA patients?
(even modest) can provide symptomatic relief.
What are the 2 meds to treat OA?
- Acetaminophen (1st choice for pain relief)
* Nonsteroidal anti-inflammatories
Where are the typical sites of fracture in osteoporosis patients?
vertebrae, hip, proximal humerus, wrist, ribs
Where are the typical sites of insufficiency fractures in osteoporosis patients?
pelvis and tibial plateau
Which T score confirms osteoporosis?
T-score of -2.5 or lower on bone density testing confirms osteoporosis
What are the available therapies for osteoporosis?
- Ca++ and hormone replacement therapy
- Bisphosphonates
- The nasal spray miacalcin (a calcitonin analogue)
- Selective estrogen modulators (a preventative therapy used when hormone replacement therapy isn’t advisable.)
