Geriatrics Flashcards
Who are the geriatric patients?
Anyone 65 y/o or older
How is geriatric medicine different?
Older patient
Understanding of the aging process
Multidisciplinary
End of Life care
What is aging?
(Time Dependent Deterioration) Weakness Increased susceptibility to disease and adverse environmental conditions Loss of mobility and agility Age-related physiologic changes
Changes associated with aging are often a result of what?
Gradual loss of homeostatic mechanisms
When do loss of homeostatic mechanisms begin?
In early adulthood, but don’t become evident until they are fairly extensive
Functional performance of an organ in an older person depends on 2 things, what are they?
Rate of deterioration
Level of performance needed
Overall, what is the hallmark of aging associated with?
How an organ performs during external stress (NOT at rest)
Atypical presentations in older persons are due to what? What are some examples?
Failure of stress response
Examples include: Unable to mount white count or fever in response to infection OR no pain with MI
What are some ill-defined symptoms that take the place of typical symptoms?
Confusion
Change in Endurance
Loss of Appetite
Nausea
What is an example of changes in aging working together to produce normal appearing resting state?
Normal serum creatinine despite decreasing GFR and renal blood flow (this is due to a concomitant decrease in lean muscle mass and therefore creatinine production)
When and how should Vital Signs be measured?
Weight at each visit
Height annually (osteoporosis)
Temperature
Pulses/BP in both arms for 30 seconds (checks for orthostatic hypotension)
Respiratory Rate (normal in elderly can be as high as 25 bpm, greater than this can be first sign of lower respiratory tract infection)
Why is BP overestimated in elderly?
Due to stiff arteries causing pseudohypertension
Changes in skin include?
Wrinkles, skin becomes lax and loses turgor
Vascularity in dermis decreases (paler and more opaque looking)
Backs of hands and forearms become thin, fragile, loose and transparent with actinic purpura
Onion skin
Changes in nails include?
Lose Luster
may become yellow and thicken (especially toes)
Brittle
Changes in hair?
Series of changes
Scalp hair loses pigmentation
Hair loss on scalp is usually genetic (men as young as 20 may have hairline recession at temples, hair loss at vertex follows)
Hair decreases in both genders as we age
Women at 55 y/o will notice coarse hairs on upper lip and chin
Changes in Face?
Eyebrows tend to drop below superior orbital rim
Chin descends
Loss of angle between submandibular line and neck
Wrinkles
Dry skin
Thick terminal hairs on ears, nose, upper lip and chin
Which artery needs to be palpated for tenderness/thickening and why?
Temporal arteries. To see if they have temporal arteritis (giant cell arteritis)
When does visual acuity gradually start to decline?
After 50 y/o and more rapidly after 70 y/o
What is presbyopia?
Loss/impairment/blurring of near vision associated with aging
Cataracts affects how many people in their 60’s and how many in their 80’s?
1 in 10 in their 60’s
1 in 3 in their 80’s
Why do older people require more light to see?
Due to thickening and yellowing of lens, which impedes the light flow to the retina
Why does narrow-angle glaucoma occur in older patients?
Because the lens continues to thicken over the years, it pushes the iris forward and further narrow the angle between the iris and cornea
Changes in the nose?
Progressive descent of nasal tip
Enlarging and lengthening of the nose may happen due to cartilage separation
What is presbycusis?
Loss of high pitched sound associated with aging with little functional changes
Angular chelitis in edentulous patients are usually due to what?
Fungal infections
Smooth painful tongue in older patients may be due to what?
Vitamin B12 deficiency
If an older patient has TMJ what should you be concerned with?
Degenerative osteoarthritis
In older patients, the thyroid gland enlarges and extends where?
It enlarges downward into the sternum (and can go unnoticed)
Why is there a displacement of the apical impulse in older patients?
Due to kyphoscoliosis
What condition intensifies with valsalva maneuvers?
Hypertrophic cardiomyopathy
