Geriatrics Flashcards
number of older adults in US
Older adults currently number over 27 million in the U.S.; this number is expected to reach 86 million by 2050
life expectancy for men and women
Life expectancy is now age 81 for women and age 79 for men on average
percent of americans over 85 projected within 40 years
5%
percent of americans over 65 that live in the community
95% - Frailty is a common myth about the older population
percent of americans over 65 that live in long-term care facilities
5%
Assessing the older adult
- Different from disease-oriented approach of history taking and physical exam of younger patient
- Focus is on healthy or “successful” aging
- -Understand and mobilize family, social, and community supports
- -Importance of skill directed to functional assessment
- -Opportunities for promoting older adult’s long-term health and safety
primary aging
- reflects changes in physiologic reserve that occur over time
- Independent of changes induced by disease
- Usually appear during periods of stress such as dehydration, shock, or other acute illnesses
heterogeneity among aging population
- Usual aging vs. successful aging
- Individuals who escape onset of debilitating disease entirely live healthy lives into their 80’s and 90’s
Blood pressure with age
systolic hypertension with widened pulse pressure often occurs
heart rate and rhythm with age
pacemaker cells decline and affect response to physiologic stress
-can lead to dizziness and falls
respiratory rate with age
unchanged
temperature regulation with age
changes lead to susceptibility to hypothermia
set point of temperature changes - get colder easier
skin, nails and hair with age
- Skin becomes fragile, loose, and transparent (hands/forearms); purple patches/macules called actinic purpura are frequently seen
- Nails lose luster, yellow, and thicken, especially toes
- Hair loses pigment and hairline recedes; also loss of hair occurs elsewhere such as trunk, pubic area, axillae and limbs, which is normal
head and neck with age
-eyeballs recede into orbit, corneas lose luster, pupils become smaller, dry eyes are a common complaint, and presbyopia occurs to nearly everyone
presbyopia
lens loses ability to focus, difficult to see objects up close (begins around age 40)
presbycusis
afflicted person fails to catch upper tones of words while hearing lower ones, causing words to sound distorted
taste with age
Diminished salivary secretions and decreased sense of taste occurs; medications and disease often account for this
thorax and lungs with age
capacity for exercise decreases; chest wall stiffens; skeletal changes accentuate dorsal curve producing kyphosis, but resulting “barrel chest” has little effect on function
vessels in the neck
systolic bruits heard in middle or upper portions of carotid arteries suggest partial arterial obstruction from atherosclerosis
extra heart sounds
after age 40, an S3 strongly suggests congestive heart failure; an S4 can be heard in healthy older people, but often suggests decreased ventricular compliance and impaired ventricular filling
cardiac murmurs
systolic aortic murmurs are common
aortic sclerosis
-results from fibrosis and calcification and does not impede blood flow
aortic stenosis
leaflets become calcified and immobile, which can cause outflow obstruction
Aortic sclerosis and stenosis implications
increase risk of CV morbidity and mortality
mitral regurgitation
usually occurs a decade later than aortic sclerosis and may become pathologic as volume overload increases in the left ventricle
breasts and axillae with age
in the aging female, breasts diminish in size as glandular tissue atrophies and is replaced by fat; ducts surrounding nipples become more palpable as firm, stringy strands
abdomen with age
fat tends to accumulate in the lower abdomen and near the hips, although total body weight remains stable; manifestations of acute abdominal disease are often blunted – pain is less severe and fever less pronounced
male genitalia with age
sexual interest remains intact with aging but frequency declines; erection is more dependent on tactile stimulation; erectile dysfunction affects half of older men
female genitalia with age
menstrual periods cease between ages 48 and 55; women often experience hot flashes for up to five years and may have vaginal dryness, urge incontinence, or dyspareunia; within 10 years, the ovaries are usually no longer palpable
prostate with age
