Geriatrics Flashcards
How much longer is life expectancy for women compared to men?
approx. 5 years
What is the average life expectancy in the USA?
78.8 y/o
What is the leading cause of death in those > 65 y/o?
Heart disease
When does muscle strength peak?
approx. 30 y/o
remains fairly constant until 50 y/o
What happens to collagen as a person ages?
- increased density
- irregular cross-links
- loss of water content
- decreased elasticity
(true/false) Weakness/fatigue in the elderly is often related to disease.
False
often related to inactivity
What happens to connective tissue as a person ages?
Becomes stiffer and denser
What training programs produce quicker and more predictable results in the older population regarding strength training?
High intensity and power training programs
(true/false) mobility gains are slower in older adults
true
When is bone mass at its peak?
late 20s
What percent of water content is lost in the IV discs by 65 y/o?
30%
What changes occur in the CNS as a person ages? What participation restrictions arise?
- decreased myelin, neurons, and neurotransmitter synthesis
- decreased blood flow
- decreased conduction velocity
- normal changes do not typically restrict participation
What changes occur in the spinal cord and peripheral nerves?
- 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)
What is presbyopia?
visual loss characterized by inability to focus properly and blurred images due to loss of accommodation; elasticity of the lens
What visual colors are commonly affected as a person ages?
blue and green
What happens to a person’s resting pupils as they age?
resting pupils increase in size
Decreased pupillary responses and sensitivity of corneal reflex
Diagnosis
opacity clouding of the lens that results in the gradual loss of vision
- darkening of vision
- loss of acuity and distortion
cataracts
What is glaucoma?
Increased intraocular pressure with degeneration of the optic disc and atrophy of the optic nerve
What part of the visual field is affected by glaucoma?
peripheral
can progress to total blindness if not treated
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
senile macular degeneration
What part of the visual field is affected by senile macular degeneration?
central
peripheral vision is commonly retained
diagnosis
damage to retinal capillaries; growth of abnormal blood vessels and hemorrhage leading to retinal scarring and detachment
diabetic retinopathy
What part of the visual field is affected by diabetic retinopathy?
central vision
total blindness is rare
(true/false) The rate of hearing loss in women is 2x that of men age they age
False
men have higher occurrence of hearing loss with an earlier onset
What causes conductive hearing loss?
damage to external auditory canal, tympanic membrane, and/or ossicles
mechanical hearing loss
What symptom may be present with conductive hearing loss?
tinnitus
What is sensorineural hearing loss?
central or neural hearing loss
What is presbycusis?
sensorineural hearing loss associated with middle and older ages
What are the s/s of presbycusis?
- bilateral hearing loss (starts with high frequency then progresses)
- poor auditory discrimination and comprehension
- tinnitus
What is otosclerosis?
Immobility of the stapes resulting in profound conductive hearing loss
What changes occur within the vestibular system?
- 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
What medications can be prescribed for treatment of BPPV?
- antihypertensives
- anticonvulsants
- tranquilizers
- aspirin
- NSAIDs
What changes occur to the somatosensory system with age?
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)
(true/false) there is no uniform decline in intellectual abilities throughout adulthood
true
- changes do not show up until mid-60s
What cardiac changes occur with aging?
- 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
What are the cardiovascular responses with rest regarding the following in terms of aging?
- RHR
- cardiac output
- resting BP
- Resting HR and cardiac output are relatively unchanged
- increased resting BP
What are the cardiovascular responses during exercise regarding the following while aging?
- HR acceleration
- Maximal O2 uptake
- HR
- exercise capacity
Decreased
What causes decreased stroke volume as a person ages?
decreased myocardial contractility
What is the decreasing rate of cardiac output? When does it start?
Decreases 1% per year starting at 20 y/o
due to decreased HR and SV
What changes are made to the lung parenchyma as a person ages?
- alveoli enlarge and become thinner
- fewer capillaries for delivery of blood
What changes in lung capacity occurs with age?
- decreased vital capacity
- increased residual volume
(true/false) Clinical signs of hypoxia are heightened in older adults.
False - they are blunted
(true/false) the couging mechanism is impaired in older adults
true
What is the result of a decreased gag reflex?
Increased risk of aspiration
What changes occur to the esophagus with age?
- reduced motility and control of lower esophageal sphincter
- acid reflux and heartburn
- hiatal hernia is more common
- decreased stomach and intestinal motility
Osteoporosis is defined by bone mineral density at the ___ and/or ____ that is _____ standard deviations below a young, normal mean reference population
Bone mineral density at the hip and/or spine that is > 2.5 standard deviations below the mean reference population
Osteopenia is defined by a bone mineral density between ____ and ____ standard deviations below the reference population
BMD between 1-2.5 standard deviations below reference population
Urinary stress incontinence is related to weakness of what muscles?
pelvic floor
What medications affect bone loss?
