Geriatric Syndromes Flashcards
Define geriatric syndromes
- Common clinical conditions that don’t fit into specific disease categories but have substantial implications for functionality & life satisfaction in older adults
- Decrease quality of life
What are common geriatric syndromes?
- Incontinence
- Falls
- Vertebral compression fractures
- Functional decline/ immobility
- Delirium
- Malnutrition
- Sensory impairment
- Pressure ulcers
- Dizziness
- Syncope
- Cognitive impairment
- Psychiatric disorders
Define urge incontinence
Bladder contractions that cannot be controlled by brain
Define stress incontinence
Dysfunction of urethral sphincter & relaxed pelvic floor muscles leads to urine leaks w/ inc intra-abdominal pressure
Define overflow incontinence
- Urinary retention leads to bladder distention & overflow of urine
- Males more than females
define functional incontinence
Untimely urination caused by physical or cognitive disability that prevents pt from reaching toilet
Define mixed incontinence
Combination of stress & urge incontinence
What is the leading cause of non-fatal injuries in older persons?
Falls
What is the leading cause of death from injury in persons over 65?
- Complications from falls
2. Hip fracture is common precursor to functional impairment, nursing home placement & death
What is the most common cause of falls?
impaired pt + environmental risk
What are the intrinsic causes of falls?
- Disorder or condition that impairs sensory input, judgment, BP regulation, reaction time, balance & gait
- Medication use is one of the most common causes of falling
A. Sedative/hypnotics
B. Antidepressants
C. Benzos
How can postural HTN be modified to help prevent falls?
Elevation of HOB; d/c or substitute offending meds
How can use of benzos or sedatives be modified to help prevent falls?
Educate about sleep hygiene; d/c or substitute meds
How can use of multiple prescription meds be modified to help prevent falls?
Review of meds
How can environmental hazards be modified to help prevent falls?
Appropriate changes, installation of safety equipment
How can gait impairment be modified to help prevent falls?
Gait training, assistive devices (canes/walkers), balance exercises
How can impairment in transfer or balance be modified to help prevent falls?
Balance exercises, grab bars/handrails
How can impairment of ext strength or ROM be modified to help prevent falls?
Exercise with resistance bands with gradual inc in resistance
What are some consequences of immobility?
- DVT/PE
- Urinary retention / UTI
- Atelectasis / Pneumonia
- Depression
- Hyperglycemia
- Worsening chronic disease
- Constipation / fecal impaction
- Osteoporosis
How can immobility be prevented/treated?
- Inspect skin, esp. pressure points
- Bedside ROM exercises
- Reduce contractures & weakness
- Antithrombotic measures
- PT / graduated ambulation ASAP
What are vertebral compression fractures asst. with?
- Associated w/ osteoporosis
A. Usually in thoracic or lumbar spine - +/- trauma
What sxs are present with vertebral compression fx?
- Deep pain over site of Fx
A. Sometimes asst w/ radicular pain in appropriate nerve root distribution
What dx studies are used for vertebral compression fx?
Dx confirmed by X-ray or MRI
How are vertebral compression fx treated?
Treatment if symptomatic w/ analgesics
Define malnutrition
Under-nutrition & frailty
What may be the etiology of malnutrition?
- 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
What are the general characteristics for cataracts?
- Opacity of natural lens of eye
2. 2° to aging, trauma, congenital causes, or meds (steroids most common), excess sun exposure
What are the sxs for cataracts?
- Insidious onset decreased vision
- Often sees “halos” around objects
- Fundi: cataract appears black on red background
What are the rx for cataracts?
- Lens replacement
2. Excellent prognosis
Define glaucoma
Increase IOP w/ optic nerve damage
Define the sxs of open angle glaucoma
- Decreased vision
- defects in peripheral vision
- Increased cup to disc ratio
Define the sxs of closed angle glaucoma
- Eye pain & acute vision loss (Medical Emergency)
- Injection (red eye), steamy cornea, fixed mid-dilated pupil, decreased visual acuity, N/V/diaphoresis.
- Increased IOP, ant chamber narrowed
What are the 2 types of hearing loss?
- Conductive
2. Sensorineural
How are conductive and sensorineural hearing loss differentiated?
- Weber & Rinne tests help to differentiate
- Sensorineural:
A. Weber: sound localizes towards the good ear
B. Rinne: AC > BC - Conductive:
A. Weber: sound localizes toward affected (bad) ear
B. Rinne: BC > AC
What is conductive hearing loss caused by?
