CM: Atypical in Elderly Flashcards
What is the concept of homeostenosis?
as we age, less reserves to respond to stressor and more in use just to maintain homeostasis combine to make us more susceptible to dzs and conditions
What changes when collecting a history from an elderly patient?
family hx loses value
social hx is expanded and more important
What changes are made to the PE when done on an elderly person?
assess cognitive fxn, performance based eval of musculoskeletal system, get up and go test
What is the major goal in the care of the elderly?
improve fxnal status so they can maintain independent living
What are the ADLs in order of loss in elderly?
bathing, dressing, toileting, transfer from bed, continence, feeding
What are the IADLs?
using telephone or transportation, shopping, preparing meals, housework, handyman work, laundry, managing meds, money or finance
What are some important treatment strategies for elderly?
improve fxn and maintain independence
provide care even if no cure
family/caregiver involvement and education
What are individual patient characteristics in the elderly that contribute to atypical presentation of disease?
comorbidities meds communication difficulties, hearing/vision impairment (harder to communicate or recognize problems) stoicism delay seeking help
What factors does aging affect in immune senescence?
decreases phagocytic capacity, antigen presenting activity and bactericidal fxn
What are changes in B cell immunity during aging?
production and titers of Abs decreases
less affinity of Abs
decreased response to inf/vaccination
increase in autoAbs - may not signify actual dz
What are Ig changes that occur during aging?
increased IgA and IgG
decrease in IgE and histamine can actually decrease allergies
What are changes in cellular immunity that occur as we age?
thymic hormones decrease decrease in T helper fxn T cells and NK increase in #, but decrease in fxn decreased lymphocyte proliferative response decrease in lymphocyte cytotoxicity decrease in IL-2 PMNs intracellular killing decreases skin thins and dries
What are the changes in the renal system that occur during aging?
decrease in GFR, decrease CCr, reduced release of and response to ADH, RAAS response to volume depleted states reduced, reduced perception of thirst, reduced renal blood flow
How is temperature different in elderly patients than younger?
often absent in older ppl w infection, even if serious
look if 2 degrees above baseline or use cutoff of 99
many present with hypothermia instead
Why is fever less common in older pts who have infection?
blunted thermogenesis by brown adipose tissue
reduced hypothalamic response to endogenous pyrogens
reduced ability to conserve and maintain body heat
What are the changes in blood pressure seen in the elderly?
more susceptible to orthostasis - if they’re on meds or have untreated HTN a normal appearing BP may not actually be normal
What are the changes in pulse seen in the elderly?
blunted response in HR and contractility to catecholamines released by exercise and acute illness
may not present w tachycardia
max HR decreases
How do RR and blood gases change in the elderly?
particularly useful in diagnosing pneumonia - look for rate >24* (>30 very significant)
V/Q mismatch causing decline in PO2 and increase in A-a O2 gradient, pH and PaCO2 don’t change
How is the presentation of abdominal pain different in the elderly?
decreased visceral pain perception - perfs don’t always have rigidity
may diagnose peritonitis if car ride painful
eval by have them cough, put hands on either side of pelvic brim and rock them, jar the bed, percussion
may not have fever, leukocytosis, rebound tenderness, etc.
How is the presentation of thyroid dz different in the elderly?
lack classic hyperadrenergic symptoms - look instead for weight loss, anorexia, fatigue, depression, CHF or A fib
How is the presentation of cardiac dz and MI different in the elderly?
S3 always indicates heart failure, diastolic murmurs always abnormal
MI may not present w chest pain - present w dyspnea/SOB = “silent MI”
angina may present w epigastric pain, back pain, shoulder pain, CHF, falls and sometimes delirium
How is the presentation of pneumonia different in the elderly?
often no fever, lower peak temp, higher mortality, lower WBC
What are two geriatric syndromes that elderly patients present with when they become acutely ill?
falls and delirium
