Geriatric conditions Flashcards
`Disability
dependency or difficulty in carrying out ADLs
Frailty
physiologic state of increased vulnerability to stressors
results from decreased physiologic reserves and dysregulation of multiple physiologic systems
syndrome where at least 3 of the ff are present:
- unintentional weight loss of at least 10 lbs over the past year
- self reported exhaustion
- weakness
- slow walking speed
- low physical activity
Comorbidity
concurrent presence of two or more disease processes in the same individual
——– aggravates —–
while ——— predict ———–
disability exacerbates frailty and comorbidities
frailty and comorbidities predict disability
primary aging
the normal aging without disability or environmental factors
universal changes that occur with aging independent of disease or environmental effects
secondary aging
lifestyle and environmental consequences and disease associated with aging
successful aging
aging without decrease in organ system function
usual aging
progressive but significant declines in physiologic functions
physiology for normal aging
decreased:
- ability to adapt to stress
- ability to adapt to environment
- internal homeostatic control
- reserve capacity of organ systems
steep decline of vo2 max after the age of
70
vo2 max
amount of oxygen a person is able to inhale when doing maximal exercise
an indication of aerobic endurance
—% decline in max breathing capcity
60
—% decline in NCV
15
Functional implications of organ system aging: hematologic
Anemia (<10.5 g/dL)
- usually due to iron deficiency which may be caused by cancer, polymyalgia rheumatica, B12 deficiency, GI blood loss, infection
may result to orthostatic hypotension, dec tolerance to rehab exercise programs, fatigue, confusion
Functional implications of organ system aging: GI system
presbyoesophagus
Distal GI system affected
- decreased force of smooth muscle contraction
- impaired rectal perception of feces
- constipation, fecal incontinence, diarrhea
signs of presbyoesophagus
decreased peristalsis
decreased esophageal emptying
incomplete sphincter relaxation
Functional implications of organ system aging: hepatic system
decreased liver size by 5-15%
decreased hepatic blood flow
- leads to decline in drug elimination, prone to adverse drug reactions
Functional implications of organ system aging: renal system
decreased renal mass
decreased number of functioning glomeruli & tubules
decreased renal blood flow
decreased glomerular filtration rate
decreased creatinine clearance of 7.5-10 mL
decreased renal function by about 1% per year
Impaired ability to concentrate & dilate urine, sodium conservation, ability to excrete acid load
due to decreases in renal function, older adults are more prone to the ff metabolic conditions
hyponatremia (d/t water intoxication)
hyperkalemia
Functional implications of organ system aging: pulmonary system
Decline in the ff
- max voluntary ventilation
- vital capacity
- expiratory flow rate
- forced expiratory ventilation
- VO2 max
Increased Residual volume & FRC
VQ imbalance
- decline in PO2 (lower in supine)
- unchanged PCO2, pH
- O2 sat is normal or slightly reduced
- prone to hypoxia
Remains unchanged in the pulmonary system
total lung capacity
changes in pulmonary system are attributed to
normal effect of aging on musculoskeletal system
- stiffening of ribcage
- weakening of intercostals and abdominals
- increased airflow resistance d/t decreased elasticity of the respiratory organs
For VO2 max: caused by cardiac and peripheral muscles (especially LE) deconditioning
Functional implications of organ system aging: CV system
HRmax decreased
Decreased myocardial contractility, ejection fraction, early diastolic filling, baroreceptor activity
Decreased inotropic response to adrenergic stimulus
- decreased reflex tachycardia upon standing
- coughing and micturition syncope syndrome; excretion of fluids = decrease in BP
Increased risk of CHF, atrial tachycardia, or fibrillation
Functional implications of organ system aging: immunologic system
decrease in total no of lymphocytes by 15%
decrease lymphocyte proliferation and antibody production –> decreased ability to fight infections
decrease in antibody production: causes apprehension in terms of their response to vaccines
Elderly are less or more symptomatic during infection
less
because active leukocytosis and total WBC is not increased
Functional implications of organ system aging: endocrine system
decreased glucose tolerance; higher insulin resistance
decreased serum testosterone levels in men
postmenopausal declines in estrogen
UNCHANGED FBS
Untreated hyperglycemia may result to coma or ketoacidosis
Functional implications of organ system aging: thermoregulatory system
hypohydrosis: diminished sweating
may result to heat strokes and heat exhaustion
vulnerable to both hypothermia and hyperthermia
Functional implications of organ system aging: sensory system
deterioration of vision:
- presbyopia
- miosis
cataracts in 95% of adults greater than the age of 65
glaucoma is common
loss of visual acuity, decline in dark adaptation, higher minimal threshold for light perception –> high incidence of falls at night
presbycusis
conductive hearing loss
presbyopia
inability to increase curvature and thickness of the lens to focus on an object
miosis
excessive constriction of pupil
cataract affects —- vision
central vision
may be a sequelae of DM
glaucoma
optic nerve damaged d/t high pressure in eye
causes blindness in elderlies
affects peripheral
may be sequelae of DM
presbycusis
gradual loss of hearing
Functional implications of organ system aging: neurologic system
decline in STM
loss of speed of motor activities
changes in posture, proprioception, and gait
decline in cognitive functioning
increased reaction time
RETENTION OF immediate & primary memory
Functional implications of organ system aging: musculoskeletal system
progressive loss of muscle strength
- decrease in muscle cross sectional area and muscle mass
14-16%/decade for LE
12% (M) and 2% (F) for UE muscles
Gains in muscle strength noted in older adults with high intensity resistance exercise program: can prescribe in the absence of serious illnesses
osteoporosis and DJD common
Functional implications of organ system aging: Genitourinary system (urinary)