- corticosteroids
- thyroid hormone
- anticonvulsants
- catabolic drugs
- estrogen antagonists
- chemotherapy
Bone loss is about __% per year starting at age 30-35 for women and age 50-55 for men
1% per year
What is the percentage of bone loss per year after menopause?
5% per year
lasts 3-5 years
What areas are commonly affected by bone loss?
- vertebral column
- femoral neck
- distal radius/wrist
- humerus
what medications may be prescribed to slow bone breakdown?
- biphosphanates
- raloxifene (evista)
- denosumab (prolia, zgeva)
- terparatide (forteo)
- abaloparatide (thymlos)
What is the recommended calcium intake for women?
< 50 y/o: 1000 mg/day
>50 y/o: 1200 mg/day
What is the recommended calcium intake for men?
<70 y/o: 1000 mg/day
>70 y/o: 1200 mg/day
What is the recommended vitamin D intake?
< 50: 400-800
> 50 y/o: 800-1000
Do women or men experience 3/4 of hip fractures?
women
About __% of those with hip Fx will not return to their PLoF.
50%
What are vertebral compression fractures commonly caused by?
osteoporosis
What are the chief complaints of vertebral compression fx?
quick onset, severe, local spine pain that is increased with trunk FLX
What must a person with chronic vertebral compression fractures do after prolonged upright activities?
lay supine for 15-30 minutes to decrease loading
(true/false) stress fractures have soft tissue injury to accompany it
false
Where are stress fractures commonly found?
- pelvis
- proximal tibia
- distal fiula
- metatarsal shafts
- foot
can be unsuspected source of pain
What must you look for if a stress fracture is suspected?
local tenderness and swelling
(true/false) UE fractures heal quicker than other fractures
false
heal slower
Adults become prone to complications such as PNA, decubitus ulcers, and mental status complication
(true/false) Arthritis is greatly associated to depression
true
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
delirium
What are the possible causes of reversible dementia (neurocognitive disorders)?
- drugs
- nutritional disorders
- metabolic disorders
- psychiatric disorders
- toxins
What type of dementia is the most prominent?
Alzheimer’s type dementia
60-80% of cases
Are men or women more susceptible to alzheimer’s type dementia?
women
What is the costliest disease in the USA?
dementia
What are risk factors for alzheimer’s dementia?
- advanced age
- family hx
- apolipoprotwin E-4 gene
- CVD risk factors
- limited social and cognitive engagement
Describe minimal cognitive impairment of alzheimer’s dementia.
- mild memory changes
- difficulty with planning or multitasking
- may not progress to dementia
- daily life is not usually affected
Decribe mild alzheimer’s dementia.
- memory loss (short-term)
- 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
Describe moderate alzheimer’s dementia.
- increased memory loss and confusion
- shortened attention span
- problem recognizing faces
- difficulty with language (reading, writing, and numbers)
- difficulty with organizing thoughts and thinking logically
- difficulty with unexpected situations
- restlessness, anxiety, and agitation
- sundowning
- repetitive statements or movement
- hallucinations
- loss of impulse control
- perceptual motor problems
Describe severe alzheimer’s dementia.
- unable to communicate
- unable to recognize faces
- complete dependence
- loss of sense of self
- weight loss
- difficulty swallowing
- lack of b/b control
What is preclinical alzheimer’s dementia?
When individuals have measurable changes in brain CSF and blood biomarkers w/o noticeable symptoms
What are the characteristics of vascular dementia?
Caused by infarctions in the grey and white matter
- sudden onset w/ step progression
- spotty distribution of deficits
- focal neuro s/s
- possible pseudobulbar affects
- associated with stroke, CVD, and HTN
What are the s/s of normal pressure hydrocephalus?
- memory loss
- difficulty walking
- inability to control urination
What is the standardized screening test for dementia?
MMSE
What ulcers are typically larger and have a higher rate of mortality in older adults?
peptic and duodenal ulcers
What is the most common large intestine disease in older adults?
diverticulitis
What medication(s) can cause dyskinesia?
involuntary, stereotypic and repetitive movements
long-term use of neuroleptic drugs and anticholinergic drugs, levodopa
What medication(s) can cause akathisia?
motor restlessness
antipsychotic drugs
What medication(s) can cause essential tremor?
- tricyclic antidepressants
- adrenergic drugs
What medication(s) can cause parkinsonism?
- antipsychotics
- sympatholytics
What gait speed is needed for safe community ambulation?
0.8-1.2 m/s
