CCP 330 Geriatrics π΄π» Flashcards
definition of a geriatric patient
- no consensus on the definition of a geriatric patient
- most authors define geriatric patients as those β₯ 65yo (no evidence to support this)
- evidence supports that a patientβs preexisting conditions and comorbidities may be a better way of defining βgeriatric patient statusβ in the older adult
mortality within 1yr of a geriatric hip fracture
- Mortality reaches 16% within 1 y after a hip fracture
these conditions pre-dispose geriatrics to cervical spine injury
- osteoarthritis (OA)
2. cervical stenosis
what percent of geriatric patients develop life threatening ICH following minor head trauma
Fifteen percent (15%)
what percent of the north american geriatric population is on anticoagulants
Ten percent (10%)
preferred option for treating acute agitation or delirium in geriatric patients
- AVOID BENZOS (2019 American Geriatric Society Beers Criteria)
- low-dose haloperidol 0.5-1 mg IV/IM/PO preferred
neurologic changes in geriatric patients
π΅π΅π΅ MONEY SLIDE π΅π΅π΅
- Underlying dementia, visual, auditory, and cognitive decline, slower reaction times, and concomitant medication use may influence mental status evaluation (eg, GCS)
- After the age of 40 y, brain volume β 5% per decade of life
- An occult brain bleed, commonly d/t shearing of the bridging veins resulting in a SDH, is possible given the β potential space d/t age-related brain atrophy that can be occupied by an intracranial bleed before clinical symptoms become apparent
- β cerebral autoregulation with aging renders the geriatric trauma patient with head injury more sensitive to hypotension
Cardiovascular changes in geriatric patients
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- after 40yo vasculature + myocardial connective tissue hardens d/t elastin and collagen changes
- β sympathetic activity and norepinephrine baseline levels lead to β SVR.
- These physiologic changes in aging lead to β vascular compliance and an β in systolic HTN.
- Ξ²-adrenergic responses to endogenous and exogenous stressors in the geriatric patient are also altered, resulting in an inappropriate ionotropic and chronotropic compensation for traumatic insults.
- Vital signs in the geriatric trauma patient may be unreliable and may appear normal, given that a baseline of HTN is common in this population.
- The blunted response may also be altered by medication use (eg, beta blockers).
pulmonary changes in geriatric patients
- β in elastic fibers, β intercostal muscle mass, β rib articulation, changes in thoracic vertebral body height, osteoporosis, β in alveolar surface area, β gas exchange, β mucociliary clearance and cough reflexes, and underlying pulmonary disease
- These changes lead to β pulmonary reserve, with β FEV, β FRC, β VC.
- Additionally, the elderly may mount only half of the compensations for hypoxia or hypercarbia compared to their younger counterparts, potentially leading to rapid decompensation
- The frail chest wall in the elderly patient β their susceptibility to trauma, as low-impact forces may result in sternal + rib fractures w/ pulmonary contusions, leading to β morbidity and mortality
Renal/Hepatic changes in geriatric patients
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- renal function decline is common in the geriatric population, GFR β approx ~7.5 mL/min per decade in geriatrics
- renal changes contribute to disturbances in electrolyte hemostasis and worsened autoregulation of volume status
- hepatic mass β up to 40% w/ advancing age, correlating with a β in function
- pharmacokinetics in the geriatric patient are affected by β renal + hepatic function, resulting in altered absorption, elimination, distribution, and metabolism of drugs
Musculoskeletal changes in geriatric patients
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- β in bony and cartilaginous mass and volume
- OA is a risk factor for fractures
- geriatric trauma patient is prone to β rates of fractures, even from low MOI
Explain considerations in geriatric pre-hospital trauma triage
ATLS recommends that patients older than 55 years old be transferred to a trauma centre regardless of injury severity score
- geriatric patients have blunted response to physiologic stressors β lack of recognition of the injury severity, especially in βlow mechanismβ MOI such as ground-level fall.
- Data shows that nearly half of geriatric trauma ptβs are under-triaged prehospitally
- up to 42% of trauma patients >65 with normal vital signs have occult hypotension
- Elderly patients w/ significant injuries have better outcomes when triaged to a level-1 or 2 trauma center
Ethical Considerations of the Critically Ill Geriatric Patient
Determine advanced directives and the desired level of intervention as early as possible
DNR DNI Patientβs wishes Selective treatment Family involvement substitute decision maker power of attorney
describe airway management changes in the geriatric patient
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- β Neck mobility d/t cervical spine degenerative changes
- poor pulmonary reserves + more susceptible to hypoxic insults
- difficult BMV d/t atrophy of the perioral musculature and edentulous
- lips are friable and prone to laceration, teeth susceptible to breaking
- Mouth opening may be affected by microstomia and TMJ arthritis
- β aspiration risk d/t swallowing muscle atrophy, β larynx sensitivity, β esophageal motility, and comorbidities (eg, Parkinsonβs disease)
- Vocal cord visualization may be obscured by bleeding (friable oral tissue trauma), masses, epiglottis floppiness, or pre-existing infections (Candida)
- Geriatrics are more sensitive to medications and doses used in RSI. more likely to develop peri-intubation hypotension and apnea and have an β risk of cardiac arrest. Dose adjustments for induction medications are recommending up to a 50% reduction in dose
Define and describe Elder Abuse and Neglect
- Abuse and neglect are defined as harm or a risk of harm due to action or negligence toward an older person who is vulnerable and targeted based on disability or age
- Abuse can be physical, sexual, verbal, or psychological, including neglect, isolation, and/or financial exploitation, with victims often experiencing multiple forms of abuse and an overall prevalence of up to 10%
- Elder abuse is associated with increased morbidity and mortality, including depression and dementia. Skilled nursing facility residents are also at risk for elder abuse
Signs and symptoms of elder abuse
- Trauma findings inconsistent with the MOI
- Various Bruising at different stages of healing
- Poor hygiene (soiled diaper and clothing, poor oral hygiene, elongated nails)
- Dehydration, malnourished appearance, weight loss
- Hypothermic
- Under-medicated
- Bed sores
- Withdrawn or changes in mental status from baseline
Define Dementia
- umbrella term for chronic disorders that result in impairment in two or more cognitive domains, including: memory loss, language, motor activity, object recognition, and disturbance of executive function
Define Delirium
- an acute confusional state with alterations in cognition
and attention
The most common chief complaints in older ED patients
chest pain, shortness of breath, and abdominal pain
Geriatric patients are susceptible to βhomeostenosisβ.
Define this term
a diminished ability to maintain homeostasis under stress
leading cause of death in men and women older than 65 years
Cardiovascular heart disease
prevalence of Acute heart failure in geriatric STEMI patients
πππMEGA PEARLπππ
Acute heart failure presents in ~50% of STEMI patients 85 years or older compared to only 1.7% of STEMI patients younger than 65 years
