Geriatrics Flashcards
What is a functional assessment?
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.
What is primary aging?
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…
What is secondary aging?
changes that occur because of environmental effects, substance abuse, lack of exercise, and disease
As a patient gets older, their systolic BP rises. What is the reason for this?
Arteries stiffen (specifically the aorta becomes less distensible), widened pulse pressure.
T/F diastolic BP continues to rise in the sixth decade
False, stops rising
As one ages, there is increased tendency towards postural (orthostatic) ___________
hypotention
What occurs for HR with the geriatric population?
Resting heart rate remains about the same, but maximum rate declines.
Increase in abnormal heart rhythms (atrial/ventricular ectopy)
What occurs with the respiratory rate for the geriatric population?
unchanged
What occurs with temperature in the geriatric population?
changes in temperature regulation lead to chance of hypothermia
Wha does a skin appear like in a geriatric patient?
Loss of turgor, wrinkles, laxity. The vascularity of the dermis decreases and skin looks more opaque.
Dry/flaky skin from loss of oil glands
Purple patches called __________ arise from poorly supported capillaries and blood leaks through the dermis (not “normal” but common).
actinic purpura
Nails in geriatric patients
Lose luster and may appear yellow and thick
Hair in geriatric patients
Loses pigment
Normal hair loss all over body (trunk, pubic area, limbs, axilla)
Hair loss is genetic
What are eye changes in the geriatric population?
Periorbital changes, pupils smaller and less responsive to light, visual acuity changes, presbyopia (blurring of near vision)
Glaucoma, macular degeneration, cataracts
What are ear changes in the geriatric population?
Presbycusis (age associated sensorineural hearing loss)
What are oral changes in the geriatric populatin?
Diminished salivary secretions, decreased taste
Worn down teeth, periodontal disease, loss of teeth
Important to note how patient is gaining nutrition
What are neck changes in the geriatric population?
Smaller cervical lymph nodes, larger submandibular glands
Thorax in geriatrics
Kyphosis with increased AP chest diameter
Stiffer chest wall
Weaker respiratory muscles – diaphragm
weakens
Lungs in geriatrics
Lose some elastic recoil
Lung mass declines
Residual volume increases
Forced expiratory volume in one second is reduced
Cough effectiveness is reduced
In the geriatric population, arteries _______, become _______ and ______
lengthen, tortuous, stiffen
T/F the incidence of varicose veins increases in the geriatric population
T
Atherosclerosis does primarily afflict older people, but they _________be considered part of the aging process
CANNOT
_________ diameter increases and impulse is harder to find
AP
_____________can commonly be heard in children and young adults, but after about 40 it is strongly suggestive of abnormal pathology (ventricular failure/mitral regurgitation)
Third heart sound
_____________can be heard in healthy older adults, but is also frequently associated with heart disease (problems with ventricular filling)
Fourth heart sounds
Systolic aortic murmur
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
Systolic murmur of mitral regurgitation
Same mech as above but happens approx. 10 year later in life
What does carotid bruits suggest?
obstruction (pathologic)
Breasts of an aging women diminish in size as _________ is replaced by _______. Breasts become flaccid and more pendulous
glandular tissue is replaced by fat
Ducts surrounding the nipple may become more easily palpable as firm, stringy strands because they lack supporting ________
tissue
Males may developed __________ or or increased breast fullness due to obesity and hormonal changes
gynecomastia
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 ____________
protrusion
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.
acute abdominal disease.
What are the impacts of aging on males?
-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
What are the impacts of aging of females?
– 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
___________ become thinner and the _________ shorten (or collapse)
This also contributes to the kyphosis of aging and increases the AP diameter of the chest.
Intervertebral discs, vertebral bodies
Scarcopenia
loss of lean body mass and strength with aging (30%-50%)
ROM diminishes (partly because of osteoarthritis)
Benign senescent forgetfulness
can occur, and older persons retrieve and process date more slowly, and take more time to learn new material.
Older patients much more susceptible to _____________
delirium states
Benign essential tremors can be confused with _________(cease with rest)
parkinsonism
Vibration sense is frequently lost in the ___________ extremities (not in upper)
lower
Which two reflexes may be diminished or absent?
Gag reflex, ankle reflexes
Physical activities of daily living (ADL)
Bathing, dressing, toileting, transferring, continence, feeding
-Self care tasks
Instrumental Activities of daily living (IADL)
Using the telephone, shopping, preparing food, housekeeping, laundry, transportation, taking medication
-Allow patient to live independently
ETOH – CAGE questions
Cutting down, Annoyance when criticized, Guilty feelings, Eye-openers