GERIATRICS Flashcards
25% of ER visits involve what age group?
> 65
What are some of the common presenting complaints an elderly person might have?
Falls, chest pain, SOB, abdominal pain, infection, dizzy/weak, and altered mental status
Describe some of the changes that occur in the cardiovascular system in an elderly person?
Decreased HR, CO, ejection fraction, ventricular compliance
Thickening of valves
Decreased response to sympathetic stimuli
Describe some of the changes that occur in the pulmonary system in an elderly person?
Decreased lung compliance, strength, endurance, vital capacity
Increased stiffness, small airway closure, sensitivity to narcotic respiratory depression
Reduced mucociliary clearance mechanisms
Describe some of the changes that occur in the renal system in an elderly person?
Decreased GFR, creatinine (d/t small muscle mass), thirst mechanism, and ability to conserve water
Dysregulated renin-angiotensin system
Describe some of the changes that occur in the GI system in an elderly person?
Impaired swallowing, motility, absorption
Impaired drug clearance
Describe some of the changes that occur in the MSK system in an elderly person?
Decreased muscle mass (thus decreased thermoregulation) & bone density
Describe some of the changes that occur in the integumentary system in an elderly person?
Loss of subQ fat, elastic collagen, glandular function
Thin/frail skin
Increased benign & malignant skin changes
Describe some of the changes that occur in the endocrine system in an elderly person?
Decreased thyroxine, insulin sensitivity
Impaired Ca & vit D metabolism
Describe some of the changes that occur in the immune system in an elderly person?
Changes in T & B cell immunity
Decreased neutrophil activity
Describe some of the changes that occur in the neurologic system in an elderly person?
Neuronal loss, cerebral atrophy
Increased risk of stroke
Impaired memory/cognition & sensory function
Describe some of the changes that occur in the psychological system in an elderly person?
Increased isolation → depression
What are some of the risk factors to falls?
Previous fall!
LE weakness, arthritis, age female gender, history of stroke, vision impairment
Dizzy/balance problems/peripheral neuropathy
Alcohol use, polypharmacy, & trip hazards
What should you always keep on your DDx when an elderly person presents to the ER with a fall?
TBI, c-spine, fracture, hematoma, intra-abdominal injuries, lacerations
What should we remember about chest pain in an elderly person?
Elderly patients are LESS likely to have typical sxs of cardiac ischemia (aka may not have any “pain”)
If an elderly patient has abdominal pain, what must we ALWAYS keep on our DDx?
AAA!
What else do we need to remember about elderly patients presenting with abdominal pain?
May not have the typically sxs you would expect (aka won’t have RLQ pain for appendicitis)
What are some common infection in elderly patients?
UTI, PNA, influenza, diverticulitis, C. diff, Sepsis, and cellulitis
What are some less common infections in the elderly but we should still be aware of?
STD, infected prosthetic device, Zoster
What do we look for as signs of serious infection in an elderly person?
T >103; RR >30; WBC >11K; HR >120; and \+ CXR
How is delirium different than dementia? What are the causes of delirium?
Delirium is ACUTE onset, is reversible
Potential causes: Infection, hypoxia, metabolic, CVA, polypharmacy, medication S/E, substance abuse/withdrawal
What are the s/e anticholinergic drugs cause? What are some examples of anticholinergic drugs?
Memory impairment, confusion, hallucinations, cognitive decline, blurred vision
Nausea/constipation
Examples = Benadryl, Detrol, oxybutynin, amitriptyline/nortriptyline, paroxetine, olanzapine, clozapine
Hospitals should be a safe place, but what are some of the risks of hospital stays in elderly people?
Increased risk of delirium, hospital acquired infection, and pressure ulcers
