Examination Of The Geriatric Patient Flashcards
Who lives longer men or women?
Women life expectancy = 84
Men = 81
What to focus on when having an older adult as a patient
They are very goal oriented
*focus on patients individual health goals
What is the sixth vital sign
Functional assessment
What are the geriatric syndromes?
- Cognitive impairments
- Falls
- Urinary incontinence
- Frailty
- Low BMI
- Dizziness
- Impaired vision and hearing
What do elderly patients do about symptoms that they may be experiencing
Under report them
*accidentally or intentionally
*overestimate health
*afraid, embarrassed, avoid clinical expenses
*over look their symptoms
What is the definition of geriatric syndromes and what are they linked to?
- A multi factorial condition that involves the interaction between identifiable situation-specific stressor and underlying age-related risk factors, resulting in damage across multiple organ systems
*linked to functional decline
What are the shared risk factors of the elderly?
- Increased age
- Cognitive impairment
- Functional impairment
- Impaired mobility
What are the different types of ADLs
- Washing
- Dressing
- Feeding
- Toileting
- Walking
- Transferring
What are IADLs
Instrumental activities of daily living
1. Shopping
2. Cooking/cleaning
3. Using telephone or transportation
4. Managing money and medications
*SCUM
What is the single most common modifiable risk factor associated with falls?
- Medications
*ask the patient to bring in all medication bottles and OTC
*keep the number of drugs to a minimum
If an elderly patient does not report their pain what can that lead to?
- Persistent pain
*make sure to ask at every visit
What advice to give for smoking an alcohol consumption
Smoking
*advise to quit at every visit
Alcohol
*no more than 2 drinks on any one day or 7 drinks a week
*CAGE
How often should you weight elderly patients?
- All the time
When should Advanced directed and palliative care be discussed ?
- Before onset of serious illness
*provide information, clarify the patients preferences, identify surrogate decision maker
What is palliative care
- Alleviation of pain, suffering
- Promotion of optimal QOL
- Considering the physical, mental, spiritual, and social well-being of patients while ensuring patient dignity and respecting autonomy
What do falls cause to the elderly
- Significant morbidity and mortality in older patients
*60% of injuries due to falls
At what age should breast cancer be screened
Start 50
End 74
When should colorectal cancer be screened
Start 60
End 70
When should lung cancer be screened for?
50 to 80
*20 pack year history, current smoker, or quit within the 15 years
*annual screen with LDCT
What is the USPSTF screening for vision and hearing?
I
*but recommend for geriatricians
*ask patients about hearing loss (use whisper test)
What can exercise do for the elderly
- Decrease in all cause mortality
- Recommend aerobic with muscle strengthening
- 150 minutes MI or 75 VI minutes per week
What are the recommendation for immunizations
- Influenza
- Td or Tdap (10 years)
- Pneumococcal vaccines
- Zoster (>50)
- COVID
How to screen for depression
- Geriatric depression scale
- USPSTF = B
- Often under diagnosed, untreated or under treated
What is dementia
- Acquired condition that is characterized by a decline in at least two cognitive domains that is severe enough to affect social or occupational functioning
*loss of memory
*attention
*language
What is the most predominant cognitive impairment disorder
- Alzheimer’s disease
How to screen for cognitive impairment
- Mini mental state examination
*24-30 = no cognitive impairment
*18-23 = mild cognitive impairment
*0-17 = serve cognitive impairment
What are changes that happen to the BP and HR
BP
*systolic HTN
*postural hypotension
HR
*resting HR remains unchanged
*decline in pacemaker cells and max HR
*common to have arrhythmias
What are changes that happen to the respiratory rate and temperature
RR
*unchanged
Temp
*unchanged
What are changes that happen to the O2 saturation, height, weight
O2
*>90%
Height and weight
*kyphosis, muscle mass loss
What does functional evaluation (sixth vital sign) provide a baseline for>
- Provides a baseline for making interventions that optimize the patients level of function and for identifying geriatric syndromes
*cognitive impairment
*falls
*incontinence
what does DIAPERS stand for?
D: Delirium
I: infection
A: atrophic urethritis / vaginitis
P: pharmaceuticals
E: excess urine output
R: restricted mobility
S: stool impaction
What does DDRRIIPP stand for?
D: delirium
D: drug SE
R: retention of feces
R: restricted mobility
I: infection of urine
I: inflammation
P: Polyuria
P: psychogenic
What is actinic purpura
Capillaries are leaky
*rupture of delicate blood vessel walls
*leads to erythematous purpura
What is actinic keratoses
*flatten yellow papule
*rough scaly patch on the skin
What is actinic lentigines
Liver spots
*due to sun exposure
what is seborrheic keratoses
- Raised yellow/brown greasy looking spots
What is ectropion, entropion and arcus senilis
Ectropion
*eyelid folds out
Entropion
*eyelid folds in
Arcus senilis
*phospholipid deposition, benign, high cholesterol
What are the eye changes that happen to the elderly
- Smaller pupils
- Visual acuity diminishes rapidly >70
*presbyopia
What are cataracts
Thickening and yellowing of the lens, impairs passage of light
*world leading cause of blindness
What is open angle glaucoma
Intraocular pressure is elevated due to reduced drainage of aqueous fluid through the trabecular mesh work
*will be sudden loss of vision emergency
What is macular degeneration
- Poor central vision and blindness
*dry atrophic (MC) and wet exudative or neovascular
*Drusen = colloid bodies causing alteration in pigmentation
What is presbycusis
Hearing loss with aging
What is angular cheilitis
- Over-closure at the angle of the mouth
*can happen when removing the dentures
What happen to the neck vessels with the elderly
Will be lengthening and tortuosity of aorta
*kink or buckling of the carotid artery
*pulsatile mass (may be mistaken for a carotid aneurysm)
How does systolic bruits happen>
- Stenosis from atherosclerotic plaque
What type of extra heart sounds will be heard
- Pathology third heart sound (S3)
*CHF, volume overload - Fourth heart sound (S4)
*decreased ventricular compliance
What happens to the cardiac output in the elderly
- Less responsive to stimulation from B adrenergic catecholamines
What is a systolic aortic murmur (cardiac murmur)
- Fibrotic changes thicken the bases of the aortic cusps, calcification occurs, turbulence in flow creates even more sound
- Aortic sclerosis
*fibrosis and calcification = no blood flow obstruction - Aortic stenosis
*aortic valve leaflets become pacified and immobile
What is mitral regurgitation (cardiac murmur)
- Calcification of mitral valve annuls or valve ring, impedes closure during systole
*may be pathology as volume overload increases in LV
What should you do if there is a loss of arterial pulses?
- Evaluate carefully
What is the glandular tissue of the breast replaced with while aging
Fat
*will be flaccid and pendulous
*ducts more easily palpable
What are some causes of erectile dysfunction
- Atherosclerotic occlusive disease
- Corpora cavernosa venous leak
- Chronic disease
- Smoking
What is the cause of loss of cortical and trabecular bone mass
- Calcium reabsorption from bone rather than diet
How to screen bone mineral density
DEXA
What is a benign essential tremor?
- Bilateral
*worse when the patient is trying to use the limb
What are the sings of Parkinson’s disease ?
TRAP
Tremor, rigidity, akinesia, postural instability
*bradykinesia, micrographia, shuffling gait, difficulty rising from a chair
