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Clin Med IV: Geriatrics and Hospital Medicine > Changes in Sensation & Function in the Elderly > Flashcards

Changes in Sensation & Function in the Elderly Flashcards

1
Q

what do older patients rely on more to determine foot placemement rather than using proprioception

A

Vision

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2
Q

what are motor performance deficits in older people due to

A

dysfunction of central and peripheral nervous system as well as neuromuscular system

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3
Q

What is included in motor performance deficits

A

coordination difficulty
increased variability of movement
slowing of movement
difficulties with balance and gait

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4
Q

If a older patient has slower information processing, what else can it affect

A

Motor performance

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5
Q

What is oropharyngeal dysphagia

A

AKA transfer dysphagia
-refers to initiation of swallow
transfer of food bolus from hypopharynx to esophagus

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6
Q

What is esophageal dysphagia

A

difficulty passing food to the stomach through the body of the esophagus

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7
Q

what can cause swallowing difficulties

A

mechanical obstruction and altered motor function

common in elderly

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8
Q

on average, how many times does a person swallow per day

A

600 times / day

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9
Q

What cranial nerves are involved in the oral phase of swallowing

A

CN V (trigeminal)
CN VII (facial)
CN XII (hypoglossal)

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10
Q

What cranial nerves are involved in the pharyngeal phase of swallowing

A

CN V (trigeminal)
CN X (vagus)
CN XI (accessory
CN XII (hypoglossal)

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11
Q

At what age goes the brain begin to shrink?

A

30-40 years old, rate of decreasing size ramps up by age 60

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12
Q

what part of the brain changes with age?

A

decrease in white matter (myelinated nerve fibers)
this slows cognitive processing and reduces cognitive function

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13
Q

What is the decrease in dopamine transmission in older people correlated with

A

increased anterior-posterior sway - impaired balance
fine motor control
working memory and executive function

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14
Q

What is the ‘compensation hypothesis’

A

healthy older adults can perform complex motor tasks automatically (like younger peers), they appear to require additional brain activity to perform at the same level as young adults

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15
Q

What interentions can we use to help prevent motor deficits

A

Exercise, exercise, motor training, pharmceuticals, exercise

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16
Q

What are the most common chronic health problem in older patients

A

HTN and arthritis
Hearing

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17
Q

Who usually experiences greating hearing loss at an earlier onset?

A

Men

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18
Q

What are normal conversation frequencies for hearing

A

500 to 3,000 Hz at 45 to 60 dB

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19
Q

how is hearing loss classified

A

Conduction or sensorinueral

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20
Q

what is the cause of conductive HL

A

problems in external or middle ear

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21
Q

what is the cause of SNHL

A

problems converting mechanical vibrations to electical potential in the cochlea and/or in auditory nerve transmissionto the brain

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22
Q

What are risk factors for age-related HL

A

genetics/fhx
noise exposure
regular exposure to 85 dB or more
drug use
chemicals
male
DM, renal failure, atherosclerosis, immunosuppression, head injury
meds
tobacco use
vitamin intake

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23
Q

What are the screening tests for HL

A

whispered voice
Single question - 90% self report
screening version of the Hearing Handicap Inventory
Audioscopy

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24
Q

what does unilateral hearing loss suggest

A

local pathology, obstruction or idiopathic sudden SNHL

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25
Q

What does a rapid onset of HL suggest

A

possible perforation of TM, trauma or idiopathic sudden SNHL

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26
Q

What is idiopathic Sudden SNHL (isSNHL)

A

develops in less than 72 hoursl usually unilat
sound is ‘harsh and distorted’, accompanied by aural fullness
emergency and requires prompt referral
MRI with Gadolinium is recommended

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27
Q

what is the most common cause of conductive HL

A

cerumen impaction

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28
Q

how can we treat cerumen impaction

A

curetting, HOH-based solution, warm water irrigation, prescription cerumenolytics

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29
Q

what is vision loss in older population associated with

A

increased fall risk, loss of independecne, depression, increased all-cause mortality

