Geriatrics Flashcards
what is the most under treated and under diagnosed illness in elders
- depression
failure to thrive
- cognition
- function
- mood
- normal aging issues/ nutrition- esp hydration
- deficit in any of the major domains
important functions to maintain
- dressing
- eating
- ambulating
- toileting
- hygiene
- home saftey
vision changes in the elderly
- loss of accomidation
- fibrosed retinas
- loss of visual acuity
- loss of 3D capability
- unable to understand gray scale
hearing loss in the elderly
- high pitched noises lost first
- inability to sense position
- dont know where sounds are coming from
loss of smell in the elderly
- loss of olfactory neurons
- taste buds change
- lose sweet and salty
- maintain bitter and sour
why does sundowning occur
- impaired senses -> inability to interact with environment well
- want to augment senses as much as possible to prevent
what is the most common cause of syncope in elders
- vasovagal
- sudden onset and slowly recover
- sx- diaphroesis, vomiting, hypotension
causes of decubiti
- immobility
- shearing
- moisture
- friction
stage 1 decubiti
- area over bony prominence is erythematous, doesnt blanch
- easily reversed by removing insult
stage 2 decubiti
- wound extends into SQ fat but doesnt go deep into fascia or muscle
- easily reversed by barrier cream or topicals
stage 3 decubiti
- would goes beyond deep fascia and into muscle
- not easily reversed
- can get worse very quickly
stage 4 decbuiti
- all the way through the muscle with risk of infection of bone
- limb threatening
unstageable decubiti
- skin remains intact
- non-blanching, bruising, fluctuant
- more difficult to treat and manage
- may require imaging
frailty measures
- weight loss
- exhaustion
- slow gait
- weak grip
- low energy output
what may be considered the 6th vital sign
- frailty
how does dysphagia happen
- decreased neck muscles
- compromised airway -> risk of aspiration
- esophageal dysmotility
- sphincter compromise -> GERD
why is B12 deficiency common in elderly
- requires stomach acid to be absorbed
- elderly have reduced stomach acid
C. diff
- loose, watery, mucousy stool
- foul smelling
- yellow green
- can cause sepsis
- abdominal cramping
risk factors for c diff
- age
- abx
- in an institution > 2 weeks
- exposure
treatment for c diff
- flagyl
- PO vanco
- time and fluids
- possible fecal transplants
types of urinary incontinence
- urgency
- stress
- overflow
- functional
urgency incontinence
- over active bladder
- bladder spasms
- frequency/ nocturia
stress incontinence
- compromised bladder closure or supportive structures
- bladder becomes easily overwhelmed
overflow incontinence
- bladder contracture issue
- blockage of urethra
- signals for bladder to evacuate dont occur or it becomes mechanically obstructed -> leak
treatment for urinary incontinence
- nonpharm first
- kegel exercises
- scheduled toileting
- indwelling catheters
- anticholinergics
- alpha 1 antagonists if due to BPH
McGreer criteria
- used to help dx and treat UTI
- constitutional sx- fever, leukocytosis, acute change in mental status, acute decline in fn
- UTI infection sx
- not based on changes in character of urine
- urine culture required
what is the most common cause of falls in elderly
- muscle weakness
what medications increase fall risk
- SSRI
- diuretics
- sedatives
why is it important to assess how long someone has bene down for?
- less peripehral fat in elderly -> hypothermia risk
- lungs can become impaired- airways do not open as well, more prone to pneumonia, weakened neck muscles
- 5% muscle loss per day
how do you assess delirium in elderly
- confusion assessment method
- mental status change
- inattention
- disorganized thinking
- altered level of consciousness
- need 1 and 2, either 3 or 4
causes of delirium
- infection
- trauma
- immobility
- pain
- pain meds
- catheters
- multiple transitions
dementia
- syndrome NOT a dx
- memory impairment with:
- chronicity (usually 9 months)
- progression and irreversibility
- may be slow and insidious
- does not meet criteria for dilirium
types of dementia
- alzheimer’s
- vascular disease
- lewy body disease
- frontotemporal disease
- reversible causes
lewy body disease
- lewy bodies accumulate in or around substantia nigra which makes dopamine
- parkinsonism, hallucinations
- antipsychotics make it worse
reversible causes of dementia
- hypo/hyperthryoidism
- B12 deficiency
- medications
- syphilis
- blood loss
- kidney/ liver disease
- delirium
mild cognitive impairment
- doesnt satisfy all requirements for dementia
- noticeable cognitive changes
- doesnt interfere with ADLs or independent functioning
- may progress to alzheimer’s or revert back to normal
risk factors for dementia
- HTN
- diabetes
- cholesterol
- smoking
main goals of dementia treatment
- keep pt at home
- maintain cognition
- preserve function
- improve behavior
- coordinate care
pharmacologic treatment for dementia
- donepazil (aricept)
- rivastigmine (exelon)
- memantine as add on for mod- severe dementia
- goa is to stabilize/ prevent worsening, NOT a cure
- procholinergic meds
alternative therapies that are effective for dementia
- exercise
- socialization
- structure/ support
