Geriatrics

Question 1

What is a functional assessment?

Answer 1

it is the central focus of evaluation of geriatric patients, it is an interdisciplinary diagnostic process, which assesses and quantifies an older adult’s medical, psychosocial and functional status.

Question 2

What is primary aging?

Answer 2

changes in physiologic reserves over time that are independent of and not induced by any disease
Predictable changes in: muscle strength, hearing, vision, taste, sensation, etc…

Question 3

What is secondary aging?

Answer 3

changes that occur because of environmental effects, substance abuse, lack of exercise, and disease

Question 4

As a patient gets older, their systolic BP rises. What is the reason for this?

Answer 4

Arteries stiffen (specifically the aorta becomes less distensible), widened pulse pressure.

Question 5

T/F diastolic BP continues to rise in the sixth decade

Answer 5

False, stops rising

Question 6

As one ages, there is increased tendency towards postural (orthostatic) ___________

Answer 6

hypotention

Question 7

What occurs for HR with the geriatric population?

Answer 7

Resting heart rate remains about the same, but maximum rate declines.
Increase in abnormal heart rhythms (atrial/ventricular ectopy)

Question 8

What occurs with the respiratory rate for the geriatric population?

Answer 8

unchanged

Question 9

What occurs with temperature in the geriatric population?

Answer 9

changes in temperature regulation lead to chance of hypothermia

Question 10

Wha does a skin appear like in a geriatric patient?

Answer 10

Loss of turgor, wrinkles, laxity. The vascularity of the dermis decreases and skin looks more opaque.
Dry/flaky skin from loss of oil glands

Question 11

Purple patches called __________ arise from poorly supported capillaries and blood leaks through the dermis (not “normal” but common).

Answer 11

actinic purpura

Question 12

Nails in geriatric patients

Answer 12

Lose luster and may appear yellow and thick

Question 13

Hair in geriatric patients

Answer 13

Loses pigment
Normal hair loss all over body (trunk, pubic area, limbs, axilla)
Hair loss is genetic

Question 14

What are eye changes in the geriatric population?

Answer 14

Periorbital changes, pupils smaller and less responsive to light, visual acuity changes, presbyopia (blurring of near vision)
Glaucoma, macular degeneration, cataracts

Question 15

What are ear changes in the geriatric population?

Answer 15

Presbycusis (age associated sensorineural hearing loss)

Question 16

What are oral changes in the geriatric populatin?

Answer 16

Diminished salivary secretions, decreased taste
Worn down teeth, periodontal disease, loss of teeth
Important to note how patient is gaining nutrition

Question 17

What are neck changes in the geriatric population?

Answer 17

Smaller cervical lymph nodes, larger submandibular glands

Question 18

Thorax in geriatrics

Answer 18

Kyphosis with increased AP chest diameter
Stiffer chest wall
Weaker respiratory muscles – diaphragm
weakens

Question 19

Lungs in geriatrics

Answer 19

Lose some elastic recoil
Lung mass declines
Residual volume increases
Forced expiratory volume in one second is reduced
Cough effectiveness is reduced

Question 20

In the geriatric population, arteries _______, become _______ and ______

Answer 20

lengthen, tortuous, stiffen

Question 21

T/F the incidence of varicose veins increases in the geriatric population

Answer 21

T

Question 22

Atherosclerosis does primarily afflict older people, but they _________be considered part of the aging process

Answer 22

CANNOT

Question 23

_________ diameter increases and impulse is harder to find

Answer 23

AP

Question 24

_____________can commonly be heard in children and young adults, but after about 40 it is strongly suggestive of abnormal pathology (ventricular failure/mitral regurgitation)

Answer 24

Third heart sound

Question 25

_____________can be heard in healthy older adults, but is also frequently associated with heart disease (problems with ventricular filling)

Answer 25

Fourth heart sounds

Question 26

Systolic aortic murmur

Answer 26

common in aortic sclerosis (fibrosis and calcification) not necessarily stenosis
Approx 1/3 of people over age 60, 50% of those >85
Caused by aging, fibrotic changes to make base of aortic cusps thicker

Question 27

Systolic murmur of mitral regurgitation

Answer 27

Same mech as above but happens approx. 10 year later in life

Question 28

What does carotid bruits suggest?

Answer 28

obstruction (pathologic)

Question 29

Breasts of an aging women diminish in size as _________ is replaced by _______. Breasts become flaccid and more pendulous

Answer 29

glandular tissue is replaced by fat

Question 30

Ducts surrounding the nipple may become more easily palpable as firm, stringy strands because they lack supporting ________

Answer 30

tissue

Question 31

Males may developed __________ or or increased breast fullness due to obesity and hormonal changes

Answer 31

gynecomastia

Question 32

Fat accumulates in the lower abdomen and near the hips, even when total body weight is stable. This accumulation, together with weakening of the abdominal muscles often produces ____________

Answer 32

protrusion

Question 33

Older age may blunt the manifestations of _______________Pain may be less severe, fever is less pronounced, and guarding/rebound tenderness, etc…may be diminished or absent.

Answer 33

acute abdominal disease.

Question 34

What are the impacts of aging on males?

Answer 34

-testosterone levels decline, affect both sexual function and drive
-The penis decreases in size and testicles drop lower in the scrotum
-Erectile dysfunction (~50% of older males) is not a part of “normal aging” and is often the first warning sign of atherosclerotic vascular disease.
-Signs of BPH (urinary hesitancy, frequency, urgency, dribbling, incomplete emptying) are also pathologic
-Begins in 3rd decade of life, plateaus in 7th

Question 35

What are the impacts of aging of females?

Answer 35

– Ovarian function diminishes during the 50’s and menstrual periods cease on average 45-52
-The vagina narrows and shortens and mucosa becomes thin, pale and dry.
-After menopause, ovaries rarely palpated

Question 36

___________ become thinner and the _________ shorten (or collapse)
This also contributes to the kyphosis of aging and increases the AP diameter of the chest.

Answer 36

Intervertebral discs, vertebral bodies

Question 37

Scarcopenia

Answer 37

loss of lean body mass and strength with aging (30%-50%)
ROM diminishes (partly because of osteoarthritis)

Question 38

Benign senescent forgetfulness

Answer 38

can occur, and older persons retrieve and process date more slowly, and take more time to learn new material.

Question 39

Older patients much more susceptible to _____________

Answer 39

delirium states

Question 40

Benign essential tremors can be confused with _________(cease with rest)

Answer 40

parkinsonism

Question 41

Vibration sense is frequently lost in the ___________ extremities (not in upper)

Answer 41

lower

Question 42

Which two reflexes may be diminished or absent?

Answer 42

Gag reflex, ankle reflexes

Question 43

Physical activities of daily living (ADL)

Answer 43

Bathing, dressing, toileting, transferring, continence, feeding
-Self care tasks

Question 44

Instrumental Activities of daily living (IADL)

Answer 44

Using the telephone, shopping, preparing food, housekeeping, laundry, transportation, taking medication
-Allow patient to live independently

Question 45

ETOH – CAGE questions

Answer 45

Cutting down, Annoyance when criticized, Guilty feelings, Eye-openers