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30
Q

how is low vision defined

A

central visual acuity of 20/70 or worse in better-seeing eye with best correction or total visual field loss of 140 degrees

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31
Q

how is legal blindness defined

A

Cental visual acuity of 20/200 or worse in better sing eye with best correction or a visual field of 20 degrees or less

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32
Q

What are major causes of severe vision loss and blindness in older adults

A

age-related macular degeneration
ocular complications of DM
Glaucoma
age-related cataracts

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33
Q

What are risk factors for macular degeneration

A

smoking, obesity, untreated HTN, age, female, fhx, sun exposure

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34
Q

What is the treatment of macular degeneration

A

vitamin supplements
vascular endothelial growth factor inhibitors - injections used for ‘wet’ MD

35
Q

what does glaucoma cause

A

progressive damage to optic nerve, leading to visual field loss and irreversible blindness

36
Q

how is glaucoma diagnosed

A

measurement of IOP in conjuction with optic disc eval and automated visual field test

37
Q
A
38
Q

what is the treatment of glaucoma

A

medicated eyedrops to decrease IOP
laser trabeculplasty for primary open-angle glaucoma

39
Q

what is assessed with age-related cataracts

A

red reflex

40
Q

what are risk factors for accelerated cataract formation

A

UV light exposure
smoking

41
Q

what is the treatment of cataracts

A

no treatment needed
surgery is the only effective treatment

42
Q

what causes peripheral neuropathies

A

m/c is idiopathic
followed by DM

43
Q

what is the medial survival time after dementia diagnosis

A

4.5 years

44
Q

what is the greatest risk for dementia

A

older age

45
Q

What is the diagnosis criteria for dementia

A

‘major neurocognitive disoers’ require deomnstation of significant cognitive decline in atleaset one of the following domains:
- complex attention
- executive function
- language
- learning and memory
- perceptual-motor
- social cognition

decline must be based on both subjective and objective findigns, and interfere with IADLs

46
Q

What are examples of IADLs

A

(Instrumental Activities of Daily Living)
managing finances
managing transportation
shopping and meal prep
house clearning/maintenance
managing communication
managing meds

47
Q

what are the cognitive domains of dementia

A

complex attention
executive function
language
learning and memory
perceptual-motor
social cognition

48
Q

What is the screening tools used for dementia

A

mini-cog, MMSE, MoCA

49
Q

What is included in the mini-cog

A
  • 3 word reptition
  • clock-drawing
  • 3 word recall
    requires < 5 min to complete
50
Q

When are MMSE and MoCA completed

A

for patient who have a positive Mini-cog
MMSE is most commonly used

51
Q

What is the definition of delirium

A

acute, flunctuating syndrome of altered attention, awareness and cognition precipitated by an underlying condition or event in vulnerable persons

AKA ‘AMS’, ‘acute confusional state’, ‘sundowning’, ‘encephalopathy’, ‘acute organic brain syndrome’

52
Q

what is delirium associated with for immediate and long-term outcomes

A

increased fall risk
lengthened hospital stay
increase hospital costs
increased duration of mechanical vent
increased degree of cognitive impairment
long-term facility placement
mortality

53
Q

what are the subtypes of delirium

A

hypoactive
hyperactive
mixed

54
Q

what are behaviors seen with hyperactive delirium

A

(atleast three ofthe following)
hypervigilance, restlessness, fast/loud speach, irritability, comativeness, impatience, swearing, singing, laughing, etx.

