Changes in Sensation and Function in Older Adults Flashcards
With advanced age comes a decline in ________ control and functioning, causes of these motor defecits are ____________
Sensorimotor, multi-factorial
What are some potential causes of motor performance impairments as we age
- Sensory receptors
- Muscles
- Peripheral nerves
- Joints
- CNS changes
What senses are older adults more dependent on for walking
What canges to this sense increases fall risk
Vision
Changes in proprioception
What are the causes of swallowing dysfunction in older adults?
Mechanical obstruction or altered motor function
On average, a person swallows over ____ times/day
600
What cranial nerves assist in the oral phase of swallowing?
CN V (trigeminal), CN VII (facial), and XII (hypoglossal)
What cranial nerves are involved in the pharyngeal phase of swallowing?
CN V (trigeminal), X (vagus), XI (accessory), and XII (hypoglossal)
What are some strategies to prevent aspiration in older adults with dysphagia?
- Swallow rehabilitation
- Thickened liquids
- Avoid certain foods
The brain begins to shrink in 30’s and 40’s, rate of decreasing size ramps up around what age?
Changes include
60
decrease in brain volume, white matter, thinning cerebral cortex
Fewer neurotransmitter production leading to decline in cognitive function, memory challenges, decreased attention, decreased ability to multitask
Dopamine receptors reduce by 5-10% each decade, therefore the aging brain is more susceptible to what neurologic disorder?
Parkinson’s
What interventions can be done to improve motor deficits associated with aging?
- Exercise!!
- Motor training
- Pharmaceuticals
- And more exercise
Has exercise been shown to improve visuospatial performance?
Does exercise improve fall risk?
Yes
Yes, because of improved visuospatial perfomance
After HTN and arthritis, what is the most common chronic health problem in older adults?
Does it impact women or men more?
Hearing Loss
Men experience greater hearing loss and have earlier onset
How is hearing loss classified?
What classification does age-related hearing loss fall under?
Conductive or Sensorineural
Sensorineural
What are some causes of conductive hearing loss in older adults?
What is the most common cause?
- Cerumen impaction
- Perforated tympanic membrane
- Otitis media
More external and middle ear problems
Cerumen Impaction
A 71 year old patient with a history of diabetes presents with complaints of hearing loss. What nerve is likely involved?
Why is diabetes a risk factor for hearing loss?
Cochlear Nerve
Damage to nerves
What are some risk factors for age-related hearing loss?
What medical conditions increase risk?
- ETOH
- Family HX
- Hormones
- Ilicit drug use
- Chemicals
- Male sex
DM, Renal Failure, Atherosclerosis, Immunosuppression, head injury
What is the treatment for cerumen impaction?
- Curetting
- HOH-based solutions
- Warm water irrigation
- Prescription cerumenolytics
No specific treatment is better than an another
Chronic otitis media with effusion is common in older patients and can be treated with short courses of what?
Steroids or abx (amoxicillin-clauvunate)
How is legal blindness defined?
Central visual acuity of 20/200 or worse in the better-seeing eye with best correction or a visual field of 20 degrees or less
What are the major causes of severe vision loss and blindness in older adults?
- Age-related macular degeneration
- Ocular complications of DM
- Glaucoma
- Age-related cataracts
What are the symptoms associated with acute angle closure glaucoma?
What is the goal of treatment?
- Severe HA
- Eye pain
- Eye redness
- N/V
- Blurred vision
- “Steamy Cornea” (corneal edema)
Reduce IOP, various medical eye drops will reduce IOP
If you don’t see a red reflex on exam what should be the top differential?
Cataracts
Red reflex appears dull, extinct or shady
What is the treatment of cataracts that compromise vision?
Surgery
What factors are associated with a lower dementia risk?
What is the greatest risk for dementia?
- Higher education level
- Improved treatment of DM and CVD
Older age
What is the new DSM-5 term for dementia?
Major neurocognitive disorders
Patients with abnormal cognitive evaluation findings should be screened for?
Depression
What is the most useful screening tool for dementia?
What tool is most commonly used when a patient fails the screening?
Mini-Cog
MMSE or MoCA
What labs should be ordered when diagnosing dementia?
- Test for anemia
- Hypothyroidism
- Vitamin B12
- Diabetes
- Liver and kidney disease
All older persons presenting with delirium require a basic work-up, which includes:
- CBC
- CMP
- Urinanlysis
- EKG
What is the treatment of choice for treating delirium?
What patients qualify for medical treatment?
