Geriatrics Flashcards
People over 65 will have how many other significant co-morbidities?
3
People under 65 will have how many other significant co-morbidities?
2
What are some consequences of falls?
- loss of self image
- social embarrassment and loss of confidence
- stigma of ‘old age’
- frailty
What are the core elements of dignity (Kinnear et al., 2015)
- Respect for personhood and the individual
- Communication and forms of address
- Privacy
- Toileting
- Nutrition and feeding
- Cleanliness and the environment
- Staff attitudes
What is the importance of dignified care?
can have a positive effect on treatment and social outcomes
What are barriers and facilitators of dignity on an organisational level?
- Time
- Staffing levels
- Staff training and experience
- Organisational support/values
- Resources
- Specific dignity measures
What are barriers and facilitators of dignity on a ward level?
- Ward environment
- Colleagues/team
- Staff attitudes
- Workload
- Support
- Communication
What are barriers and facilitators of dignity on an individual level?
- Addressing patient needs
- Involving family/carers
- Reflection
- Dealing with an emergency
- Religion
- Neglect
Why does depersonalisation occur in healthcare?
- when workers have negative cynical attitudes towards their clients
- clinicians try to distance themselves from the patient to protect themselves emotionally (may be a result of heavy responsibilities and workload pressure)
Primary aging
processes that occur independent of disease processes
Secondary aging
physical and physiologic deteriorations caused by pathologic processes
Chronological aging
changes associated with passage of time
Biologic aging
success for adaptation with the passage of time (tied up with functional abilities and capacities)
What are characteristic changes in the integumentary system for geriatrics?
- Epidermis thins, collagen is lost and connections between cells weakens
- Greater risk of injury, tears and infections and the skin repairs less quickly
- Skin can become ‘paperthin’ and translucent
- Vitamin D3 production decreased by 75% and melanocyte activity decreased
- Sweat glands are less effective so cannot lose heat as well and sebaceous gland activity decreased so becomes dry
- Dermal blood supply decreased and blood vessels can become more fragile causing redness (rosacea).
- Dermis thins and elastic fibres decrease – sagging and wrinkling skin
- Nerve endings decline so feel less pressure, touch and injurious stimuli
- Pigment production in hair decreases with age, it lightens and becomes grey
What are bone and joint characteristic changes for geriatrics?
- Decreased bone mass and calcium content
- Osteoporosis can weaken bones to a point that fractures occur in normal stresses
- Joints are subjected to wear and tear
- Arthritic problems – Arthritis means damage to the articular surface
- Intervertebral discs reduce in size and desiccate
What are muscle characteristic changes for geriatrics?
- Skeletal muscle fibres get smaller, fewer myofibrils, smaller ATP and glycogen reserves
- Cardiovascular performance decreases (by 65 there is a decrease of 30-50 % anaerobic and aerobic performance)
- Skeletal muscles are less elastic so are less flexible - restrict movement and circulation
- Tolerance to exercise decreases and ability to recover from injury decreases
What are nervous system characteristic changes for geriatrics?
- Reduced brain size, fewer cortical neurones and nearly 40% reduction in number of spinal cord axons
- Myelin sheaths degenerate ad 10% decline in nerve conduction velocity contributes to a decrease in neuromuscular performance
- Number of branches and synaptic interconnections decreases (synaptic transmission is less efficient)
- Decrease blood flow to brain
- Reaction rates are slowed and motor control precision and coordination decreases
What are blood characteristic changes for geriatrics?
Decreased packed cell volume (less cells) - resulting in anaemia from nutritional deficiencies, inadequate exercise, and disease
What are circulation characteristic changes for geriatrics?
- Thombi causing constriction or blockage of peripheral veins
- Valves less efficient causing blood pooling in periphery
- Arteries less elastic
- Calcium salts and lipids can be deposited
What are heart characteristic changes for geriatrics?
- Decreased maximum cardiac output
- Changes in activity of pacemaker and conducting system
- Reduced elasticity of cardiac skeleton
- Damaged cardiac cells replaced by scar tissue (diminished mechanical efficiency)
- Reduced cardiac reserve capacity (amount of cardiac output remaining above that required for ADL decreases)
What are immune system characteristic changes for geriatrics?
becomes less effective
What are endocrine system characteristic changes for geriatrics?
- Pituitary, pancreas, adrenal glands and thyroid change with age, there is also decline in reproductive hormones.
- Changes in peripheral tissues may make them less responsive to some hormones (glucocorticoids and ADH)
What are digestive system characteristic changes for geriatrics?
- Taste ability changes with age – food tastes bland and unappetising and there is a decrease in olfactory receptors. - - Reduced olfactory and gustatory activity often causes changes in diet
- Epithelium more susceptible to damage and peptic ulcers become more likely
- Smooth muscle tone decreases
- Loss of teeth due to dental caries (cavities)
What are respiratory characteristic changes for geriatrics?
- Elastic tissue decreases (less elastic support structure)
- Chest movements are restricted by arthritic changes (vital capacity and forced expiratory volume fall)
- Reduction in exercise capabilities and performance
- Respiratory muscle weakness
- Some degree of emphysema in normal in age >50 so there is and increase in alveolar size
- Static and dynamic lung function decreases
What are urinary characteristic changes for geriatrics?
- Decrease in functional nephrons by about 30-40 %
- Reduced glomerular filtration rate
- Problems with urinary reflexes
- Voiding can become problematic
What are reproductive characteristic changes for geriatrics?
- Male climacteric (perimenopause and andropause)
- Ovulation and menstruation cease (menopause) between ages 45-55 (interval preceding is perimenopause)
What are fluid, electrolyte and acid-base balance
characteristic changes for geriatrics?
- Total body water decreases slightly from 40-60 so reduces dilution of wastes, toxins and drugs
- Reduced sensitivity to ADH - maintaining fluid balance means taking in more fluid (but elderly people have less sense of thirst and may not drink enough to maintain blood osmolality so dehydration is common)
- Net loss of body mineral content as muscle mass and bone mass decreases
