Final: OAT Geriatric Patient Flashcards
What are the subgroups for old?
Young old: 65-75
Older-old: 75-85
Old-Old: 85+
What is important to consider in elderly patient treatment?
- Decreased healing
- Increase risk of side effects
- Patient centered care**
What are the goals for geriatric treatment?
Optimize function
Avoid Hospitalization
Maintain Community Involvement
How do arteries change as we age? How does this complicate things?
More calcification, decreased elasticity and loss of baroreceptor reflex makes treatment harder and increases risk of hypotension and falls
If a patient is older than 60, what are the BP goals?
SBP <150mmHg
If a patient is older than 60 with a history of TIA or CV risk, what is BP goals?
SBP <140mmHg
What are the two most common causes of HF?
HTN and CAD
Fatigue, DOE, and sleeping propped up in a chair are signs and symptoms of?
Heart failure
When treating an elderly patient for HTN, what is important to watch for?
Orthostatic Hypotension
-falls!
If systolic BP drops more than 20mmHg, or diastolic more than 10mmHg after pt stands, what is diagnosis?
Orthostatic Hypotension
-fall risk=hip fractures
As we age, how does immune function change?
Immune system decreases
- loss of T cell fxn, decreased renal mass
- -increase infections (especially if catheters!)
As we age, how does metabolic function change?
Relative altered glucose metabolism
- relative resistance to insulin/islet cell dysfunction
- -altered muscle mass, functional disability, frailty
How does fever change in frail, older adults?
> 37.8 in single temp
or
1.1 C increase from baseline
In healthy adults its just >38 C (100.4 F)
As you age, do you have more or less chance for adverse drug reactions?
More
-renal/hepatic function declines means you clear less
What is considered pre-diabetes, diabetes, and uncontrolled diabetes on A1C?
Pre: 5.7-6.4%
Diabetes: >6.5%
Uncontrolled: >8%
What are the geriatric goals for A1C? For healthy, complex and poor health
Healthy: <7.5%
Complex: <8.0%
Poor: <8.5%
A T-score on a DEXA scan less than -2.5 means what?
Osteoporosis
How can you prevent osteoporosis?
Regular weight Bearing exercise
Ca++ and Vit D supplementation
What is the cause of the leading risk of injury among elderly?
Falls
- less proprioception
- less muscle mass
- less stability
After one fall, is a patient more or less likely to have another fall?
More
-just a vicious cycle
The Get up and Go test for your patient times out to 13s. What does this mean?
It took your patient too long=fall risk
-they stood up, walked three steps forward, walked three back and sat down
If an older patient has a fall, and their leg swollen, painful, there is significant bruising and the leg is shortened and externally rotated what does that mean?
Intertrochanteric fracture
How do you diagnose intertrochanteric fx?
AP and Lateral veiw comparison between bad and good leg
As we age, what happens to our neurologic system?
Decreased brain weight
Decreased vibratory sense
Alteration in CNS NTs
Increased postural instability
All leads to more dementia and fall risk