benign prostatic hyperplasia common in M >60 yrs (prostate gland enlargement)
incontinence caused by underlying diseases, NOT AGING
decreased bladder capacity, ability to postpone voiding, detrusor contractility, & urinary flow rate
- frequent urination
- decreased urine retention
- decreased force by detrusor muscle –> incomplete emptying
post void residual volumes increased –> increased frequency of urination later in the day
Functional implications of organ system aging: genitourinary system (genital part)
RETAIN sexual functioning and desire
older men with reduced psychogenic erections
ejaculatory force is less
less intense sensation of orgasm
impotence caused by underlying diseases
increased fragility of vaginal wall
decreased vaginal lubrication, attenuation of excitement phase
women maintain ability to engage in sexual intercourse throughout life cycle
Effects of acute hospitalization
disorientation
increased incidence of medical and iatrogenic complications
anxiety and confusion
depression
functional dependency
deconditioning
classifications devised by spirduso
physically elite
physically fit
physically independent
physically frail
physically dependent
physically elite
high risk and power sports enthusiasts
physically fit
individuals engaging in moderate physical work (endurance sports and common hobbies)
physically indepndent
engage in very light physical work and all instrumental ADLs
physically frail
those who are still able to do all ADLs and some instrumental ADLs but are home bound
physically dependent
can no longer engage in simple ADLs
predictor of CV and all cause mortality in older adults
deconditioning or decrease in physical activity
primary prevention
preventing onset of diseases
prophylactic
secondary prevention
diagnosis and treatment of asymptomatic diseases to prevent development of symptoms
tertiary prevention
treatment of symptomatic diseases
Siebens Domain Management Model
clinical framework for organizing care for adults
four domains:
- medsurg issues
- mental status/emotions/coping
- physical function
- living environment
Common geriatric syndromes
incontinence
sleep disorders
pain
falls
timed voiding program
offers toileting opportunities at regular intervals
initially short intervals; every 15-20 mins –> progress to longer intervals
when are long term indwelling catheters used
overflow incontinence due to detrusor overstretch; no urge to void even if bladder is full
patient voids excess fluid; incomplete emptying of bladder
helps in addressing bowel incontinence
biofeedback
acute insomnia
<1 month
related to stressors
treated with support and short term intermittent meds
chronic insomnia
> 1 month
due to underlying diseases
management for chronic insomnia
regular sleep schedule
keep pt out of bed until bedtime; cannot do activities in bed
snacks before bedtime
mental imagery
deep breathing relaxation; jacobson’s relaxation exercises
most common causes of pain in the elferly
OA
DJD
cancer
herpes zoster
temporal arteritis –> manifestations of polymyalgia rheumatica
polymyalgia rheumatica
PVD
common disabling conditions in older adults
hip fracture
arthritis and joint replacements
stroke
amputation
SCI
TBI
ageism coined by
robert butler
programmed theory
aging is regulated by biological clocks operating throughout the lifespan
regulation would depend on changes in gene expression that affect the systems responsible for maintenance, repair, and defense responses
stress theoru
DNA damage theory
proposes that aging is a consequence of unrepaired DNA damage accumulation
mutation theory
aging is a non-adaptive trait
natural selection is negligent of events that occur in a few long-lived animals that provide little additional contribution to offspring numbers
free radical theory
elderly = 65 y/o & older
old old = 75-85
oldest old >85
organisms age because cells accumulate free radical damage over time
free radical is a
any atom or molecule that has a single unpaired electron in an outer shell; use anti-oxidants
Body composition: increase
fat
body composition: decrease
gradual loss of lean tissue
muscle mass
limb muscle volume
muscle fiber number and area
bone density
respiratory system: increase
residual volume
functional residual capacity
lung dead space
sleep related disorder
minute volume with exercise
respiratory system: decrease
vo2 max
vital capacity
maximal breathing capacity
force and volume of airflow
CV system: increase
systolic and diastolic BP
orthostatic hypotension
thrombosis
serum lipid
HD lipoproteins
CV system: decrease
cardiac output
orthostatic tolerance
maximal o2 consumption
maximal exercise HR
capacity to work
arterial elasticity
contractile function
cardiac reserve
MSK system: increase
osteoporosis
degenerative diseases
poor posture
Msk system: decrease
muscle strength by 20-30%
work rate/power output
calcium
neurological system: increase
choice of reaction time
neurological system: decrease
fluid intelligence
ability for new learning
NCV
coordination and balance
sensory system: decrease
vision
hearing
vibratory perception
touch and pain sensitivity
skin: increase
susceptibility to pressure sores and infection
skin: decrease
moisture content
epidermal renewal
elasticity
blood supply
increase or decrease: risk of dehydration
increase
increase or decrease: susceptibility of hyper or hypothermia
increase
increase or decrease: thirst perception
decrease
increase or decrease: febrile response to infection
decrease
increase or decrease: body water
decrease
increase or decrease: glucose tolerance
decrease
postural changes of UE
head forward
shoulder extended
scapula protracted
elbow flexed
wrist ulnar deviated
finger flexed
postural changes of spine
thorax increased kyphosis
lumbar spine straightening
postural changes of LE
hip and knee flexion
ankle decreased dorsiflexion
minimum rom
should have at least 90 deg shoulder abd with sufficient ER/IR
45 pron/sup
45 wrist flex
30 wrist ext
finger flexion within 1 inch of palm
N hip ext
90 deg hip flex
N knee ext
110 deg knee flex
most common cervical disc degeneration
c5-6
followed by c6-c7 then c4-c5
most common reason for sc dysfunction
cervical spondylotic myelopathy
peripheral nervous system impairments
loss of vibratory sense
decreased ankle stretch reflex