Haloperidol
Patients that are a threat to their own safety or end of life
A 78-year-old woman presents with a complaint of worsening memory loss and difficulty with daily activities. Her family reports personality changes and social withdrawal. What is the appropriate diagnosis?
Alzehimerz Disease
What is the saying that is used to describe the presentation of normal pressure hydrocephalus?
What are the symptoms?
“Wet, Wobbly, and Wet”
Dementia, gait disturbance, and urinary incontineance
What is the treatment for normal pressure hydrocephalus?
VP Shunt
What is the evaluation for OSA or CSA?
Sleep Study (Polysomnography)
What is the first line treatment for OSA?
What is an alternative cheaper treatment for mild OSA?
Positive airway pressure
Dental devices to move the jaw forward
What is the treatment for CSA?
Individualized CPAP with our without supplemental O2
May require BiPAP
Does restless leg syndrome require a sleep study for diagnosis?
What labs need to be drawn?
Yes
Iron studies
What are some options for treating restless leg syndrome?
- Iron supplementation if needed
- Dopamine agonists - ropinirole, pramipexole, carbidopa/levodopa
- Calcium channel ligands - gabapentin, pregabalin
A 90-year-old patient presents with a recent history of falls and unsteady gait. On examination, you notice a broad-based ataxic gait. What are the potential causes of gait disturbances in the elderly?
Potential Causes of Gait Disturbances in the Elderly:
- Cerebellar Dysfunction: Dysfunction of the cerebellum can lead to ataxic gait. Causes may include cerebellar strokes, tumors, or degenerative conditions like cerebellar ataxia.
- Peripheral Neuropathy: Peripheral neuropathy, often related to diabetes or other metabolic conditions, can result in sensory deficits and affect gait.
- Vestibular Disorders: Disorders of the vestibular system in the inner ear can cause balance problems and unsteady gait.
- Musculoskeletal Issues: Arthritis, joint problems, and musculoskeletal conditions can impact gait stability.
- Medications: Certain medications, such as sedatives, antiepileptics, and psychotropic drugs, may contribute to gait disturbances, especially in the elderly.
- Normal Aging: Age-related changes in musculoskeletal and sensory systems can lead to gait changes in older adults.
Mrs. Johnson, an 80-year-old female, presents with progressive difficulty walking and occasional falls. She has a history of osteoarthritis and hypertension. On examination, you notice muscle weakness and decreased deep tendon reflexes in her lower extremities. What is the most likely diagnosis?
What orders will you order to diagnose?
Spinal Stenosis
*Her age, history of osteoarthritis puts them at a higher risk
MRI is gold standard
Although helpful in younger patients to treat insomnia, what medications should be avoided in the elderly with insomnia?
What should be used instead?
Benzodiazepines and Benzodiazepine receptor agonists (NBRAs)
Ramelton (Melatonin receptor agonist)
What is the most common malnutrition deficiency in older adults?
Protein deficiency
Mrs. Johnson, an 80-year-old woman, presents with acute confusion, fever, and lower abdominal pain. On examination, you note suprapubic tenderness. What is the most likely diagnosis?
A) Urinary tract infection (UTI)
B) Dementia exacerbation
C) Gastroenteritis
D) Osteoarthritis
Urinary Tract Infection (UTI)
Which of the following medications should be used with caution in older adults due to the risk of anticholinergic side effects?
A) Acetaminophen
B) Lorazepam
C) Lisinopril
D) Metformin
Lorazepam
Lorazepam is a benzodiazepine that will increase the risk of anticholinergic side effects. Anticholinergic side effects can include confusion, memory impairment, and an increased risk of falls.
Which screening tool is commonly used to assess cognitive impairment in older adults and is sensitive to detecting Alzheimer’s disease?
A) Mini-Mental State Examination (MMSE)
B) Geriatric Depression Scale (GDS)
C) Katz Index of Independence in Activities of Daily Living (ADL)
D) Timed Up and Go (TUG) Test
Mini-Mental State Exam (MMSE)
What is the primary risk factor for developing pressure ulcers in older adults residing in long-term care facilities?
A) Malnutrition
B) Smoking
C) Frequent position changes
D) Adequate hydration
Malnutrition
Can physical therapy and relaxation techniques be helpful in reducing delirium risk in hospitalized older adults?
Yes, uncontrolled pain can lead to delirium. PT or relaxation techniques are a few non-pharmacological pain managament strategies in preventing delirium.
Early mobilization should be encouraged!
