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
