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NPTE > Geriatrics > Flashcards

Geriatrics Flashcards

1
Q

How much longer is life expectancy for women compared to men?

A

approx. 5 years

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2
Q

What is the average life expectancy in the USA?

A

78.8 y/o

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3
Q

What category of elderly makes up the majority of the elderly population?

A

Young elderly (65-74 y/o)

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4
Q

What is the leading cause of death in those > 65 y/o?

A

Heart disease

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5
Q

When does muscle strength peak?

A

approx. 30 y/o

remains fairly constant until 50 y/o

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6
Q

What happens to muscle fiber types as a person ages?

A

Type II (fast twitch) muscle fibers decrease
Type I (slow twitch) muscle fibers increase

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7
Q

What happens to collagen as a person ages?

A
  • increased density
  • irregular cross-links
  • loss of water content
  • decreased elasticity
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8
Q

(true/false) Weakness/fatigue in the elderly is often related to disease.

A

False

often related to inactivity

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9
Q

What happens to connective tissue as a person ages?

A

Becomes stiffer and denser

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10
Q

What training programs produce quicker and more predictable results in the older population regarding strength training?

A

High intensity and power training programs

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11
Q

(true/false) mobility gains are slower in older adults

A

true

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12
Q

By the age of ___, more than 60% of adults have degenerative joint changes and cartilage abnormalities.

A

60 y/o

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13
Q

When is bone mass at its peak?

A

late 20s

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14
Q

When does bone mass decrease?

A

between age 45-70 y/o

decreases another 5% by age 90 y/o

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15
Q

What percent of water content is lost in the IV discs by 65 y/o?

A

30%

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16
Q

What contractures do most elderly people experience?

A

Hip and knee FLX contractures

due to prolonged sitting

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17
Q

What foot deformities do most elderly people produce as they age?

A
  • hallux valgus
  • pes planus
  • pes cavus
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18
Q

What muscles should postural exercise focus on in the older population?

A

Shoulder extensors and scapular stabilizers

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19
Q

What changes occur in the CNS as a person ages? What participation restrictions arise?

A
  • decreased myelin, neurons, and neurotransmitter synthesis
  • decreased blood flow
  • decreased conduction velocity
  • normal changes do not typically restrict participation
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20
Q

When is there an accelerated loss of cerebral mass/brain weight?

A

after age 70 y/o

  • atrophy of gyri
  • ventricular dilation
  • cell loss in cerebral cortex
  • selective cell loss in basal ganglia
  • decreased cerebral blood flow
  • decreased synthesis and metabolism of major neurotransmitters
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21
Q

What changes occur in the spinal cord and peripheral nerves?

A
  • loss of anterior horn cells and posterior roots (sensory fibers)
  • loss of motoneurons result in the increased size of remaining motor units
  • essential tremor (age-related)
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22
Q

What is presbyopia?

A

visual loss characterized by inability to focus properly and blurred images due to loss of accommodation; elasticity of the lens

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23
Q

What visual colors are commonly affected as a person ages?

A

blue and green

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24
Q

What happens to a person’s resting pupils as they age?

A

resting pupils increase in size

Decreased pupillary responses and sensitivity of corneal reflex

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25
Q

Diagnosis

opacity clouding of the lens that results in the gradual loss of vision

  • darkening of vision
  • loss of acuity and distortion
A

cataracts

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26
Q
A
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27
Q

What is glaucoma?

A

Increased intraocular pressure with degeneration of the optic disc and atrophy of the optic nerve

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28
Q

What part of the visual field is affected by glaucoma?

A

peripheral

can progress to total blindness if not treated

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29
Q

diagnosis

Loss of central vision associated with age-related degeneration of the macula, compromised by decreased blood supply or abnormal growth of blood vessels under the retina

A

senile macular degeneration

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30
Q

What part of the visual field is affected by senile macular degeneration?

A

central

peripheral vision is commonly retained

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31
Q

diagnosis

damage to retinal capillaries; growth of abnormal blood vessels and hemorrhage leading to retinal scarring and detachment

A

diabetic retinopathy

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32
Q

What part of the visual field is affected by diabetic retinopathy?

