Geriatric Assessment Flashcards
1
Q
What are the 3 most common chronic disease in the elderly (+65%)?
A
- arthritis
- diabetes
- hypertension
2
Q
How is Blood Pressure Affected in the Elderly Patient?
A
- aorta and large vessels stiffen and become atherosclerotic
- causes rise in systolic pressure (systolic hypertension with a widened pulse pressure)
- diastolic stops rising in 60s
- orthostatic hypotension
3
Q
How is Pulse Affected in the Elderly Patient?
A
- resting HR unchanged
- decline in pacemaker cells at SA node
- maximal HR decreases
- increased likelihood of abnormal heart rhythms
4
Q
How is Respiratory Rate and Temperature Affected in the Elderly Patient?
A
- rr unaffected
- harder to regulate temp (susceptible to hypothermia)
5
Q
How does the Skin change in the elderly?
A
- wrinkles, becomes lax, loses turgor
- vascularity of dermis decreases (looks paler)
- back of hands/forearms become thin, fragile, loose, transparent
- purple patches/macules (actinic purpura) from blood that has leaked through poorly supported capillaries
- nails lose luster, yellow and thicken
6
Q
How do the eyes and visual acuity change with age?
A
- atrophy of fat - eyeball recedes
- eyelid skin wrinkles
- soft bulges of eyelids
- decrease in lacrimal secretions
- corneas lose luster
- pupils smaller (harder to examine ocular fundi)
- pupils become slightly irregular
- visual acuity decreases gradually until 70 (and then more rapidly)
- lens loses elasticity (decrease in accommodation and near focus)
- increased risk: glaucoma, cataracts, macular degeneration
- thickening and yellowing of lenses (more light for reading and fine work)
- lens continues to grow, pushing iris forward (narrow-angle glaucoma)
7
Q
How does hearing change in the elderly?
A
- acuity diminishes with age after 50
- high pitch sounds affected first
8
Q
How are the mouth, teeth, and lymph nodes changed in the elderly?
A
- decreased salivary secretions and sense of taste
- decreased olfaction
- increased sensitivity to bitterness and saltiness
- teeth wear down/cavities/peridontal disease
- cervical nodes harder to palpate
- submandibular glands easier to feel
9
Q
How are the thorax and lungs changed in the elderly?
A
- chest wall stiffens
- respiratory muscles weaken
- lungs lose elastic recoil
- increased closing volume of sm airway cells (atelectasis and pneumonia)
- cough less effective (speed of forced exhalation decreases)
- accentuated dorsal curve of thoracic spine, producing kyphosis from osteoporotic vertebral collapse and increased AP ratio
10
Q
How does age affect the neck vessels?
A
- lengthening and tortuosity of aorta and its branches (kinking of carotid artery predominantly on R)
- pulsatile mass (may be mistaken for a carotid aneurysm)
- occasionally raises JVP on L side (impairing drainage within thorax)
- systolic bruits in mid/upper carotids (suggest partial atherosclerosis)
11
Q
How does age affect extra heart sounds?
A
- S3 strongly suggest heart failure from volume overload in LV (as in coronary artery diseases of valvular heart disease - mitral regurgitation)
- S4 often suggests decreased ventricular compliance and impaired ventricular filling
12
Q
How does age affect cardiac murmurs?
A
- systolic aortic murmurs (increased risk with age)
- thickening base of aortic cusps with fibrous tissue calcification = audible vibrations
- mitral valve changes happen about a decade later
- calcification of mitral valve annulus impedes normal valve closure during systole (mitral regurgitation)
13
Q
How does age affect the peripheral vascular system?
A
- arterial/venous disorders (atherosclerosis) affect older ppns more but cannot be considered part of normal aging
- peripheral arteries lengthen, become tortuous, feel harder and less resilient
- loss of arterial pulsations demands careful evaluation (AAA)
- giant cell or temporal arteritis (rare)
14
Q
How does age affect the breasts and axillae?
A
- female breasts diminish (glandular tissue atrophies and is replaced by fat)
- breasts - flaccid and more pendulous
- ducts around nipple become more firm, stringy, easier to palpate
- axillary hair diminished
15
Q
How does age affect the abdomen?
A
- fat accumulates in lower abdomen and near hips, weakening of abdominal muscles leads to soft, protruding abdomen
- aging may blunt manifestations of acute abdominal disease (pain less severe, fever less diminished, fever less pronounced, signs of peritoneal inflammation diminished)
16
Q
How does age affect the male genitalia?
A
- sexual interest intact
- frequency of intercourse declines
- decreased testosterone and penis size
- erections more difficult
- testicles drop lower
- decreased pubic hair
- proliferation of prostate epithelial and stromal tissue (BPH) in 30s-70s
- symptoms of enlargement include urinary hesitancy, dribbling, incomplete emptying
17
Q
How does age affect the female genitalia?
A
- ovarian function decreases, menopause (45-52)
- decreased estrogen (hot flashes, sleep disruption, mood changes)
- vaginal dryness, urge incontinence, dyspareunia
- decrease in pubic hair and size of labia and clitoris
- vaginal mucosa becomes thin, pale, dry
- vagina narrows and shortens
- within 10 yrs of menopause, ovaries no longer palpable
- suspensory ligaments of adnexa, uterus, and bladder relax
18
Q
How does age affect the musculoskeletal system?
