GERIATRICS

Question 1

25% of ER visits involve what age group?

Answer 1

> 65

Question 2

What are some of the common presenting complaints an elderly person might have?

Answer 2

Falls, chest pain, SOB, abdominal pain, infection, dizzy/weak, and altered mental status

Question 3

Describe some of the changes that occur in the cardiovascular system in an elderly person?

Answer 3

Decreased HR, CO, ejection fraction, ventricular compliance

Thickening of valves

Decreased response to sympathetic stimuli

Question 4

Describe some of the changes that occur in the pulmonary system in an elderly person?

Answer 4

Decreased lung compliance, strength, endurance, vital capacity

Increased stiffness, small airway closure, sensitivity to narcotic respiratory depression

Reduced mucociliary clearance mechanisms

Question 5

Describe some of the changes that occur in the renal system in an elderly person?

Answer 5

Decreased GFR, creatinine (d/t small muscle mass), thirst mechanism, and ability to conserve water

Dysregulated renin-angiotensin system

Question 6

Describe some of the changes that occur in the GI system in an elderly person?

Answer 6

Impaired swallowing, motility, absorption

Impaired drug clearance

Question 7

Describe some of the changes that occur in the MSK system in an elderly person?

Answer 7

Decreased muscle mass (thus decreased thermoregulation) & bone density

Question 8

Describe some of the changes that occur in the integumentary system in an elderly person?

Answer 8

Loss of subQ fat, elastic collagen, glandular function

Thin/frail skin

Increased benign & malignant skin changes

Question 9

Describe some of the changes that occur in the endocrine system in an elderly person?

Answer 9

Decreased thyroxine, insulin sensitivity

Impaired Ca & vit D metabolism

Question 10

Describe some of the changes that occur in the immune system in an elderly person?

Answer 10

Changes in T & B cell immunity

Decreased neutrophil activity

Question 11

Describe some of the changes that occur in the neurologic system in an elderly person?

Answer 11

Neuronal loss, cerebral atrophy

Increased risk of stroke

Impaired memory/cognition & sensory function

Question 12

Describe some of the changes that occur in the psychological system in an elderly person?

Answer 12

Increased isolation → depression

Question 13

What are some of the risk factors to falls?

Answer 13

Previous fall!

LE weakness, arthritis, age female gender, history of stroke, vision impairment

Dizzy/balance problems/peripheral neuropathy

Alcohol use, polypharmacy, & trip hazards

Question 14

What should you always keep on your DDx when an elderly person presents to the ER with a fall?

Answer 14

TBI, c-spine, fracture, hematoma, intra-abdominal injuries, lacerations

Question 15

What should we remember about chest pain in an elderly person?

Answer 15

Elderly patients are LESS likely to have typical sxs of cardiac ischemia (aka may not have any “pain”)

Question 16

If an elderly patient has abdominal pain, what must we ALWAYS keep on our DDx?

Answer 16

AAA!

Question 17

What else do we need to remember about elderly patients presenting with abdominal pain?

Answer 17

May not have the typically sxs you would expect (aka won’t have RLQ pain for appendicitis)

Question 18

What are some common infection in elderly patients?

Answer 18

UTI, PNA, influenza, diverticulitis, C. diff, Sepsis, and cellulitis

Question 19

What are some less common infections in the elderly but we should still be aware of?

Answer 19

STD, infected prosthetic device, Zoster

Question 20

What do we look for as signs of serious infection in an elderly person?

Answer 20

T >103; 
RR >30; 
WBC >11K; 
HR >120; and 
\+ CXR

Question 21

How is delirium different than dementia? What are the causes of delirium?

Answer 21

Delirium is ACUTE onset, is reversible

Potential causes: Infection, hypoxia, metabolic, CVA, polypharmacy, medication S/E, substance abuse/withdrawal

Question 22

What are the s/e anticholinergic drugs cause? What are some examples of anticholinergic drugs?

Answer 22

Memory impairment, confusion, hallucinations, cognitive decline, blurred vision

Nausea/constipation

Examples = Benadryl, Detrol, oxybutynin, amitriptyline/nortriptyline, paroxetine, olanzapine, clozapine

Question 23

Hospitals should be a safe place, but what are some of the risks of hospital stays in elderly people?

Answer 23

Increased risk of delirium, hospital acquired infection, and pressure ulcers