A

central vision

total blindness is rare

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33
Q

What is homonymous hemianopsia?

A

Loss of half of the visual field in each eye (nasal half of one eye and temporal half of the other eye)

produces inability to receive information from the side of sensorimotor deficit

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34
Q

(true/false) The rate of hearing loss in women is 2x that of men age they age

A

False

men have higher occurrence of hearing loss with an earlier onset

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35
Q

What causes conductive hearing loss?

A

damage to external auditory canal, tympanic membrane, and/or ossicles

mechanical hearing loss

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36
Q

What symptom may be present with conductive hearing loss?

A

tinnitus

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37
Q

What is sensorineural hearing loss?

A

central or neural hearing loss

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38
Q

What is presbycusis?

A

sensorineural hearing loss associated with middle and older ages

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39
Q

What are the s/s of presbycusis?

A
  • bilateral hearing loss (starts with high frequency then progresses)
  • poor auditory discrimination and comprehension
  • tinnitus
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40
Q

What is otosclerosis?

A

Immobility of the stapes resulting in profound conductive hearing loss

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41
Q

What tests are used to assess air and bone conduction within the ear?

A
  1. Rinne’s test
  2. weber test
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42
Q

What changes occur within the vestibular system?

A
  • degenerative changes of utricle and saccule
  • loss of hair-cell receptors
  • decreased number of vestibular neurons
  • decreased VOR functioning
  • decreased acuity/delayed reaction times
  • disorganized postural response patterns
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43
Q

What is meniere’s disease?

A

Episodic attackes characterized by tinnitus, dizziness, and sensation of fullness or pressure within the ears

may experience sensorineural hearing loss

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44
Q

What is BPPV?

A

Brief episodes of vertigo associated with position changes

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45
Q

How long are episodes of BPPV?

A

< 1 minute

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46
Q

What causes BPPV to occur?

A

degeneration of the utricular otoconia that settles on the cupular of the posterior semicircular canal

47
Q

What medications can be prescribed for treatment of BPPV?

A
  • antihypertensives
  • anticonvulsants
  • tranquilizers
  • aspirin
  • NSAIDs
48
Q

What changes occur to the somatosensory system with age?

A

decreased muscle spindles, joint receptors, cutaneous receptors, and corresponding myelinated axons

Decreased distal to proximal extremity vibration, discriminative touch, and proprioception (may contribute to impaired balance, ataxic gait, difficulty walking on uneven surfaces, and increased fall risk)

49
Q

(true/false) there is no uniform decline in intellectual abilities throughout adulthood

A

true

  • changes do not show up until mid-60s
50
Q

What cardiac changes occur with aging?

A
  • decreased coronary blood flow
  • cardiac valves thicken and become stiff
  • loss of pacemaker cells in SA node
  • arteries thicken
  • decreased exchange through capillary walls
  • increased peripheral resistance
  • decreased blood volume
  • increased blood coagulation
51
Q

What are the cardiovascular responses with rest regarding the following in terms of aging?

  • RHR
  • cardiac output
  • resting BP
A
  • Resting HR and cardiac output are relatively unchanged
  • increased resting BP
52
Q

What are the cardiovascular responses during exercise regarding the following while aging?

  • HR acceleration
  • Maximal O2 uptake
  • HR
  • exercise capacity
A

Decreased

53
Q

What causes decreased stroke volume as a person ages?

A

decreased myocardial contractility

54
Q

What is the decreasing rate of cardiac output? When does it start?

A

Decreases 1% per year starting at 20 y/o

due to decreased HR and SV

55
Q

What changes are made to the lung parenchyma as a person ages?

A
  • alveoli enlarge and become thinner
  • fewer capillaries for delivery of blood
56
Q

What changes in lung capacity occurs with age?

A
  • decreased vital capacity
  • increased residual volume
57
Q

(true/false) Clinical signs of hypoxia are heightened in older adults.

