Geriatrics

Question 1

What is the life span at birth currently?

Answer 1

79 y/o women

74 y/o men

Question 2

What is the life expectancy at 65yo, 75yo, 85yo, 95yo?

Answer 2

at 65 –> 15 years
at 75 –> 10 years
at 85 –> 5 years
at 95 –> 2-3 years

Question 3

who is considered a geriatric pt?

Answer 3

65 y/o and older

Question 4

How is geriatric med different?

Answer 4

older pt
understand aging process
multidisciplinary
end of life care

Question 5

what is aging?

Answer 5

time-dependent deterioration

ie. weakness, loss of mobility, age-related physiologic changes

Question 6

Changes assoc. w/aging often a result of…

Answer 6

gradual loss of homeostatic mechanisms

Question 7

functional performance of an organ in an older pt depends upon…

Answer 7

1. rate of deterioration

2. level of performance needed

Question 8

hallmark of aging is assoc. w/ organ performance during…

Answer 8

during external stress not at rest

Question 9

How often should weight and height be recorded in an older pt?

Answer 9

weight at each visit

height annually

Question 10

Vitals in an older pt

Answer 10

pulses/bp record in both arms for at least 30 secs

BP can be overestimated d/t stiff aa. (pseudohypotension)

check for orthostatic hypotension

RR can be normally high as 25bpm

Question 11

RR of >25bpm can be the first sign of…

Answer 11

lower respiratory tract infection

Question 12

what skin changes will you notice in older pt’s

Answer 12

wrinkles

lose turgor

vascularity in dermis decr’s = paler

back of hands/forearms: thin, fragile, transparent skin w/actinic purpura

Question 13

What nail changes will you notice in older pt’s

Answer 13

loose luster, may yellow and thicken (esp. toes)

brittle

Question 14

Hair changes in elderly

Answer 14

of scalp hairs in both sexes decreases
women ~55y/o course facial hairs on upper lip/chin
loses pigment

esp. for lighter-skinned people

Question 15

changes in head and neck in elderly

Answer 15

eyebrows drop, chin descends, loss of angle between submandibular line and neck, thick terminal hairs

temporal aa. palpated for tenderness and or thickening –> indicates temporal arteritis (giant cell)

Question 16

Eye changes in elderly

Answer 16

eyeball sunken appearance

dry eye d/t lack of decreased lacrimal production

lens at risk for cataract, glaucoma, macular degeneration

thickening and yellowing of lens –> pushes iris forward –> narrow angle glaucoma

presbyopia = near vision blurs

Question 17

nose changes in elderly

Answer 17

progressive descent of nasal tip

enlarging and lengthening of the nose d/t cartilage separation

Question 18

Ears changes in elderly

Answer 18

presbycusis = hearing diminishes w/age

high pitch sound loss and gradually loss of middle and lower ranges too

Question 19

mouth in elderly

Answer 19

darkened teeth

fissures in the mouth and tongue

tongue sticks to buccal mucosa d/t xerostomia

tongue: varicosities on ventral side, geographic tongue, smooth/painful d/t vitamin B12 defiency

remove dentures

angular cheilitis d/t fungal infx if no teeth and not dentures wearer

Question 20

thyroid gland, bruits, neck flexibility?

Answer 20

thyroid can enlarge downward into sternum

carotid bruits AND transmitted heart murmur
(bruit louder as you go from <3 to neck)

check for resistance to passive ROM

Question 21

chest and back changes in elderly

Answer 21

basilar rales (crackles) can be present at lung bases should be clear w/deep inhalation and cough

check for excursion and expansion

look for scoliosis and tenderness

Question 22

heart changes in elderly

Answer 22

displacement of apical impulse d/t kyphoscoliosis

asxs sinus bradycardia (check at least 30sec-1min for Afib rhythm)

cardiac output: modest drop in resting HR, less responsive to stimulation from B-adrenergic catecholamines, diastolic dysfx d/t atrial dep., incr myocardial stiffness, incr. risk of HF

Question 23

systolic murmurs in elderly

Answer 23

aortic valve sclerosis
aortic valve stenosis (radiates to carotid)
mitral regurgitation (loudest at apex–> axilla)
hypertrophic cardiomyopathy

Question 24

Peripheral vascular system changes in elderly

Answer 24

peripheral aa. lengthen, tortuous, feel harder

increased stiffness

loss of arterial pulsations NOT normal!

back and abd pain worry about AAA

artherosclerosis is not normal aging changes

Question 25

Breast changes in men and women elderly pt’s

Answer 25

females- smaller, flaccid, pendulous, glandular tissue atrophies, ducts may feel like firm stringy strands

men- gynecomastia

both- axillary hair decreases

Question 26

respiratory changes in elderly

Answer 26

chest wall stiffer
mm. weaken
lose elastic recoil
lung mass declines, residual volume incr's
worsened resp. fx d/t kyphosis
cough reflex less effective

Question 27

abdominal changes in elderly

Answer 27

mm. weaken
decr. activity of lipoprotein lipase w/fat accumulation in lower abd near hips –> incr. CV risk

aging can blunt manifestation of acute abd dz (s/s of peritonitis reduced or absent)

Question 28

GI system changes in elderly

Answer 28

palpate for hepatosplenomegaly, FOB, anorectal area examined for lesions, anal wink reflex tested, DRE for masses, palpate for AAA

Question 29

GU system changes in elderly men

Answer 29

sexual interest remains intact
testosterone decreases
erection dep. on tactile stimulation
testicles drop lower in scrotum
androgen proliferation --> BPH (50% sxs)

Question 30

GU system changes in elderly women

Answer 30

ovarian fx declines and menstrual periods cease b/t 45-52y/o

estrogen stimulation decr’s –> hot flashes

vagina narrows and shortens

vaginal dryness, urge incontinence, dyspareunia

Urinary incontinence d/t loss of bladder capacity, urinary flow rate, denervation/contractility of detrusor m.

Question 31

Female reproductive system changes in elderly

Answer 31

pap test every 2-3 years until age 65

pap smear still recommended even if hysterectomy

lie on left side for bimanual pelvic exam if lack of hip ROM

lack of estrogen after menopause –> vaginal/urethral mucosa atrophy

examine for prolapse of urethra, vagina, cervix, uterus

Question 32

MSK changes in elderly

Answer 32

M/W: lose cortical and trabecular bone mass throughout adulthood

check joints: TTP, sw, subluxation, crepitus, warmth, redness

active/passive ROM

joint contractures

Question 33

MSK changes feet

Answer 33

hallux valgus, hammer toe, claw toe

deformities d/t ill-fitting shoes, RA, DM, neurologic

refer to podiatry any abnormality

Question 34

Mental status changes in elderly

Answer 34

most perform well on MSE
more susceptible to delirium
distinguish b/t age-related change

Question 35

cranial nn. changes

Answer 35

small pupils, pupillary light reflex sluggish, bell phenomenon absent, loss of smell/taste

Question 36

Motor changes in elderly

Answer 36

sarcopenia (decr. in muscle mass)

benign essential tremor in head, jaw, lips, hands confused w/Parkinson’s

B/L weakness that doesn’t bother pt = benign, tx w/resistance training

Question 37

sensory changes in elderly

Answer 37

vibratory sense is lost in feet and ankles

position sense may diminish/disappear

gag reflex decr/absent

ankle reflexes may be symmetrically decr./absent

Question 38

Gait and posture changes in elderly

Answer 38

shorter steps d/t calf m. weakness or balance
reduced gait velocity
reduced joint motion

Question 39

How do you test gait velocity?

Answer 39

8m, w/2m increments