CM: Geriatrics Flashcards
What are some normal changes contributing to homeostenosis?
sarcopenia
body composition (more fat, less water)
decreased renal fxn
decreased CV reserve (max HR, autonomic fxn)
pulm fxn (PaO2 of 80 at 80, pulse ox less helpful)
immune fxn
What are the key components of an H&P on a geriatric patient?
environment, communication issues
less focus on family hx, more social hx
cognitive eval, multiple co-morbidities, fxnal assessment, health maintenance, polypharmacy, interdisciplinary team approach, involvement of family and caregivers
mental status, performance based eval of musculoskeletal system
What is a very important prognostic indicator for the geriatric patient?
functional status
What are the current demographics of elderly patients?
over 65 is cut-off
fastest growing portion of population, oldest of old (>85) are increasing at most rapid rate
What two factors contribute to homeostenosis?
less physiologic reserves available to respond to stressor
increasing reserves used just to maintain homeostasis
What are geriatric syndromes?
delirium, urinary incontinence, falls
often multifactorial etiology and treatment
can be confused w normal aging
What is delirium as a geriatric syndrome?
acute, fluctuating change in mental status w inattention and altered levels of consciousness
risk factors = severity and acuity of illness, advanced age, underlying dementia, fxnal impairment, number of comorbidities and its treatments (meds)
inf, electrolyte abnormalities, change in surroundings
MI or CNS problems
How can delirium be recognized?
hyperactive - pt screaming, pulling out IV, etc
hypoactive - most common, sleepy or out of it
use CAM (confusion assessment method)
How is delirium treated?
treat underlying causes, ensure safety of pt, sometimes pharm treatment (esp for hyperactive, use lowest dose for shortest time)
What is the ddx for acute etiologies of urinary incontinence?
DIAPPERS = delirium, inf, atrophic vaginitis, pharm causes, psych causes, endocrine causes, restricted mobility, stool impaction/severe constipation
What are the four categories of chronic urinary incontinence?
urge: most common, uninhibited detrusor contractions, sudden urge can’t make it in time = bladder instability, treat w scheduled voiding
stress: coughing or laughing when intra-ab pressure increases, normal post void volume
overlow: obstructed due to enlarged prostate or stricture, detrusor is denervated (neuropathy from DM, idiopathic), large post void residual volume
functional: immobility, cognitive impairment, environmental barriers
can have mixed, w two or more of above together
What are broad categories of risk factors for falling?
age associated disease associated meds time-related (acute illness, med change, postural hypoT) risk taking behavior environmental challenges to balance
What are important components of the hx for falling?
SPLATT = symptoms, previous falls, location, activity, time, trauma
What are good practices to prevent falls and their sequelae?
pattern of physical activity to maintain mobility
discuss home hazards
review meds periodically
prevent osteoporosis so fractures less likely if fall
multidisciplinary once pt has fallen once
What are key parts of the physical exam when evaluating falls?
vital signs, visual or balance problems on head and neck, arrhythmia or valve dysfxn, neurologic signs, musculoskeletal signs
*must watch pt walk and get orthostatic BPs
