Geriatrics Flashcards
What is the life span at birth currently?
79 y/o women
74 y/o men
What is the life expectancy at 65yo, 75yo, 85yo, 95yo?
at 65 –> 15 years
at 75 –> 10 years
at 85 –> 5 years
at 95 –> 2-3 years
who is considered a geriatric pt?
65 y/o and older
How is geriatric med different?
older pt
understand aging process
multidisciplinary
end of life care
what is aging?
time-dependent deterioration
ie. weakness, loss of mobility, age-related physiologic changes
Changes assoc. w/aging often a result of…
gradual loss of homeostatic mechanisms
functional performance of an organ in an older pt depends upon…
- rate of deterioration
2. level of performance needed
hallmark of aging is assoc. w/ organ performance during…
during external stress not at rest
How often should weight and height be recorded in an older pt?
weight at each visit
height annually
Vitals in an older pt
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
RR of >25bpm can be the first sign of…
lower respiratory tract infection
what skin changes will you notice in older pt’s
wrinkles
lose turgor
vascularity in dermis decr’s = paler
back of hands/forearms: thin, fragile, transparent skin w/actinic purpura
What nail changes will you notice in older pt’s
loose luster, may yellow and thicken (esp. toes)
brittle
Hair changes in elderly
of scalp hairs in both sexes decreases
women ~55y/o course facial hairs on upper lip/chin
loses pigment
esp. for lighter-skinned people
changes in head and neck in elderly
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)
Eye changes in elderly
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
nose changes in elderly
progressive descent of nasal tip
enlarging and lengthening of the nose d/t cartilage separation
Ears changes in elderly
presbycusis = hearing diminishes w/age
high pitch sound loss and gradually loss of middle and lower ranges too
mouth in elderly
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
thyroid gland, bruits, neck flexibility?
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
chest and back changes in elderly
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
heart changes in elderly
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
systolic murmurs in elderly
aortic valve sclerosis
aortic valve stenosis (radiates to carotid)
mitral regurgitation (loudest at apex–> axilla)
hypertrophic cardiomyopathy
Peripheral vascular system changes in elderly
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
Breast changes in men and women elderly pt’s
females- smaller, flaccid, pendulous, glandular tissue atrophies, ducts may feel like firm stringy strands
men- gynecomastia
both- axillary hair decreases
respiratory changes in elderly
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
abdominal changes in elderly
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)
GI system changes in elderly
palpate for hepatosplenomegaly, FOB, anorectal area examined for lesions, anal wink reflex tested, DRE for masses, palpate for AAA
GU system changes in elderly men
sexual interest remains intact testosterone decreases erection dep. on tactile stimulation testicles drop lower in scrotum androgen proliferation --> BPH (50% sxs)
GU system changes in elderly women
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.
Female reproductive system changes in elderly
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
MSK changes in elderly
M/W: lose cortical and trabecular bone mass throughout adulthood
check joints: TTP, sw, subluxation, crepitus, warmth, redness
active/passive ROM
joint contractures
MSK changes feet
hallux valgus, hammer toe, claw toe
deformities d/t ill-fitting shoes, RA, DM, neurologic
refer to podiatry any abnormality
Mental status changes in elderly
most perform well on MSE
more susceptible to delirium
distinguish b/t age-related change
cranial nn. changes
small pupils, pupillary light reflex sluggish, bell phenomenon absent, loss of smell/taste
Motor changes in elderly
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
sensory changes in elderly
vibratory sense is lost in feet and ankles
position sense may diminish/disappear
gag reflex decr/absent
ankle reflexes may be symmetrically decr./absent
Gait and posture changes in elderly
shorter steps d/t calf m. weakness or balance
reduced gait velocity
reduced joint motion
How do you test gait velocity?
8m, w/2m increments
