Geriatrics

Question 1

An Aging Nation

Answer 1

• 15.2% of US population is over 65
  1. new technologies, medications, care facilities, procedures
  2. treat people with chronic conditions who may have died from illness in the past
  3. people live longer with more comorbidity

Question 2

Example of Long Term Care Facilities

Answer 2

• Long Island State Veterans Home @ SBU

Question 3

Definition: Geriatric Patient

Answer 3

• patient that is 65 years of age or older

Question 4

Changes in Respiratory System

Answer 4

• less lung elasticity
• limited chest expansion (costochondral (cartilage) calcification = chest wall stiffens)
• defense mechanism are less effective
• cough and gag reflex diminish
• ciliary mechanisms slow
• size/strength of respiratory muscles decrease (higher risk of respiratory infection)

Question 5

Changes in Cardiovascular System

Answer 5

• vascular stiffening due to lowered collagen and elastin production
• higher bp
• widening pulse pressure
• poor circulation
• aortic valve undergoes fibrosis and calcification (obstructs blood flow from left ventricle)
• electrical conduction system deteriorates
• number of pacemaker cells decrease
• sedentary life cycle = increased risk of clots

Question 6

Changes in Renal System

Answer 6

• kidneys are responsible for: maintaining fluid and electrolyte balance, maintaining body’s acid-base balance, eliminating drugs from body
• kidney mass declines with age
• loss of functional nephrons which is important for blood filtration
• can cause electrolyte imbalance and severe dehydration

Question 7

Changes in Musculoskeletal System

Answer 7

• osteoporosis: decrease in bone mass that leads to brittle, easily breakable bones
• arthritis: tendons and ligaments lose elasticity and cartilage decreases
• muscles atrophy
• intervertebral discs wear down: shorter height and posture issues; increased risk of vertebrae fractures
• difficulty with tasks requiring fine motor skills or hand/finger strength

Question 8

Changes in Digestive System

Answer 8

• rectal sphincter decreases in size and strength
• fecal incontinece becomes more likely
• peristalsis slows: increased constipation, worsened by medication, diet, and decreased physical activity
• diverticula are more common: NSAID’s and osteoporosis medications increase risk; characterized by burning abdominal pain, usually worse when hungry
• peptic ulcers (sores in the upper gut which is esophagus, stomach, or duodenum)

Question 9

Changes in Nervous System

Answer 9

• cognitive function, memory, and postural stability declines
• regulation of respiratory rate/depth, pulse rate, bp, hunger, thirst, and temperature declines
• the vasovagal response: vasovagal syncope occurs when part of nervous system that regulates HR and BP (the vagus nerve) malfunctions due to sudden change in sympathetic tone such as defecation or micturition, exercise, or even coughing or laughing

Question 10

Other Changes

Answer 10

1. hematologic:
   - less skin cell replication = thinner, less firm skin
   - less RBC replication = tendency for anemia
   - less WBC replication = susceptibility to infection
2. Thinner, less elastic skin with less subcutaneous fat
   - prone to bruising
   - less bone cell replication = thinning bones
3. Homeostatic mechanisms decline
   - impaired thirst mechanism (risk of dehydration)
   - impaired thermoregulation
   - impaired BGL regulation
   - diminishing appetite

Question 11

Polypharmacy

Answer 11

• elderly patients are often prescribed multiple medications at once
• increased likelihood of adverse reaction
• increased chance of noncompliance

Question 12

Noncompliance

Answer 12

• failing to fill a prescription
• administering a medication improperly
• taking the wrong medication

Question 13

Pneumonia

Answer 13

• risk of respiratory infections increases with age because of frequent hospitalization and inactivity
• S/Sx: labored breathing or SOB, wheezing cough, phlegm production, fever and chills, crackling or rhonchi lung sounds, can be symptomatic due to weakened immune response

Question 14

Decubitus Ulcers

Answer 14

• aka “bed sores” or “pressure ulcers”
• occur because of pressure on tissue, leading to lack of perfusion and necrosis
• most commonly seen on lower legs, sacrum and glutes

Question 15

Delirium

Answer 15

• a symptom, not a disease
• impaired function of neurons
• temporary, reflects some underlying disturbance
• rapid onset but waxes and wanes
• hallucinations are common, reversible if underlying cause is treated
• causes: DELIRIUM
• Drugs/toxins
• Emotional
• Low O2
• Infection
• Recent Surgery
• Ictal (seizures)
• Undernutrition or dehydration
• Metabolism

Question 16

Dementia

Answer 16

• progressive brain failure and loss of cognitive function; death of neurons
• causes: vascular dementia, Parkinson’s Disease, Alzheimer’s Disease
• symptoms: baseline AMS, rarely hallucinations, general irreversible

Question 17

Alzheimer’s Disease

Answer 17

• most common form of dementia
• thought to be caused by abnormal build up of proteins in/around brain cells
• progressive function loss:
• • at first: difficulty recalling names, memory loss, can’t reason clearly, misplacing objects
• • Late stage: forget current events, can’t understand language or interact verbally, can’t perform self-care

Question 18

Parkinson’s Disease

Answer 18

• age-related neurological disease
• thought to be caused by gradual loss of cells that produce dopamine
• dopamine = major neurotransmitter that helps coordinate activity between two regions of the brain
• S/Sx: resting tremors, rigid extremities, slow movement, depression (can mimic dementia)

Question 19

Sepsis

Answer 19

• increased risk due to higher susceptibility to infection
• consider decubitus ulcers, UTI’s, pneumonia, and the many other causes of sepsis
• remember S/Sx of septic shock

Question 20

Falls and Trauma

Answer 20

• increased risk of bone fracture
• consider pelvis and femur fracture
• find out if pt is on blood thinners
• assess c-spine
• find out height of fall (lower heights can be significant in elderly patients)

Question 21

Suicide and Depression

Answer 21

• common issue in elderly
• increases likelihood of other diseases
• elderly tend not to complain about their feelings; depression may be difficult to recognize
• be sensitive
• suicide rate in ages 80-84 is more than twice the general population

Question 22

Communication

Answer 22

• sensory changes require us to change our communication
• talk slowly and clearly
• ask one question at a time
• if hearing/vision is impaired, show and explain what you’re doing before you do it
• make sure they’re focused

Question 23

Resources

Answer 23

• aka patient’s family/caregivers questions
• normal baseline, medical history, medications they take, history of present illness
• collect any relevant paperwork before leaving the scene
• may have information on medications prescribed and/or medical history DNR/MOLST

Question 24

Sheet Transfers

Answer 24

• useful way to move elderly patients
• have the patient “hug themselves”
• all crew members hold the same sheet; make sure it is taut
• use good patient communication
• count to 3 to move

Question 25

Elder Abuse

Answer 25

• most likely in patient’s home or in long-term care facilities
• signs include lack of proper cleaning, lack of proper feeding, and injuries unexplained by reported mechanism
• not required to report, but please consider