Geriatrics Flashcards
What is heart hypertrophy?
Thickening of the myocardium
8 Cardiovascular changes
-heart hypertrophy
-decline in cardiac output
-arteriosclerosis
-atherosclerosis
-aortic stenosis
-electric conduction system deteriorates
-muscle degeneration
-valve degeneration
Arteriosclerosis vs. Atherosclerosis
Arteriosclerosis - stiffening of vessels
Atherosclerosis - plaque buildup
What is aortic stenosis?
The aortic valve doesn’t open fully
What happens when the electric conduction system deteriorates? What does it lead to?
Number of pacemaker cells in SA node decreases leading to bradycardia, dysrhythmias, and heart blocks
What happens with muscle degeneration?
Decreased contractility, stroke volume and cardiac output
What are some causes of cardiovascular decline?
Sedentary lifestyle
Disabilities or physiological factors leading to limited physical activity
What are 6 respiratory changes?
-decrease in elasticity of the lungs
-decrease in size and elasticity of respiratory muscles
-stiffer lungs due to calcification of costochondral cartridge
-respiratory drive dulls with decreased sensitivity to arterial blood gasses
-cough and gag reflex declines
-ciliary mechanism slows
What happens to vital capacity and residual volume when you have stiffer lungs?
Vital capacity goes down
Residual volume goes up
What happens when cough and gag reflexes decline?
Increased risk of aspiration
What happens when ciliary mechanisms slow?
Ineffective removal of bronchial secretions
How much does the blood flow change in the kidneys with renal changes?
Decreases by 50%
What happens to kidney size and what results from this?
Decrease in size resulting in small surface area for filtration
4 Renal changes
-blood flow decreases
-kidney size decreases
-imbalance of electrolytes and fluids
-bowel and bladder incontinence
2 types of incontinence
Urge incontinence
Stress incontinence
6 Digestive changes
-decrease in olfactory receptors
-decrease in enjoyment of food
-reduction of saliva
-reduction of gastric secretions
-weakening of esophageal sphincter
-slower gastric motility
How much do taste buds decrease and by what age?
1/3 of taste buds decrease by 70 years old
6 Musculoskeletal changes
-widespread decrease in bone mass
-bones become brittle
-decrease in height
-joints loose flexibility
-arthritis
-muscle mass decreases
Changes in nervous system
-Changes in thinking speed, memory and postural stability
-Age associated declines in mental function
-Slow responses or requests to repeat a question
How much does the weight of the brain decrease?
5-10%
True or false: smaller and lighter brain does not interfere with the mental capabilities of productive elderly people
True
Changes in sensory organs
-decrease in sight and hearing
-decreases tear production
-decreased night vision / colour differentiation
Corneal drying
Decreased tear production
What can hearing loss cause?
Decreased ability to communicate, meniere disease, presbycubis
Presbycubis
Degeneration of the cochlea / inner ear / auditory nerves
Proprioception
Postural stability through a variety of receptors, less steady in their feet, higher tendency to fall
What does the acronym DELIRIUMS stand for?
D - drugs or toxins / dehydration
E - emotional (psychiatric)
L - low PaO2
I - infection
R - retention of stool or urine
I - ictal
U - under nutrition / under hydration
M - metabolism
S - subdural hematoma
What are the 6 types of dementia?
-Alzheimer’s
-Vascular
-Frontotemporal
-Excessive alcohol / drug use
-Chronic traumatic encephalopathy
-HIV
What is the most common type of dementia?
Alzheimer’s (50-70%)
What causes vascular dementia?
Stroke, TIA, cardiovascular disease
Frontotemporal dementia
Effects personality, behaviour, language, speech
Mild dementia
Need help with usual tasks; finances, keeping appointments, getting lost on new routes
Moderate dementia
Difficulty recognizing family or friends, help with daily activities, fear or suspicion of others, visual/auditory hallucinations, mood changes
Severe dementia
Loss of communication, physical / intellectual dysfunction
What percent of elders may have serious infection without fever? What is this due to?
30% of elder due to aging immune system not being able to initiate a fever
What is the leading cause of death from infection in people over 65 years old?
Pneumonia
4 integumentary changes
-wrinkling/loss of resiliency
-skin becomes thinner/drier/more fragile
-subcutaneous fat becomes thinner, bruising more common
-elastin/collagen decrease
Why do integumentary changes happen?
-Sebaceous glands produce less oil
-Sweat gland activity decreases
-Hair follicles produce thinner hair or stop producing hair
-follicles produce less melanin
What happens to blood vessels supplying the skin?
