Geriatric Health Maintenance Flashcards
Typical presentation of presbyacusis
elderly person complains of difficulty understanding speech and conversation in noisy areas (loss of high frequency and speech discrimination)
age-related SENSORINEURAL hearing loss
Examples of IADL
cooking, driving, shopping, housecleaning, laundry, using the phone, money management
Examples of ADL
bathing, dressing, eating, continence, toilet, grooming
What kinds of conditions lead to vision loss in elderly
presbyopia, cataracts, glaucoma, macular degeneration, diabetic retinopathy
What is the leading cause of severe vision loss in elderly
age-related macular degeneration AMD
What happens to vision in presbyopia
difficulty focusing on nearby objects while distant vision remains intact
Pathophysiology of AMD
atrophy of cells in central macular region of retinal pigment epithelium resulting in loss of central vision
How to treat AMD
laser photocoagulation and intravitreal injections of vascular endothelial growth factor (VEGF)
Increased intraocular pressure leading to optic nerve neuropathy
glaucoma
risk factors for glaucoma
increased intraocular pressure, family history, vision changes, AA race…if have risk factors, do routine screening
Most common cause of blindness worldwide
cataracts…definitive treatment is surgery
Leading cause of blindness in working age adults in US
diabetic retinopathy
Common causes of geriatric hearing impairent
presbycusis, noise-induced hearing loss, cerumen impaction, otosclerosis, central auditory processing disorder
otosclerosis
autosomal dominant disorder of bones in the inner ear that results in progressive conductive hearing loss with onset late 20s-early 40s
central auditory processing disorder
conditions that reult from CNS dysfunction; can hear sounds fine just has difficulty understanding spoken language
Evidence for routine screening of vision and hearing in elderly
INSUFFICIENT
Leading cause of nonfatal injuries in elderly
falls
how to prevent falls
incorporation of exercise and physical therapy, as well as vitD supplementation
How to screen for dementia
MMSE; clock draw; three item recall
Easy screen for depression
have you felt down/depresed/hopeless in last two weeks? have you felt little interest or pleasure in doing things?
How to assess nutritional status in elderly
serial weight measurements and inquiry about changing appetite
What can protein undernutrition look like?
increased risk of infections, anemia, orthostatic hypotension, decubitis ulcers
2 greatest risk factors for stroke
- HTN
2. afib
How to reduce risk of strokes in patients with afib
anticoagulation!
warfarin, dabigatran, apixaban
When to stop mammograms?
until life expectancy falls below 5 to 10 years; insufficient evidence for or against screening in women over 75
When to stop colon cancer screening
75-85
When to stop cervical cancer screening
65; only if you’ve had adequate prior screening and aren’t at high risk for cervical cancer
What vaccines should someone over 65 get?
influenza annually, at least one pneumococcal and single booster Tdap
one dose of herpes zoster at 60 older
advance directive
oral/written statements made by patients when they are competent that are intended to guide care should they become incompetent
What proportion of patients who undergo CPR in the hospital actually survive to discharge?
15% :(