proliferation of prostate epithelial and stromal tissue, known as benign prostatic hyperplasia, begins in the third decade, continues until the seventh and then plateaus; only half of men with BPH have symptoms
peripheral vascular with age
aging itself conveys relatively few clinically important changes for the peripheral vascular system
musculoskeletal with age
significant shortening becomes obvious in old age with most loss of height occurring in the trunk as intervertebral discs become thinner and vertebral bodies shorten/collapse from osteoporosis; skeletal muscles decrease in bulk and power; range of motion diminishes due to osteoarthritis
nervous system with age
- aging may affect all aspects of the nervous system, from mental status to motor and sensory function and reflexes; most elders do well on mental status exam but selected impairments become evident; “benign forgetfulness” causes difficulty in recalling names, objects, and certain details
- Difficult to distinguish changes of normal aging from age-related or other diseases
communicating with older adults
- Provide well-lit, moderately warm setting w/ minimal background noise and safe chairs and access to the examining table
- Face patient and speak in low tones; make sure the patient is using glasses, hearing devices, and dentures if needed
- Adjust the pace and content of the interview to the stamina of the patient; consider two visits for initial evaluations if needed
- Allow time for open-ended questions and reminiscing; include family, caretakers when needed, especially if the patient has cognitive impairment
- Carefully assess symptoms, especially fatigue, loss of appetite, dizziness, and pain, for clues to underlying disorders
- Ensure written instructions are in large print and easy to read
cultural dimensions of aging
- Clinicians must acquire new knowledge and awareness about the health beliefs and culture that shape the older adult’s response to illness and the health care system
- Federal reporting categories no longer capture the wide array of cultural differences that affect how older adults understand suffering, illness, and decisions about care, ranging from the use of alternative therapies to when to seek health care
- Cultural values particularly affect decisions about the end of life
10 minute geriatric screener
- Assesses vision, hearing, mobility, urinary incontinence, nutrition/weight loss, memory, depression, and physical disability
- Assesses physical, cognitive, and psychosocial factors
cognitive impairment tests for geriatric
MoCa, MMSE
Dpression for geriatrics
GERIATRIC DEPRESSION SCALE
Activities of Daily Living tests
Lawton IADL Scale
“sixth vital sign”
- assessing functional status
- Assessment of older adults places special emphasis on maintaining independence and optimal level of function
- Primary focus is maintaining functional status
- A number of performance-based assessment instruments are available such as:
- -10-Minute Geriatric Screener
- Patients should also undergo risk factor assessment for falls
General survey of geriatrics
Undernutrition, slowed motor performance, loss of muscle mass, and weakness suggest frailty
Isolated systolic hypertension after age 50 triples risk of what?
coronary heart disease
skin of geriatrics
- Physiologic changes of aging: thinning, loss of elastic tissue, turgor, and wrinkling
- Actinic purpura - well-demarcated, vividly purple macules
HEENT of geriatrics
Conduct a careful and thorough evaluation of the head and neck
thorax and lungs of geriatrics
perform usual examination, noting subtle signs of changes in pulmonary function
cardiovascular system of geriatrics
S3 suggests dilatation of the left ventricle from CHF; systolic crescendo-decrescendo murmur in the 2nd intercostal space suggests aortic sclerosis or aortic stenosis
peripheral vascular of geriatrics
Diminished or absent pulse may indicate arterial occlusion
Abdomen of geriatrics
Widened aorta and pulsatile mass in abdominal aortic aneurysm
Breasts and axillae of geriatrics
Lumps or masses mandate further investigation
female genitalia and pelvic exam of geriatrics
Allow careful time for positioning; rectovaginal exam
male genitalia/prostate of geriatrics
Pay special attention to any masses in the rectum and nodularity or masses of the prostate
musculoskeletal system of geriatrics
Joint deformity, deficits in mobility, or pain with movement requires more thorough examination
nervous system of geriatrics
- Pursue further examination if any deficits are noted
- Focus especially on memory and affect
- Abnormalities of gait and balance correlate with risk of falls