55
Q

how should we workup delirium

A

older persons with delirium require basic workup: CBC, CMP, UA, EKG
CT head is recommended if new neuro deficits, hx head trauma or fever associated iwth encephalopathy

56
Q

How is delirium managed

A

prevention is key
avoid constipation/dehydration, assess hypoxia, assess for and treat infection, promote good sleep patterns, supplementation between meals, continually assess for verbal and non-verbal signs of pain
pharmacotherapy reserved for patient who are a threat to their own safety or others saftety (haloperidol)

57
Q

what are the most common psychiatric problems among older adults

A

depression and anxiety

58
Q

what are risk factors for anxiety/depression

A

female
unmarried (esp. for men)
lower income
having functional limitations
believing in an external locus of control
fhx of depression/anxiety
death of a partner

58
Q

what is the first line pharmacotherapy for MDD

A

SSRIs

58
Q

what is short and disturbed sleep associated with

A

poor cognitive and health outcomes

59
Q

what defines apnea

A

repetitive events while asleep of complete cessation of airflow lsting at least 10 seconds

60
Q

What is classicially associated with OSA

A

obesity

61
Q

what is CSA

A

central sleep apnea
due to defect in central control of breathing (no respiratory effort) - classically associated with HF

62
Q

What is Cheynes-Stokes respiration

A

alternating between hypo- and hyper-ventilation

63
Q

what is the gold standard testing for OSA or CSA

A

polysomnography - sleep testing
HSAT (home sleep apnea test) - challenging for some older adults to place sensors

64
Q

what is the first line managmeent of OSA

A

positive airway pressure therapy (CPAP)

65
Q

What is PLMS

A

periodic leg movements in sleep
- atleast 4 cycles or sterotyped movements in a row

66
Q

What is PLMD

A

periodic limb movement disorder
-diagnosis requires 15 PLMS per house, causes sleep disturbance
requires sleep study for dx
cause unknown

67
Q

what is circadian rhythm

A

24 hour biological rhythms that govern hormone secretion, core body temp and sleep-wake cycle

68
Q

what is the suprachiasmatic nucleus (SCN)

A

internal circadian pacemaker

69
Q

what drives sleep-wake cycles

A

melatonin secretion

70
Q

what is the treatment of circadian rhythm disorders

A

appropriately timed bright light therapy
can augment with melatonin
increased daytime activity
quiet environment and dark room at night, cooler temps

71
Q

what is the definition of insomnia

A

inability to FALL asleep and/or
inability to STAY asleep and/or
waking up TOO EARLY
-has a negative impact on QOL

72
Q

what medical problems are associated with Insomnia

A

HTN
CAD
arthritis
lung disease
GERD
CVA and neurodegenerative d/o

73
Q

what are the treatment options for restless leg

A

iron supplementation if needed (often IV)
dopamine agonists - ropinirole, pramipexole
calcium channel ligands - gabapentin, pregabalin

74
Q

what is the best tool for evaluating circadian rhythm disorders

A

comprehensive sleep hisotry
(official sleep study not generally needed)

75
Q

what is the first line management for insomnia

A

CBT
(sleep diary for 2 weeks)

76
Q

what are the pharmacologic managements for insomnia

A

benzodiazephines(Tiazolam, temazepam, lorazepam) - increase risk of falls/confusion
non-benzos (zolpidem, zaleplon) - concern for sleep eating/driving
melatonin receptor agonists (ramelton)
Dual orexin receport agnoists (DORA) - Lemborexant and Suvorexant

76
Q

what is ETOH effect on sleep

A

creates feeling of relaxation and sleepiness but interferes with sleep length and quality

77
Q

What vitamins/minerals need to be increased in patients > 70 yo

A

Calcium (1200mg/day) and vitamin D (800 IU/day)

78
Q

what are medical causes of unintentional weight loss

A

malignancy
CHF
COPD
malabsorption
dementia
endocrine (DM, hyperthryoidism)
end stage liver or renal failure
poor dentition, poorly fitting or lack of dentures

79
Q

What are psychological causes of unintentional weight loss

A

depression, dementia, bereavement, anxiety, parinoia

80
Q

what medication classes can affect appetite and olfactory/taste sensation

A

antidepressants
anti-inflammatories
anti HTN, cardiac meds
lipid lowering meds
antihistamines
antimicrobials
antineoplastics
bronchodilators or other asthma meds
muscle relaxants
parkinsonism meds
anticonvulsants
vasodilators

Clin Med IV: Geriatrics and Hospital Medicine (8 decks)

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