A

False - they are blunted

58
Q

(true/false) the couging mechanism is impaired in older adults

A

true

59
Q

What is the result of a decreased gag reflex?

A

Increased risk of aspiration

60
Q

What changes occur to the esophagus with age?

A
  • reduced motility and control of lower esophageal sphincter
  • acid reflux and heartburn
  • hiatal hernia is more common

  • decreased stomach and intestinal motility
61
Q

Osteoporosis is defined by bone mineral density at the ___ and/or ____ that is _____ standard deviations below a young, normal mean reference population

A

Bone mineral density at the hip and/or spine that is > 2.5 standard deviations below the mean reference population

62
Q

Osteopenia is defined by a bone mineral density between ____ and ____ standard deviations below the reference population

A

BMD between 1-2.5 standard deviations below reference population

63
Q

Urinary stress incontinence is related to weakness of what muscles?

A

pelvic floor

64
Q

What medications affect bone loss?

A
  • corticosteroids
  • thyroid hormone
  • anticonvulsants
  • catabolic drugs
  • estrogen antagonists
  • chemotherapy
65
Q

Bone loss is about __% per year starting at age 30-35 for women and age 50-55 for men

A

1% per year

66
Q

What is the percentage of bone loss per year after menopause?

A

5% per year

lasts 3-5 years

67
Q

What areas are commonly affected by bone loss?

A
  1. vertebral column
  2. femoral neck
  3. distal radius/wrist
  4. humerus
68
Q

what medications may be prescribed to slow bone breakdown?

A
  • biphosphanates
  • raloxifene (evista)
  • denosumab (prolia, zgeva)
  • terparatide (forteo)
  • abaloparatide (thymlos)
69
Q

What is the recommended calcium intake for women?

A

< 50 y/o: 1000 mg/day
>50 y/o: 1200 mg/day

70
Q

What is the recommended calcium intake for men?

A

<70 y/o: 1000 mg/day
>70 y/o: 1200 mg/day

71
Q

What is the recommended vitamin D intake?

A

< 50: 400-800
> 50 y/o: 800-1000

72
Q

Do women or men experience 3/4 of hip fractures?

A

women

73
Q

About __% of those with hip Fx will not return to their PLoF.

A

50%

74
Q

Where are 95% of hip Fx found?

A
  1. femoral neck fc
  2. intertrochanteric fx
75
Q

What are vertebral compression fractures commonly caused by?

A

osteoporosis

76
Q

Vertebral compression fractures are common at _____ and ____.

A

T8-T12 and L4

77
Q

What are the chief complaints of vertebral compression fx?

A

quick onset, severe, local spine pain that is increased with trunk FLX

78
Q

What must a person with chronic vertebral compression fractures do after prolonged upright activities?

A

lay supine for 15-30 minutes to decrease loading

79
Q

(true/false) stress fractures have soft tissue injury to accompany it

A

false

80
Q

Where are stress fractures commonly found?

A
  1. pelvis
  2. proximal tibia
  3. distal fiula
  4. metatarsal shafts
  5. foot

can be unsuspected source of pain

81
Q

What must you look for if a stress fracture is suspected?

A

local tenderness and swelling

82
Q

(true/false) UE fractures heal quicker than other fractures

A

false

heal slower

Adults become prone to complications such as PNA, decubitus ulcers, and mental status complication

83
Q

Is OA more common in males or females?

A

Females

84
Q

(true/false) Arthritis is greatly associated to depression

A

true

85
Q

What are the characteristics of OA?

A
  • pain, swelling, and stiffness
  • s/s worse in the morning or with overuse
  • decreased ROM; crepitus
  • bony deformity/spurs
86
Q

When do most strokes occur?

A

After the age of 74 y/o

30% die in the acute phase
30-40% will have severe disability

87
Q

diagnosis s/s

  • acute onset (often at night and is worse at night)
  • duration: hours to weeks
  • hypoalert or hyperalert
  • distracted
  • hallucinations
  • episodes of agitation
  • memory deficits: immedient and recent
  • disorganized thinking and incoherent speech
  • disrupted sleep/wake cycles
A

delirium

88
Q

What are the possible causes of reversible dementia (neurocognitive disorders)?

