Class 8 (2/25/21) - Geriatrics Flashcards
Geriatrics?
The branch of medicine that treats all health problems associated with aging and the aged
What are health issues in elderly patients?
Loss of Autonomy
Loss of Physical Function
Loss of Mental Function
Abandonment
Functional evaluation?
- ADL (Activities of daily living) - mean the ability of the elderly person to perform their own basic care: eating, using the toilet, dressing, walking, and bathing
- IADL: Instrumental activities of daily living mean the ability of the elderly person to live independently: shop, manage finances, use a telephone, prepare meals, get around the community by oneself.
Geriatric Population at Risk “Frail Elderly”
- Usually over 75
- Multiple diseases and syndromes
- Polypharmacy (4-5 medications)
- Multiple physicians
- Frequent utilizers of ED
- High rates of Hospitalization
- Significant functional psychosocial impairments
The fourteen I’s of geriatric medical practice
Instability (when walking or standing) Immobility Intellectual impairment Impairment of vision and hearing Incontinence Irritable bowel syndrome Isolation, with possible depression Inanition Impecunity (lack of financial resources) Iatrogenesis (suffering from mistakes by treating professionals) Insomnia Immune deficiency Impotence Improper labeling of the elderly person
Instability?
Degenerative changes in the balance centers of the brain coupled with increasing weakness of the muscles and stiffness of the joints and ligaments lead many elderly people to an instability whenever they are ambulatory.
____ are major problem in the older population
Falls
Immobility?
Weakness and stiffness may lead to decreasing activity. In addition, many of the elderly have chronic diseases, such as heart disease or diabetes, that result in increasing immobility
Intellectual impairment in elderly can be due to ____
Alzheimer’s disease, multi-infarct dementia, and the associated mental problems of Parkinson’s disease
Impairment of vision and hearing?
- Decreased vision and hearing acuity
- Decreased ability to hear higher pitched (higher frequency) sounds
Incontinence
- high percentage of the elderly have stress or urge incontinence of urine. Incontinence is common in women who have had children in younger years and in men with prostate enlargement. Incontinence can happen due to medications also.
IBS
is common in elderly
Inanition
Malnutrition due to improper eating can happen in elderly
Impecunity
lack of financial resources is seen in elderly
Insomnia in elderly?
Less sleep, less deep
Immune deficiency in elderly cause?
Increased incidence of infections
Impotence in elderly
Common in elderly
Decreased testosterone in men
diminished libido in women
Improper Labeling of the Elderly Person
Disoriented older patients in the hospital or nursing facility can be mislabeled as suffering from dementia when they are mentally competent but simply unable to process the confusing environment of a medical center
latrogenesis
- Suffering from mistakes made by treating professionals.
- The elderly is a vulnerable target for medical mistakes by doctors and nurses.
Potential Complications of Bed-rest in Geriatric Patients
Pressure sores Bone re-absorption leading to osteoporosis Postural hypotension pneumonia Deep Vein thrombosis Urinary incontinence, constipation Decreased muscle strength Decreased capacity for physical work Contractions of joints Depression, anxiety and disorientation
Americans are living
longer
Why are there so many old people today?
- Improvements in social living conditions: clean water, better infant survival, better fire protection
- Advances in medical science: improved survival rates for those with heart disease, diabetes, cancer, strokes, AIDS
- The birth rate: a large number of baby boomers are coming into old age.
Nowadays the most common causes of death are due to
- personal habits or health-damaging lifestyle behaviors
- These include smoking, excessive drinking, overeating of a high-fat diet, obesity, lack of exercise, use of street drugs or misuse of prescriptions drugs, high-risk sexual behavior, and the failure to manage and cope with stress and anger properly.
Many of these problem behaviors come home to roost when people reach their older years and develop cancer, heart disease, diabetes, or hypertension.
Healthy aging is related to …
Genes Diet Social activity Exercise Productive pursuit
In elderly …
- Decreased height (vertebral compression and increased kyphosis)
- Decreased weight, over age 80.
- Increased fat to lean-body ratio.
- Decreased water content in skin.
- Increased wrinkling.
- Atrophy of sweat glands, affecting thermoregulation when it is very hot.
Cardiovascular system in elderly …
- Thickening of arteries.
- Decreased cardiac output
- Decreased heart rate response to stress and exercise.
Gastrointestinal tract in elderly …
Slower intestinal motility, so constipation
Decreased hydrochloric acid secretion.
Decreased number of taste buds.
Kidney in elderly …
Decreased renal blood flow.
Decreased creatinine clearance.
Skeleton in elderly …
Osteoarthritis
Osteoporosis
Eyes in elderly ..
Arcus senile
thickening of lens, with less accommodation, myopia (decreased ability to see things in the distance clearly)
Hyperopia (decreased ability to see things that are close clearlyDecreased visual acuity
Ears in elderly …
Decreased perception of high frequencies
Endocrine system in elderly …
Decreased testosterone
Nervous system in elderly …
Decreased brain weight, cortical cell count.
Decreased short-term memory.
Primary prevention
Rendering the environment less harmful or the patient more resistant to disease
Secondary prevention
This occurs when we are screening for the early detection of disease
Tertiary Prevention
Efforts to modify or halt the progress of an established disease to prevent its spread or worsening. In a disease epidemic, for example, this would include isolation of people who are infected.
