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Gen Med: Geriatrics > Geriatric Syndromes > Flashcards

Geriatric Syndromes Flashcards

1
Q

Define geriatric syndromes

A
  1. Common clinical conditions that don’t fit into specific disease categories but have substantial implications for functionality & life satisfaction in older adults
  2. Decrease quality of life
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2
Q

What are common geriatric syndromes?

A
  1. Incontinence
  2. Falls
  3. Vertebral compression fractures
  4. Functional decline/ immobility
  5. Delirium
  6. Malnutrition
  7. Sensory impairment
  8. Pressure ulcers
  9. Dizziness
  10. Syncope
  11. Cognitive impairment
  12. Psychiatric disorders
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3
Q

Define urge incontinence

A

Bladder contractions that cannot be controlled by brain

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4
Q

Define stress incontinence

A

Dysfunction of urethral sphincter & relaxed pelvic floor muscles leads to urine leaks w/ inc intra-abdominal pressure

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5
Q

Define overflow incontinence

A
  1. Urinary retention leads to bladder distention & overflow of urine
  2. Males more than females
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6
Q

define functional incontinence

A

Untimely urination caused by physical or cognitive disability that prevents pt from reaching toilet

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7
Q

Define mixed incontinence

A

Combination of stress & urge incontinence

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8
Q

What is the leading cause of non-fatal injuries in older persons?

A

Falls

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9
Q

What is the leading cause of death from injury in persons over 65?

A
  1. Complications from falls

2. Hip fracture is common precursor to functional impairment, nursing home placement & death

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10
Q

What is the most common cause of falls?

A

impaired pt + environmental risk

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11
Q

What are the intrinsic causes of falls?

A
  1. Disorder or condition that impairs sensory input, judgment, BP regulation, reaction time, balance & gait
  2. Medication use is one of the most common causes of falling
    A. Sedative/hypnotics
    B. Antidepressants
    C. Benzos
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12
Q

How can postural HTN be modified to help prevent falls?

A

Elevation of HOB; d/c or substitute offending meds

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13
Q

How can use of benzos or sedatives be modified to help prevent falls?

A

Educate about sleep hygiene; d/c or substitute meds

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14
Q

How can use of multiple prescription meds be modified to help prevent falls?

A

Review of meds

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15
Q

How can environmental hazards be modified to help prevent falls?

A

Appropriate changes, installation of safety equipment

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16
Q

How can gait impairment be modified to help prevent falls?

A

Gait training, assistive devices (canes/walkers), balance exercises

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17
Q

How can impairment in transfer or balance be modified to help prevent falls?

A

Balance exercises, grab bars/handrails

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18
Q

How can impairment of ext strength or ROM be modified to help prevent falls?

A

Exercise with resistance bands with gradual inc in resistance

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19
Q

What are some consequences of immobility?

A
  1. DVT/PE
  2. Urinary retention / UTI
  3. Atelectasis / Pneumonia
  4. Depression
  5. Hyperglycemia
  6. Worsening chronic disease
  7. Constipation / fecal impaction
  8. Osteoporosis
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20
Q

How can immobility be prevented/treated?

A
  1. Inspect skin, esp. pressure points
  2. Bedside ROM exercises
  3. Reduce contractures & weakness
  4. Antithrombotic measures
  5. PT / graduated ambulation ASAP
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21
Q

What are vertebral compression fractures asst. with?

A
  1. Associated w/ osteoporosis
    A. Usually in thoracic or lumbar spine
  2. +/- trauma
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22
Q

What sxs are present with vertebral compression fx?

A
  1. Deep pain over site of Fx

A. Sometimes asst w/ radicular pain in appropriate nerve root distribution

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23
Q

What dx studies are used for vertebral compression fx?

A

Dx confirmed by X-ray or MRI

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24
Q

How are vertebral compression fx treated?

A

Treatment if symptomatic w/ analgesics

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25
Q

Define malnutrition

A

Under-nutrition & frailty

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26
Q

What may be the etiology of malnutrition?

A
  1. Cause is most often “pre-mouth”
    A. Inability to shop for food
    B. Inability to prepare meals
    C. Inadequate assistance w/ feeding
2. Other causes
A. Mouth disorders
B. Dysphagia
C. Malignancy 
D. Pain
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27
Q

What are the general characteristics for cataracts?

A
  1. Opacity of natural lens of eye

2. 2° to aging, trauma, congenital causes, or meds (steroids most common), excess sun exposure

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28
Q

What are the sxs for cataracts?

A
  1. Insidious onset decreased vision
  2. Often sees “halos” around objects
  3. Fundi: cataract appears black on red background
29
Q

What are the rx for cataracts?

A
  1. Lens replacement

2. Excellent prognosis

30
Q

Define glaucoma

A

Increase IOP w/ optic nerve damage

31
Q

Define the sxs of open angle glaucoma

A
  1. Decreased vision
  2. defects in peripheral vision
  3. Increased cup to disc ratio
32
Q

Define the sxs of closed angle glaucoma

A
  1. Eye pain & acute vision loss (Medical Emergency)
  2. Injection (red eye), steamy cornea, fixed mid-dilated pupil, decreased visual acuity, N/V/diaphoresis.
  3. Increased IOP, ant chamber narrowed
33
Q

What are the 2 types of hearing loss?

A
  1. Conductive

2. Sensorineural

34
Q

How are conductive and sensorineural hearing loss differentiated?

A
  1. Weber & Rinne tests help to differentiate
  2. Sensorineural:
    A. Weber: sound localizes towards the good ear
    B. Rinne: AC > BC
  3. Conductive:
    A. Weber: sound localizes toward affected (bad) ear
    B. Rinne: BC > AC
35
Q

What is conductive hearing loss caused by?

