Geriatrics Flashcards
What group of pts is more likely to be reported to APS for self-neglect?
Older adults with higher levels of psychological distress and lower levels of social relations
What pt pop is at inc risk of self neglect?
75 years of age, African Americans, lower socioeconomic status
cognitive impairment and physical disability
Epi RF for unbefriended elders
Older male lower income lives alone CVA hip fx Cog impaitment Depression MMSE <10
Signs of neglect
invol wt loss BMI <22 Hypoalbumenia <3.8 Hypocholesterolemia Vit or micronut deficiencies sarcopenia
Loss of homeostenosis
the eventual breakdown of the organism’s ability to maintain cells, tissues, and organ system
Effect of loss of homeostenosis
progressive changes that lead to cell death
Poss dz outcome of ↑ vascular intimal thickening
Early stages of atherosclerosis
Poss dz outcome of ↑ vascular stiffness
Systolic HTN
Stroke
Atherosclerosis
Poss dz outcome of ↑ LV wall thickness
↓ early diastolic cardiac filling
↑ cardiac filling pressure
Lower threshold for dyspnea
↑ risk for atrial fibrillation
Poss dz outcome of ↑ Left Atrial size
Atrial Fibrillation
Poss dz outcome of ↓ Sinus node function and conduction velocity
Atrioventricular Block
Sick Sinus Syndrome (tachy-brady)
Poss dz outcome of ↓ baroreceptor responsiveness
↑ risk of orthostatic hypotension
Poss dz outcome of Altered regulation of vascular tone (Stiffening)
HTN
Poss dz outcome of Decreased cardiovascular reserve
Lower threshold for and increased severity of heart failure
Poss dz outcome of ↓ Exercise Response (↓ max HR, CO, VO2 max, coronary blood flow, peripheral vasodilation)
↓ exercise capacity and
↑ cardiac complications (Ischemia, heart failure, shock, arrythmias, death) with illness
Poss dz outcome of Changes in connective tissue (↓ size of airways, shallow alveolar sacks- ↓ surface area)
Pulmonary fibrosis / Interstitial lung disease
COPD / Asthma physiology
Poss dz outcome of Loss of cilia and increased mucous glands à Loss of mucociliary clearance
Bronchiectasis, chronic or recurrent lung infections, Rhinosinusitis
Poss dz outcome of Kyphoscoliosis, calcification, and arthritis of costovertebral jointsà
↓ chest wall compliance
Restrictive lung physiology Obstructive sleep apnea
Poss dz outcome of Loss of diaphragmatic strength (by 25%) and intercostal muscle atrophy due to sarcopenia à ↓ FVC and FEV1 by 25-30mL/yr in nonsmokers (approx 60mL/yr in smokers)
Restrictive lung physiology
Poss dz outcome of Decreased laryngeal nerve endings à ↑ aspiration risk
Aspiration pneumonia, chronic cough
Sx of cardiac dysfn w/ aging
Dizziness, Shortness of breath, Angina, Lower extremity edema, Syncope (and pre-syncope), Decreased exercise tolerance, Fatigue, Impotence, Falls, Cognitive Impairment
Sx of respiratory dysfn w/ aging
Shortness of breath, cough, wheeze, decreased exercise tolerance, apnea, nasal discharge, fatigue
Potential dz states of resp dysfn w/ aging
Emphysema, Obstructive Sleep Apnea, Asthma, Pneumonia, Rhinosinusitis, Pulmonary Fibrosis / Interstitial Lung Disease, Aspiration
Sc of GI dysfn w/ aging
Dry mouth, dysphagia, early satiety, nausea, constipation, dysgeusia, fecal incontinence, hypo or hyperglycemic symptoms, fragility fractures
Physiologic changes of vision w/ aging
Pupil shrinks from 5 - 6 mm diameter to 2 mm diameter by age 60
Lens becomes thicker and more opaque, only 1/3 of light reaches retina by age 70
Presbyopia, caused by increased lens rigidity and thickness, is universal
Sx of visual dysfn w/ aging
Glare recovery declines
Speed of dark adaptation declines
Peripheral vision declines
Loss of lid tone often leads to entropion, ectropion, and tear overflow
Decreased tears leads to dry eye syndrome
Physiologic changes of hearing w/ aging
Tympanicmembrane flexibility decreases with age
Ossiclearticulation becomes more rigid
Cerumen becomes drier and more tenacious
Sx of hearing dysfn w/ aging
Highfrequencysound perception declines much faster than low frequency sound perception
Presbycusis= SNHL of aging
Impacted cerumen
What does screening tool FRAIL stand for?