A
  • drugs
  • nutritional disorders
  • metabolic disorders
  • psychiatric disorders
  • toxins
89
Q

What type of dementia is the most prominent?

A

Alzheimer’s type dementia

60-80% of cases

90
Q

Are men or women more susceptible to alzheimer’s type dementia?

A

women

91
Q

What is the costliest disease in the USA?

A

dementia

92
Q

What are risk factors for alzheimer’s dementia?

A
  • advanced age
  • family hx
  • apolipoprotwin E-4 gene
  • CVD risk factors
  • limited social and cognitive engagement
93
Q

Describe minimal cognitive impairment of alzheimer’s dementia.

A
  • mild memory changes
  • difficulty with planning or multitasking
  • may not progress to dementia
  • daily life is not usually affected
94
Q

Decribe mild alzheimer’s dementia.

A

-memory loss
short-term memory loss
- difficulty finding words
- confusion about location of familiar faces
- longer to accomplish normal, daily tasks
- trouble handling money and bills
- compromised judgement
- loss of initiative
- mood and personality changes

95
Q

Describe moderate alzheimer’s dementia.

A
  • increased memory loss and confusion
  • shortened attention span
  • problem recognizing faces
  • difficulty with language (reading, writing, and numbers)
  • difficulty with organizing thoughts and thicking logically
  • difficulty with unexpected situations
  • restlessness, anxiety, and agitation
  • sundowning
  • repetitive statements or movement
  • hallucinations
  • loss of impulse control
  • perceptual motor problems
96
Q

Describe severe alzheimer’s dementia.

A
  • unable to communicate
  • unable to recognize faces
  • complete dependence
  • loss of sense of self
  • weight loss
  • difficulty swallowing
  • lack of b/b control
97
Q

What is preclinical alzheimer’s dementia?

A

When individuals have measurable changes in brain CSF and blood biomarkers w/o noticeable symptoms

98
Q

What are the characteristics of vascular dementia?

Caused by infarctions in the grey and white matter

A
  • sudden onset w/ step progression
  • spotty distribution of deficits
  • focal neuro s/s
  • possible pseudobulbar affects
  • associated with stroke, CVD, and HTN
99
Q

What are the s/s of normal pressure hydrocephalus?

A
  • memory loss
  • difficulty walking
  • inability to control urination
100
Q

What is the standardized screening test for dementia?

A

MMSE

101
Q

What score of the MMSE is indicative of mental decline/dementia?

A

< 24 points out of 30

102
Q

What ulcers are typically larger and have a higher rate of mortality in older adults?

A

peptic and duodenal ulcers

103
Q

What is the most common large intestine disease in older adults?

A

diverticulitis

104
Q

How many prescription drugs does an older adult take on average daily?

A

4-7

Plus 3 OTC drugs

105
Q

Who is targeted for being a target of aggessive marketing for drug companies?

A

elderly

106
Q

What medication(s) can cause dyskinesia?

involuntary, stereotypic and repetitive movements

A

long-term use of neuroleptic drugs and anticholinergic drugs, levodopa

107
Q

What medication(s) can cause akathisia?

motor restlessness

A

antipsychotic drugs

108
Q

What medication(s) can cause essential tremor?

A
  • tricyclic antidepressants
  • adrenergic drugs
109
Q

What medication(s) can cause parkinsonism?

A
  • antipsychotics
  • sympatholytics
110
Q

What 5xSST time is the cut off for fall risk?

A

12 seconds

60-69 y/o: 11.4 sec
70-79 y/o: 12.6 sec
80-89 y/o: 14.8 sec

111
Q

What BBS value is indicative of an increased fall risk?

A

< 50/56

112
Q

What gait speed is required to safely cross the street?

A

1.2 m/s

113
Q

What gait speed is needed for safe community ambulation?

A

0.8-1.2 m/s

NPTE (20 decks)

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