A
  1. Cerumen impaction
  2. Acute external otitis
  3. Otosclerosis (abnormal new bone growth in oval window)
  4. OM
36
Q

Define the pathophys of conductive hearing loss

A

Caused by impaired transmission of sound along external canal, across the ossicles, & thru oval window

37
Q

Define the pathophys of sensorineural hearing loss

A

Hearing loss secondary to disruption in nerves or mechanics of hearing

38
Q

What may be the causes of sensorineural hearing loss?

A

Causes include presbycusis (most common), Meniere’s disease, acoustic trauma, acoustic neuroma, drug induced

39
Q

Define pressure ulcers. What effects can they have?

A
  1. Ulcers caused by unrelieved pressure on soft tissues overlying a bony prominence
  2. Ulcer reduces or completely obstructs the blood flow to the superficial tissues
40
Q

Where are pressure ulcers most commonly seen?

A

Sacrum

Hips

41
Q

What is the Braden scale?

A

Risk assessment instrument commonly used in hospitalized pts

42
Q

What predisposing factors can lead to pressure ulcers?

A
  1. Immobility – 1° risk factor
  2. Loss of subcu fat
  3. Decline in elasticity
  4. Reduced skin & tissue perfusion
  5. Moisture (fecal & urinary incontinence)
  6. Dehydration
43
Q

How can pressure ulcers be prevented?

A 
1. Specialized support surfaces 
A. Mattresses
B. Beds
C. Cushions
2. Patient repositioning
3. Optimizing nutritional status
4. Moisturizing sacral skin
44
Q

What is a stage I pressure ulcer?

A

Non-blanchable hyperemic

45
Q

What is a stage II pressure ulcer?

A

Extension through epidermis

46
Q

What is a stage III pressure ulcer?

A

Full thickness skin loss

47
Q

What is a stage IV pressure ulcer?

A

Full thickness skin loss with extension into muscle, bone or supporting structures

48
Q

How is pressure ulcer treated?

A
  1. Remove eschar
  2. Clean ulcer
  3. Relieve pressure
  4. Keep moist
  5. Manage exudate
49
Q

Define dizziness

A

Sensation of lightheadedness, spinning or impending syncope

50
Q

Define vertigo dizziness

A

sensation of rotational movement of self or surroundings

51
Q

Define non-vertigo dizziness

A

unsteadiness, lightheadedness

52
Q

What is included in the pe for dizziness?

A
  1. Orthostatic BP
  2. Observation of gait
  3. Check for nystagmus
  4. Cardiac assessment
  5. Neurologic assessment
53
Q

How is dizziness treated?

A

Varies with etiology

54
Q

Define syncope

A

Sudden, transient loss of consciousness not resulting from trauma

55
Q

What are the common etiologies of syncope?

A
  1. Increases in occurrence w/ age
  2. Cardiac arrhythmias
  3. Aortic Stenosis
  4. MI
  5. Hypoglycemia
  6. Orthostatic hypotension
  7. PE
56
Q

What dx studies are used for syncope?

A
  1. H&P are key to DX
  2. Diagnostic studies should be based on H&P:
    A. EKG
    B. Holter monitor
    C. Echo
    D. Tilt table test
    E. Intracardiac Electrophysiologic studies
    F. CT / MRI brain
57
Q

True/false: impairment of cognition is normal part of aging

A

False: Impairment of cognition is NOT a normal part of aging

58
Q

Define mild cognitive impairment (MCI)

A
  1. Characterized by deficits in cognition w/out deficits in ADLs
  2. May or may not progress to dementia
  3. Reduced performance on cognitive tests
59
Q

What are the sxs of MCI?

A
  1. Pattern of forgetfulness develops; forgetfulness is noted by others
  2. Maintains normal judgment and reasoning
  3. Carries on ADL’s
60
Q

Define cognitive impairment

A

Progressive impairment of intellectual functioning w/ compromise in at least 2 of the following: language, memory, ability to problem solve, concentration, judgement, emotional behavior, personality & cognition

61
Q

What is the most common form of dementia?

A

Alzheimer’s Disease

62
Q

Define vascular dementia

A
  1. AKA multi-infarct dementia
  2. Prevalence: M>F & those w/ cardiovascular risk factors
  3. Affects small & medium sized cerebral vessels
  4. May have carotid bruits
63
Q

What are the clinical features of vascular dementia?

A
  1. Forgetfulness in absence of depression & inattentiveness
  2. Stepwise deterioration, fluctuating course, depression
64
Q

How is vascular dementia treated?

A

Control of BP & metabolic disorder

65
Q

What are the general characteristics of depression?

A
  1. Older adults tend to be self reliant
  2. Stoicism is typical
  3. Many times, patients often deny mental illness
  4. Most common mental health issue in elderly
66
Q

What are the rf for depression in elderly?

A
  1. Female
  2. Widowed/divorced
  3. Hx of prior depression
  4. Vascular brain changes
  5. Disabling illness
  6. Polypharmacy
  7. Excessive ETOH use
  8. Low social support
  9. Caregiver of person w/ major disease
67
Q

What are the clinical features of depression?

A
  1. Characterized by sadness, withdrawal from activities, anhedonia (no pleasure)
  2. Typical presentation in elderly:
    A. Memory impairment
    B. Agitation or anxiety
    C. Somatic complaints
    D. Sleep difficulties
  3. Dx established by clinical suspicion & completion of depression screening tool
68
Q

How is depression treated in the elderly?

A

SNRI or SSRI

Gen Med: Geriatrics (5 decks)

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