CM: Atypical in Elderly

Question 1

What is the concept of homeostenosis?

Answer 1

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

Question 2

What changes when collecting a history from an elderly patient?

Answer 2

family hx loses value

social hx is expanded and more important

Question 3

What changes are made to the PE when done on an elderly person?

Answer 3

assess cognitive fxn, performance based eval of musculoskeletal system, get up and go test

Question 4

What is the major goal in the care of the elderly?

Answer 4

improve fxnal status so they can maintain independent living

Question 5

What are the ADLs in order of loss in elderly?

Answer 5

bathing, dressing, toileting, transfer from bed, continence, feeding

Question 6

What are the IADLs?

Answer 6

using telephone or transportation, shopping, preparing meals, housework, handyman work, laundry, managing meds, money or finance

Question 7

What are some important treatment strategies for elderly?

Answer 7

improve fxn and maintain independence
provide care even if no cure
family/caregiver involvement and education

Question 8

What are individual patient characteristics in the elderly that contribute to atypical presentation of disease?

Answer 8

comorbidities
meds
communication difficulties, hearing/vision impairment (harder to communicate or recognize problems)
stoicism
delay seeking help

Question 9

What factors does aging affect in immune senescence?

Answer 9

decreases phagocytic capacity, antigen presenting activity and bactericidal fxn

Question 10

What are changes in B cell immunity during aging?

Answer 10

production and titers of Abs decreases
less affinity of Abs
decreased response to inf/vaccination
increase in autoAbs - may not signify actual dz

Question 11

What are Ig changes that occur during aging?

Answer 11

increased IgA and IgG

decrease in IgE and histamine can actually decrease allergies

Question 12

What are changes in cellular immunity that occur as we age?

Answer 12

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

Question 13

What are the changes in the renal system that occur during aging?

Answer 13

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

Question 14

How is temperature different in elderly patients than younger?

Answer 14

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

Question 15

Why is fever less common in older pts who have infection?

Answer 15

blunted thermogenesis by brown adipose tissue
reduced hypothalamic response to endogenous pyrogens
reduced ability to conserve and maintain body heat

Question 16

What are the changes in blood pressure seen in the elderly?

Answer 16

more susceptible to orthostasis - if they’re on meds or have untreated HTN a normal appearing BP may not actually be normal

Question 17

What are the changes in pulse seen in the elderly?

Answer 17

blunted response in HR and contractility to catecholamines released by exercise and acute illness
may not present w tachycardia
max HR decreases

Question 18

How do RR and blood gases change in the elderly?

Answer 18

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

Question 19

How is the presentation of abdominal pain different in the elderly?

Answer 19

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.

Question 20

How is the presentation of thyroid dz different in the elderly?

Answer 20

lack classic hyperadrenergic symptoms - look instead for weight loss, anorexia, fatigue, depression, CHF or A fib

Question 21

How is the presentation of cardiac dz and MI different in the elderly?

Answer 21

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

Question 22

How is the presentation of pneumonia different in the elderly?

Answer 22

often no fever, lower peak temp, higher mortality, lower WBC

Question 23

What are two geriatric syndromes that elderly patients present with when they become acutely ill?

Answer 23

falls and delirium