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ICM > Geriatrics > Flashcards

Geriatrics Flashcards

1
Q

What is Aging?

A

Gradual and spontaneous change:

Maturation: childhood/puberty/young adulthood

Then decline through middle/late age

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2
Q

What is senescence?

A

Capacity for cell division, growth, and function is lost over time and ends with death

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3
Q

What senses change?

What change occurs in the mouth?

A

Senses: Smell and Taste

Mouth: decrease saliva production

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4
Q

What changes occur in the esophagus?

A

Generally little change:

Decrease UES pressure/relaxation

Decrease amplitude of peristalsis

Longer duration of reflux episodes

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5
Q

*** Know the GI tract in the geriatric patient:

Change in the bowel?

A

Decline in absorption of Vit D, Zinc, and Ca++

Decrease in anal sphincter pressure (incomplete evac or incontinence)

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6
Q

What changes occur in the pancreas?

A
  • Decrease insulin secretion and sensitivity
  • Increase incidence of Diabetes II
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7
Q

What changes occur in the liver with age?

A
  • Delayed regeneration after injury
  • Decreased BF and metabolism of drugs
  • Decrease in serum albumin binding capacity
  • Decrease in LDL extraction from blood
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8
Q

What changes occur in the Gallbladder?

A
  • Decrease bile acid secretion
  • Increase phospholipid/cholesterol composition of bile
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9
Q

What types of medications cause constipation?

A
  • Anticholinergics
  • Opiates
  • Iron
  • Ca++ channel blockers
  • Ca++ supplements
  • NSAIDs
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10
Q

What types of medications cause diarrhea?

A
  • Antibiotics
  • Donepezil
  • Supplements
  • Metformin (she mentioned in class)
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11
Q

What changes in the Kidney of the elderly?

A

Decrease in:

  • weight, mass, and number/size of nephrons
  • Glomeruli and GFR
  • BF
  • Renin/Aldosterone levels
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12
Q

What changes in the urinary bladder?

A
  • Decrease in capacity and contractility
  • Increase of uninhibited contractions
  • Women: decrease urethral length and sphincter strength
  • Men: prostatic hypertrophy
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13
Q

Falls - standard?

A

IT IS NOT NORMAL TO FALL***

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14
Q

Intrinsic factors contributing to falls?

A
  • Cerebellum
  • Cognitive health
  • Musculoskeletal system
  • Nervous system
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15
Q

Extrinsic factors involved with falls?

A
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16
Q

What medications can cause falls?

A
  • Antidepressants
  • Antipsychotics
  • Benzos
  • Beta-blockers
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17
Q

*** important

General important causes of weight loss?

A

Ability to:

  • obtain food
  • prepare food
  • ingest/digest/absorb food
18
Q

*****

Treatable causes of undesired wt. loss

A
  • Meds
  • Emotional probs (depression)
  • Anorexia/alcoholism
  • Late paranoia
  • Swallowing probs
  • Oral factors (dentures)
  • No money
  • Wandering (DIMENTIA)
  • Hyper/othyroidism
  • Enteric probs
  • Eating probs (cant feed oneself)
  • Low salt/cholesterol
  • Social probs
19
Q

Meds that cause wt loss

A
  • CV: digoxin
  • GI: cimetidine
  • Psychiatric
  • Anti-ineffectives
  • Supplements
  • Antineoplastics
  • Anti-rheumatics
  • Theophylline (pulm)
  • Thyroid replacement
20
Q

Memory loss?

A

IT IS NOT NORMAL TO HAVE MEMORY LOSS**

21
Q

What is dementia?

A

Cognitive and behavior disorder from a chronic disease

****Symptom only***

22
Q

What is benign senescent memory loss?

A

Normal decline in cognition with age

Does NOT impact functional status or behavior

23
Q

What is delirium

A

Acute (abrupt) confusional state:

Inability to sustain attention and a change in perception with evidence that the disturbance is related to another condition

24
Q

***** MUST KNOW DIFFERENCES BETWEEN DIMENTIA AND DELIRIUM

A

Dimentia

  • Gradual, chronic, irreversible, no change in attention

Delirium

  • Abrupt, acute, reversible, mental status varies drastically and quickly, short attention span
25
Q

****

Primary dementias?

A

Alzheimers

Multi-infarct

Lewy Body disease

26
Q

******

Most common treatable cause of dementia?

A

Depression*****

27
Q

Large difference between alzheimers and lewy body disease?

A

Lewy body disease has a much faster progression and is thus harder to “treat”

28
Q

Late onset of alzheimers has an increased risk when?

A

If allele 4 of APO-E on C19

29
Q

Genetic testing and dementia?

A

Not recommended:

  • If you have the gene - may not get
  • If you dont have the gene - may get
  • No cure
  • Insurance
30
Q

Dimentia symptoms?

A

Memory loss, aggression, hallucinations

Change in personality, behavior, and functionality

Sleeplessness

Sexually inappropriate

31
Q

Physical exam Indicators of:

Focal neurologic deficits?

Parkinsonism?

Normal exam?

A
  • Focal
    • Multi-infarct
  • Parkinsonism
    • Lewy body
  • Normal
    • Alzheimers
32
Q

First stage - mild dementia?

A

2-4 yrs prior and including diagnosis

Recent memory loss

33
Q

Second stage - moderate dementia?

A

2-10 years after diagnosis

Memory loss, confusion, and short attention span

34
Q

Third stage - Severe dementia?

A

1-3 years at the end

Unable to recognize family or self in mirror

35
Q

** Know basics of Functional assessment of Alzheimers

Stage 1?

Stage 2?

Stage 3?

Stage 4?

A
  • S1
    • no difficulties
  • S2
    • word finding difficulties, forgetful
  • S3
    • decreased organization, difficulty in job
  • S4
    • Difficulty with complex tasks
36
Q

** Know basics of Functional assessment of Alzheimers

Stage 5?

Stage 6?

Stage 7?

A
  • S5
    • Assistance with proper clothing
  • S6
    • very debilitating
  • S7
    • Less than 6 months left
37
Q

Competency vs cognitive ability? (she discussed in class)

A

Competency: legal

ability and right to manage their own affairs

Cognitive ability: medical

38
Q

***Greatest difficulty with medication and the elderly?

A

Compliance

  • Social circumstance
    • lives alone, transportation, finances
  • Regimen
    • ease of dosing
  • Health
    • cognition and vision
39
Q

Metabolic changes in absorption and distribution?

A
  • Absorption
    • Decreased in GI tract and topical
  • Distribution
    • decrease in lean body mass, total body water, and serum plasma proteins
    • increase in body fat
40
Q

Three main drug related problems (not including compliance)?

A
  • Adverse drug reactions
  • Adverse withdrawl events
  • Therapeutic failure
41
Q

Risk factors for adverse drug reactions?

A
  • Mutiple meds and comorbidities
  • Certain drug classes

*Significant cause of hospitalization

42
Q

When regimening the elderly - what extra precautions should be taken?

A
  • Determine necessity
  • Know potential ADRs
  • Start low
  • Go slow
  • Change only one medication at a time
  • Simplify regimen (and review at every visit)

ICM (9 decks)

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