F—Fatigue R—Resistance A—Aerobic capacity I— Illnesses L -- Weight loss
Primary Frailty
Inflammatory vs reduced immunity vs. anemia, reduced DHEA-S vs Low levels of vitamins and Carotenoids
Secondary Frailty
Result of chronic disease
Define pressure ulcer
localized inj to skin or underlying tissue, usually over a bony prominence as a result of unrelieved pressure
Intact skin with non-blanching redness
Stage I pressure ulcer
Shallow, open ulcer with red-pink wound bed
Stage II pressure ulcer.
Full-thickness tissue loss with visible subcutaneous fat
Stage III pressure ulcer
Full-thickness tissue loss with exposed muscle and bone
Stage IV pressure ulcer
How often does the Agency for Health Care Policy and Research recommend that pts who are bedridden be repositioned (even though no evidence)
And what angle should the head of the bed be?
every 2 hrs
No more than 30 deg
MC etiology of LE ulceration
venous ulcer (stasis ulcer)
poss causes of venous ulcers
inflammatory processes resulting in leukocyte activation, endothelial damage, platelet aggregation, and intracellular edema.
General PE of venous ulcers?
irregular, shallow, and located over bony prominences
Granulation tissue and fibrin are typically present in the ulcer base
Triad of diabetic ulcers
peripheral sensory neuropathy, trauma, and deformity
Assisted Living
Good for indiv who have difficulty with ADLS
Residents at assisted living communities are free to live an independent lifestyle, but also receive regular support for a range of daily activities ranging from cleaning to meal preparation
Housekeeping and maintenance services are often included in the monthly rental of an apartment, along with laundry services, utilities, transportation and meals
Independent Living
ideal for indiv who can still live indep but enjoy access to assitance when needed
access to dining, med care, entertainment
housekeeping and laundry may also be included
complications of MVA with elderly
complicates cardiopulmonary disease and has independent complications (PNA, flail chest)
what falls have greatest mortality in elderly?
Falls with blunt cerebral injury or long bone fx
FIM score factors
age (less improvement with inc age)
GIM score at admin (less improvement with high admit FIM score)
head inj (greater improvement w/ head inj)
what is FIM score used for
assess phys and cog relative to burden of care ie: level of disability indicating the burden of caring for them
what d/c destination has mortality highest?
skilled nursing facility d/c
What albumin level has inc post surg comp in hip fx and why
<3.8
inc in infections, cardiac, pulm, hemorrhage and thromboembolic comp
4th leading cause of death in US as of 2014
polypharm
Why is LT PPI use concerning?
Inc risks-
changes in microbiome B12 and mag deficiency falls and fx penumonias C diff Kidney fx
How do pts qualify for post acute care (rehab) that is covered by medicare?
need and would benefit from rehab
req 3 day hospital stay
acute rehab in hospital 3+ hrs
subacute is in nursing home 2+ hrs
How are nursing homes funded?
privately until poor then covered by medicaid
How are assisted living facilities funded?
privately- rarely accept medicaid
Define MCI
Evidence of modest cognitive decline (change from baseline)
Deficits DO NOT INTERFERE with independence (ADLs)
Benefits of cholinesterase inhibitors with alzheimers or vascular demenita
show a small effect to slow the decline of progression, give people a few additional months before need for nursing home placement; may have a greater effect on daily symptom burden – data is in development
