Chronic conditions Flashcards
Substance abuse- Eti
- Alcohol & psychoactive drugs most common
- Approx 1.8-0.5% in older generations
- Decreases with older age
- Female, isolated hx of substance abuse or MH
Substance abuse- Sx
- More difficult to ID
- Isolation, current GI sx and depressed feelings mask use
- Polypharmacy and decreased alcohol tolerance create issues
Substance abuse- Dx
65+ No more than 1 drink per day
- Substance/ alcohol abuse questionaires
Substance abuse- Tx
- Motivational intervention
Hypothyroid- Eti
- Autoimmune thyroiditis
- Radioiodine tx
- 1-17%
Hypothyroid- Sx
- Fatigue and weakness
- Constipation
- Neuro: dementia, ataxia, delayed DTRs
- ## May not have classic sx: wt gain, cold intolerance, cramps
Hypothyroid- Dx
- High TSH, low free T4
Hypothyroid- Tx
Levothyroxine, may require smaller amount
Malnutrition- Eti
- 17-65% geriatric pts suffer malnutrition
- Protein most common
- CA, GI issues, not hungry
Malnutrition- Sx
- Impaired wound healing
- 4-5% wt loss in 6-12 months
- Reduced functional status
Malnutrition- Dx
- Monitor wt, BMI
- >15% is severe malnutrition
Malnutrition- Tx
- Tx underlying cause
- Use enhancers, nutritional counseling
Poor dentition- Eti
- 1/3 >65 edentous
- Average 11 missing teeth
- Carries, periodontal disease, prolonged use
Poor dentition- Sx
- Pain, infection in mouth
- Dark lesions around teeth
- Plaque build up
- Malnutrition
Poor dentition- Tx
Refer to dentist for tooth repair, prosthesis
- Teach oral hygiene, fluoride use
Dizziness- Eti
- 4-30% 65+
- Increases 10% every 5 years older
- Meds, alcohol, vertigo, hypotension, vestibular defecits
Dizziness- Sx
- Hx of falls
- Orthostatic hypotension
- Lt headed & dysequilibrium
Dizziness- Dx
- BP
- Eye & ear exam
- B12
Dizziness- Tx
Underlying cause
- Vestibular rehab
Dismobility- Eti
- Independant- 5-7.5% dépendent for standing, ambulating
- Institution: 80% dependent for standing & ambulating
Dismobility- Sx
Inability to move that interferes with activities of daily living
Dismobility- Dx
- Fall questionnaire
- Get up and go
- Romberg
Dismobility- Tx
- Cane or walker
- Proper footwear
- Assistive devices
Diabetes- Eti
- 27% age >65
- Increased risk of M&M
- longer duration, higher rate of complications, more functional dependance
Diabetes- Sx
- DM 2 most common
- Decreased insulin production is predominant factor
Diabetes- Dx
- A1c > 6.5%
- Fasting >126
- 2 hr gtt > 200
Diabetes- Tx
- Reduced efficacy of metformin in older adults
- Diet, exercise & wt loss
- Ok to have higher A1c scores due to consequences of hypoglycemia 8%
Arthritis- Eti
- Most common joint disease
- Old age greatest risk factor
Arthritis- Sx
- Space narrowing on X-ray
- Joint line tenderness and boney enlargement
- Worse with activity, better with rest
- Hands, knees, hips, and spine
- Heberden & bouchard nodes
Arthritis- Dx
Xray findings
Arthritis- Tx
- Higher level of NSAID toxicity in elders
- Acetaminophen is first line
- Multidisciplinary tx with exercise, wt loss
Heart failure- Eti
- Incidence & prevalence increases with age
- 4 fold increase btwn 65-85
- Men>W
- Most common cause of hospitalization
Heart failure- Sx
- Altered sx: lethargy, anorexia, abd discomfort, GI disturbance
- Exertional dyspnea
- fatigue, orthopnea
Heart failure- Dx
- Echo, ECG & CXR
Heart failure- Tx
- Manage HTN
- ACE & Beta blockers
Venous insufficiency- ETI
- W>M
- Limited mobility, stroke, ankle orthoses
Venous insufficiency- Sx
- Pain, burning, aching and fatigue in legs
- Pitting edema t fibrosis
- Brawny, dry, or atrophic white scarring, ulcers
Venous insufficiency- Dx
Clinical
Venous insufficiency- Tx
- Emollients
- Compression and elevation
- Sclerotherapy
HTN- Eti
63-74% adults age 65-85
- Increased arterial stiffness due to collagen replacing elastin
- Endothelial dysfunction
- Age related renal dysfunction- renal artery stenosis most common cause
- Increased salt sensitivity
- Higher risk of CV events
HTN- Sx
- Older = asymptomatic
- Dizziness, palpitations, headache
- Occipital morning headache
- End organ damage
HTN- Tx
- Tx to target BP: 140/90 80
- Takes 1 yr for tx to be effective
- Thiazide diuretics, ACE & ARB
- Beta blockers less effective
Pressure ulcer- Eti
- Dermal tissue damage
- Acute hospital stay = highest risk, 60%
- Fracture, incontinence, and low serum albumin
- Non-blanchable erythema, lyphopenia, immobility, decreased body wt
Pressure ulcer- Sx
- Sacrum, heels & trochanters
- 1: blanchable hyperemia
- 2: ulcer through epidermis
- 3: full thickness skin loss, damage to subq tissue
- 4: extensive destruction, necrosis, muscle, bone exposure
Pressure ulcer- Tx
- Moist occlusive dressings
- Debridement of necrosis
Sleep disorders- Eti
Common with neuro disorders- parkinson, dementia
- >65% institutionalized experience
Insomnia
- Daytime impairment due to sleep issue
- > 1 month
- Pain, dyspnea, reflux interfere with sleep
- ## CBT to tx