- Cerumen impaction
- Acute external otitis
- Otosclerosis (abnormal new bone growth in oval window)
- OM
Define the pathophys of conductive hearing loss
Caused by impaired transmission of sound along external canal, across the ossicles, & thru oval window
Define the pathophys of sensorineural hearing loss
Hearing loss secondary to disruption in nerves or mechanics of hearing
What may be the causes of sensorineural hearing loss?
Causes include presbycusis (most common), Meniere’s disease, acoustic trauma, acoustic neuroma, drug induced
Define pressure ulcers. What effects can they have?
- Ulcers caused by unrelieved pressure on soft tissues overlying a bony prominence
- Ulcer reduces or completely obstructs the blood flow to the superficial tissues
Where are pressure ulcers most commonly seen?
Sacrum
Hips
What is the Braden scale?
Risk assessment instrument commonly used in hospitalized pts
What predisposing factors can lead to pressure ulcers?
- Immobility – 1° risk factor
- Loss of subcu fat
- Decline in elasticity
- Reduced skin & tissue perfusion
- Moisture (fecal & urinary incontinence)
- Dehydration
How can pressure ulcers be prevented?
1. Specialized support surfaces A. Mattresses B. Beds C. Cushions 2. Patient repositioning 3. Optimizing nutritional status 4. Moisturizing sacral skin
What is a stage I pressure ulcer?
Non-blanchable hyperemic
What is a stage II pressure ulcer?
Extension through epidermis
What is a stage III pressure ulcer?
Full thickness skin loss
What is a stage IV pressure ulcer?
Full thickness skin loss with extension into muscle, bone or supporting structures
How is pressure ulcer treated?
- Remove eschar
- Clean ulcer
- Relieve pressure
- Keep moist
- Manage exudate
Define dizziness
Sensation of lightheadedness, spinning or impending syncope
Define vertigo dizziness
sensation of rotational movement of self or surroundings
Define non-vertigo dizziness
unsteadiness, lightheadedness
What is included in the pe for dizziness?
- Orthostatic BP
- Observation of gait
- Check for nystagmus
- Cardiac assessment
- Neurologic assessment
How is dizziness treated?
Varies with etiology
Define syncope
Sudden, transient loss of consciousness not resulting from trauma
What are the common etiologies of syncope?
- Increases in occurrence w/ age
- Cardiac arrhythmias
- Aortic Stenosis
- MI
- Hypoglycemia
- Orthostatic hypotension
- PE
What dx studies are used for syncope?
- H&P are key to DX
- 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
True/false: impairment of cognition is normal part of aging
False: Impairment of cognition is NOT a normal part of aging
Define mild cognitive impairment (MCI)
- Characterized by deficits in cognition w/out deficits in ADLs
- May or may not progress to dementia
- Reduced performance on cognitive tests
What are the sxs of MCI?
- Pattern of forgetfulness develops; forgetfulness is noted by others
- Maintains normal judgment and reasoning
- Carries on ADL’s
Define cognitive impairment
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
What is the most common form of dementia?
Alzheimer’s Disease
Define vascular dementia
- AKA multi-infarct dementia
- Prevalence: M>F & those w/ cardiovascular risk factors
- Affects small & medium sized cerebral vessels
- May have carotid bruits
What are the clinical features of vascular dementia?
- Forgetfulness in absence of depression & inattentiveness
- Stepwise deterioration, fluctuating course, depression
How is vascular dementia treated?
Control of BP & metabolic disorder
What are the general characteristics of depression?
- Older adults tend to be self reliant
- Stoicism is typical
- Many times, patients often deny mental illness
- Most common mental health issue in elderly
What are the rf for depression in elderly?
- Female
- Widowed/divorced
- Hx of prior depression
- Vascular brain changes
- Disabling illness
- Polypharmacy
- Excessive ETOH use
- Low social support
- Caregiver of person w/ major disease
What are the clinical features of depression?
- Characterized by sadness, withdrawal from activities, anhedonia (no pleasure)
- Typical presentation in elderly:
A. Memory impairment
B. Agitation or anxiety
C. Somatic complaints
D. Sleep difficulties - Dx established by clinical suspicion & completion of depression screening tool
How is depression treated in the elderly?
SNRI or SSRI