Affected by atherosclerosis, provide less oxygenated blood at the cellular level, epidermal cells develop more slowly
What are the elderly at higher risk of?
Secondary infection, skin tumours, drug induced eruptions, fungal or viral infections
Cellulitis
Acute inflammation in the skin and soft tissue beneath
Cause of cellulitis
Bacterial infection
Symptoms of cellulitis
Fever, chills, general malaise, systemic sepsis
Treatments for cellulitis
Antibiotics, adequate fluid intake, local dressings
Shingles / herpes zoster
Localized unilateral skin leisures
Cause of shingles / herpes zoster
Dormant virus since chickenpox
Symptoms of shingles / herpes zoster
Begins with fever, headache and malaise. Followed by severe deep pain, pruritis, paresthesia. Can develop into small blisters
Stooped posture
-atrophy of the supporting structures
-2/3 elder patients will show some degree of kyphosis
-lost height from compression in the spinal column up to 2’’
Osteoporosis
Decrease in bone mass leading to reduction in bone strength
Osteoarthritis
Progressive disease of joints destroying cartilage, promoting the formation of bone spores in joints and leads to joint stiffness
Risk factors of trauma in elderly people
Slower reflexes, visual/hearing deficits, equilibrium disorders, overall reduction in agility
What percent of elderly account for fall related deaths?
75%
Why are MVCs the 2nd leading cause of accidental death among elderly people?
Impaired vision, errors in judgement, underlying medical conditions
Head trauma or injury common in elderly people?
Intracranial bleeding
Chest/abdomen trauma common in elderly?
Rib fracture/flail chest
Abdominal trauma produces liver injury
Cervical spine / cord compression injuries common in elderly people?
Degenerative changes, nerve roots become compressed, femur/pelvis/tibia/upper extremity fractures
Polypharmacy
Multiple drug therapy’s in which there is a concurrent use of a number of drugs
5 toxicology changes due to medications
-drug metabolism
-diminished hepatic drug elimination
-diminished renal function
-body composition
-responsiveness to drugs that affect the CNS
Medication noncompliance
-Not following instructions or advice
-Failure to fill prescription
-Improper administration of medication
-Discontinuation of medication
-taking inappropriate medications
Drugs and alcohol maltreatment
-Preferred substance of maltreatment among elders
-Much smaller segment use illicit drugs
-some develop maltreatment problems in response to a life changing event
Psychiatric conditions
-depression
-suicide
-psychological complaints
Depression in elderly
-not normal part of aging
-treatable with medication and therapy
-often goes unrecognized and untreated
Suicide in geriatrics
-recently diagnosed with depression
-recently seen their physician
-typically don’t make suicidal gestures or seek help
Psychotic in geriatrics
-out of touch with reality
-paranoid behaviours
Elder maltreatment
Physical, sexual, emotional, financial neglect
Hypochondriac
-dozens of imaginary or minor complaints
-far less common in elderly
Normal part of aging process
-Signs and symptoms and disease may be altered from their presentation in younger patients
-Variety of acute illnesses may present simply as delirium
Potential clues from an initial assessment
-general home conditions
-home to hot or to cold
-hazards
-availability of social and family support
-activity level
-medications
-overall appearance
-attitude and mental wellbeing
Examples of terminal illness
End-stage cancer, renal failure, heart and lung disease, AIDs
What is palliative care?
Preventative care to prevent or lessen physical, psychological and spiritual suffering
Illness trajectory
Course of illness
Four trajectories of illness progression
-sudden death
-terminal illness
-organ failure
-frailty
Illness trajectory of terminal illness
Diagnosis > cure or control > disease progression > terminal (end of life care) > death
Diagnosis
When the illness is identified
Cure or control
Prognosis, course of illness, and treatment. Chemo, radiation, surgery
Disease progression
Disease progresses further even with cure or control
Terminal
Patient may need early, advanced, or terminal palliative care
Early palliative care
Ambulatory and functioning relatively well
Advanced palliative care
Patients functioning is declining, some assistance may be needed
Terminal palliative care
Patients are mainly bedridden and require total care
Euthanasia
Deliberate intervention with the intention of ending a life as to relieve suffering
Physician assisted suicide
Physician provides the knowledge and necessary means but the patient performs the act
Stage 0
No cancer, only abnormal cells with potential to become cancer
Stage 1
Small mass and only in one area
Stage 2/3
Small mass is larger and has spread to nearby tissues or lymph nodes
Stage 4
Cancer has spread to the other parts of the body
TNM System
Tumour, Node, Metastasis
