Age in a Graying America Flashcards
1
Q
Why we have a gray crisis
A
- Improved life expectancy
- Decrease in birth rate
- Public health improvements
- Antibioitics
- Vaccination
- Decrease in cardiac deaths
2
Q
Life expectancy
A
- 1900 à 47.3
- 1950 à 68.2
- 2000 à 77
- 2017 à 78.5
3
Q
Life expectancy at age 65
A
- 1900 –> 11.9
- 1950 –> 13.9
- 2000 –> 18.2
- 2017 –> 19.3
4
Q
Those over 85yo
A
- 1995 –> 1.4 %
- 2030 –> 2.4 %
5
Q
Baby boomers
A
- 2010-2050 we will double the number of people of 65 years old
- By 2050, 30% of the population will be over 65yo, 82.5 million people
6
Q
Biology of aging
A
- 2 key theories
- Genetic predisposition
- “wear and tear”
- Rule of fourths
- ¼ disease
- ¼ disuse
- ¼ misuse
- ¼ physiology
7
Q
Characteristics of aging
A
- Increased mortality with age after maturation
- Biochemical composition of tissues changes with age
- Physiological capacity decreases
- Decrease in response to environmental stimuli
- Increased vulnerability to disease
- Epigenetics
8
Q
Age-related physical changes
A
- Blood pressure regulation: orthostasis
- Volume regulation: dehydration
- Thermoregulation: generally colder
- Impaired immune response: increased infection
9
Q
Age related sensory changes
A
- Vision: reduced lens elasticity
- Hearing: increase vestibular sensitivity, reduced acoustic sensitivity
- Taste: reduced
- Smell: reduced
- Touch: reduced reflex
10
Q
age related physical changes
A
- Heart: max hr 195 as adult reduces to 155 as geriatric
- Skin: reduced elasticity
-
Kidneys: reduced by 50% perfusion
- Important because we give medications that are cleared renally or are toxic to the kidney
- GI: reduced peristalsis/secretions
11
Q
Diminished reserve
A
- Physiological examples
- Pulmonary capacity
- Renal clearance 1/10 of pop: CKD, 8th cx of death
- Clinical examples
- Increased sleep requirement
- Decreased calorie needs (less activity)
- Skin alterations that results in decreased protection
- Nocturia
12
Q
Brain atrophy
A
- CT brain sections
- Loss of brain parenchyma
- Enlargement of ventricles
- Widened sulci
13
Q
Bones and aging
A
- AP hand
- Not normal bone density and trabecula
- Ostophyte à bone spur (frayed edge)
14
Q
Osteoporosis
A
- Thinned cortex from inside out
- Scanty trabecula
15
Q
Congestive heart failure
A
- PA chest
- LEADING CAUSE OF DEATH
- Blood pressure increase, valve degeneration, infection in the heart
- If the blood backs up in the R side of the heart, you get lower leg edema (pitting), hepatomegaly and splenomegaly
- Interstitial pulmonary edema
- Cardiomegaly –> often reported on chest x ray which is suggestive of CHF
- Redistribution of pulmonary blood to upper lungs
- Indistinct hilar margins and blurring of pulmonary vessels
- Kerley B lines at costophrenic angles
- Increased central interstitial markings
16
Q
Consequences
A
- Atypical presentation of disease
- Failure of occam’s razor
- Among competing hypothesis, the one with the fewest assumptions should be selected
- i.e. seldom is a single unifying diagnosis possible, i.e. assume things are multifactorial
- decreased physiological compensation
- increased risk of iatrogenic (3rd leading cause) consequences of illness (polypharmacy, d/t increased problem list)
17
Q
Leading causes of death 2017
A
- Heart disease
- Cancer
- Iatrogenic
- COPD
- Accidents
- CVA
- Dementia
- Diabetes
- PNA
- CKD
- Suicide
18
Q
Prevention of aging
A
- Disengagement
- Let go of trappings of earlier life
- Popular driver of retirement communities of the 50s-80s
- Activity
- Stay active and fit to stay young
- Much more prevalent today
- Still less integration in community
19
Q
Elders and the health care system
A
- PCPs and elders
- Benefits of continuity:
- Much easier to see changes over time
- Improved preventive services
- Flu and pneumonia vaccination
- Herpes zoster vaccination
- Osteoporosis prevention
- Benefits of continuity:
20
Q
Screening
A
- Breast CA:
- Bienneal mammography 50-74yo
- > 75 no evidence
- No manual breast screening > 40?
- Colon CA:
- FOBT (fecal occult blood test), sigmoidoscopy or colonoscopy annual 50-75yo
- Not routine 76-85yo
- No screening >85yo
- Edematous polyps 90% premalignant for 5-10 years
- Cervix and prostate
- No screening over 65yo
- Eg no PAP or PSA
- Exception is if female has never had a pap the no pap if there are 2x negative paps
- No screening over 65yo
21
Q
Flaws in the care of elders
A
- Agism
- Eg: withholding rx or intervention 2/2 age
- Lack of respect of cognition
- Failure to recognize acute change of mental status (continuity vs baseline)
- Poor communication from setting to setting (emr, polst, fu)
- Hospitalists
- Specialists
- Long-term care
- Failure to utilize critical team members:
- Pharmacy
- Rehabilitation
- Physical therapy
- Occupational therapy
- Speech therapy
- Nutrition
- Failure of providers to accept medicare/medical
- Eg: coverage of PT/OT
- Medicare
- Difficult to navigate
- Medicare D: prescription drug coverage
22
Q
Diagnosis vs treatment
A
- Looking for a solution to disease
- Quality of life
- Risks versus benefits
- Eg coumadin/anticoagulation
- Polypharmacy
- >65yo 13% of population but 33% of Rx
- Majority of 65yo plus have over 5 rx
23
Q
Iatrogenic disease: 3rd leading cause of death
A
- ADE: side effects vs intended effects
- 1/3 of 65 and older have had ADE
- AKI: 2/3 of pt over 65 yo and 7-10% of those hospitalized have had AKI
- Reduced surgical outcomes across the board
- Careful what you look for!
- Send to a specialist… or not?
- Falls: neuro (hydro) cards (arrhythmia), ortho spin (stenosis)
24
Q
Difficulties in geriatric medicine
A
- The demographic burden: ethnic, cultural and socioeconomic
- The medical perspective
- Different diseases
- Different presentation of diseases
- Different treatment needs of older patients
- Multiple concurrent chronic diseases
25
Q
Diversity issues from a geriatric medicine perspective
A
- California diversity
- Elder diversity:
- Young old versus 85+
- Singles versus couples
- Fit versus disabled
- Independent living versus institutional
- $ secure versus $ worried
- Cognitively fit versus impaired
26
Q
Age bias and medicine: a multi-issue problem
A
- Training
- Lack of training to manage multi-problem patient
- Lack of training to manage psychosocial issues
- Time
- Communication issues
- Sensory (diminished hearing, vision and speech)
- Cognitive reliability
- Reimbursement: ~60%
27
Q
TB and the elderly
A
- Common, especially in long-term care
- Seek history of prior disease and immune limitations
- Screening
- PPD x 2
- Blood
- CXR
- Check for weight loss, fever, night sweats