A
- loss of height (flexion at knees and hips, intervertebral discs thin and vertebral bodies shorten)
- kyphosis and increased AP diameter
- skeletal muscles decrease in bulk and power
- ligaments lose tensile strength
- ROM diminishes, partly because of osteoarthritis
- sarcopenia (loss of lean body mass and strength)
19
Q
How does age affect the nervous system?
A
- brain volume and number of cortical brain cells decrease
- microanatomical and biochemical changes
- benign forgetfulness
- retrieve and process data more slowly and take more time to learn new material
- motor responses slow and ability to perform complex tasks diminishes
- depression, dementia, delirium
- occasional benign essential tremor in head, jaw, lips, or hands
- decreased sense of vibration on feet and ankles
- position sense and reflexes may diminish
20
Q
ADLs vs IADLS
A
Activities of Daily Living: bathing, dressing, toileting, transferring, continence, feeding
Instrumental Activities of Daily Living: using telephone, shopping, preparing food, housekeeping, laundry, transportation, taking medicine, managing money
21
Q
What is the 10-minute Geriatric Screener and Falls Assessment?
A
- vision
- hearing
- leg mobility
- urinary incontinence
- nutrition/weight loss
- memory
- physical disability
- depression
22
Q
How do you assess Vision in the 10-minute Geriatric Screener?
A
Two parts:
- Do you have difficulty driving, watching tv, reading…?
- If yes, test with Snellen Chart.
- positive screen is yes and an inability to read >20/40 on Snellen Chart
23
Q
How do you assess Hearing in the 10-minute Geriatric Screener?
A
- audioscope at 40dB using 1,000 and 2,000 Hz
- positive screen is inability to hear 1,000 or 2,000 Hz in both ears or either of these frequencies in one ear
24
Q
How do you assess Leg Mobility in the 10-minute Geriatric Screener?
A
Time to “rise from chair, walk 20 feet briskly, turn, walk back and sit down”
- positive screen is inability to complete task in 15 seconds
25
How do you assess Urinary Incontinence in the 10-minute Geriatric Screener?
Two parts:
1. In the last year, have you ever lost your urine and gotten wet?
2. If yes: Have you ever lose urine on at least 6 separate dates?
- positive screen is yes to both questions
26
How do you assess Nutrition/Weight Loss in the 10-minute Geriatric Screener?
Two parts:
1. Have you lost 10 lbs over the past six months without trying to do so?
2. Weight patient
- positive screen is yes to question or weight<100lbs
27
How do you assess Memory in the 10-minute Geriatric Screener?
Three-Item Recall
Positive screen is inability to remember all three items
28
How do you assess Depression in the 10-minute Geriatric Screener?
Do you feel sad or depressed?
Positive screen is yes
29
How do you assess Physical Disability in the 10-minute Geriatric Screener?
Are you able to:
1. Do strenuous activities like fast walking or bicycling?
2. Do heavy work around the house like washing windows, walls or floors?
3. Go shopping for groceries or clothes?
4. Get to places out of walking distance?
5. Bathe, either a sponge bath, tub bath, or shower?
6. Dress, like putting on a shirt, buttoning and zipping, or putting on shoes?
Positive screen is no to any of the questions
30
What are common concerns for the older patient?
- ADLs
- IADLs
- medications
- acute and persistent pain
- smoking and alcohol
- nutrition
- frailty
- advance directives and palliative care
31
What are senile lentigines?
Liver/age spots
| non pathological
32
What is Epidermal Hyperkeratosis?
- senile (solar) keratosis
| - actinic keratosis (pre-cancerous lesions)
33
What is Seborrheic Keratosis?
- benign skin growths
| - often appear on back or chest
34
What is the Mini-Cog Test?
- have pt listen to and remember 3 unrelated words, have them repeat
- have pts draw face of clock, read time
- ask pt to repeat 3 previously stated words
Demented: 0 recall or 1-2 item recall with abnormal CDT
Nondemented: 3 items recalled or 1-2 items recalled with CDT normal
35
What is the SOAP problem focused history?
Subjective: source, cc, relevant HPI, PMH, FH, SH, pertinent + and -
Objective: PE 9 vitals, observations, lab findings, test results)
Assessment: interpretation of S and O; hypothesis (dd, listing and narratives, reflects your reasoning)
Plan: details for treatment chosen (tests, meds, follow up, pt education)
36
Barnett's Notes on Delirium
- acute
- fluctuating
- culprits are medical illness or drug toxicity
- disturbed levels of consciousness
- attention fluctuates
- speech may be slow, rapid, or incoherent
- usually disoriented
37
Barnett's Notes on Elder Abuse
- gotta look for it
- 66% of abuse by adult children or spouse
- 42% of murder victims above 60 are killed by their children
38
Barnett's Notes on Dementia
- slow onset, progressive
- usually no medical illness involved
- normal level of consciousness until later
- attention unaffected until late
- aphasic speech
- oriented until later on
39
Barnett's Notes on Epidemiology
- average life span is 84 yo for women and 82 for men
| - know that the aging ppn is increasing in size across all ethnicities
40
Barnett's Notes on Functional Decline
functional decline with falls, weight loss, dementia, polypharmacy, incontinence, social support, special sense
41
Barnett's Notes on Incontinence
- affects social interactions and self esteem
- places them at risk for falls and infections
- DIAPERS: Delirium, Infection, Atrophic urethritis or vaginitis, Pharmacotherapy, Excess urine out due to various disorders, Restricted mobility, Stool impaction
- DDRRIIPP: Delirium, Drug side effects, Retention of feces, Restricted mobility, Infection of urine, Inflammation, Polyuria, Psychogenic
