Geriatrics Quiz 1 Flashcards
Geriatrics stands at the intersection of three forces, what are those three forces?
- Gerontology (both basic and applied)
- Chronic disease management, especially multimorbidities
- End of life care
What do the principles of gerontology help to explain?
The insights of geriatric care.
Ex- the presentation of a disease is often different in the elderly because the response to stress is different.
What is a hallmark of aging?
The decreased ability to respond to stress
What typically generates the symptoms of an illness?
The body’s stress response
What is the emphasis in care planning of the geriatric patient directed at?
Containing the disease
Maintaining function
Improving the quality of life
What has one compromise that has been made for geriatric care?
The evolution of palliative care
What combination of factors is said to be the difference in care of the elderly compared to care of younger patients?
Biological changes that occur during the course of aging.
Associated diseases
Attitudes and beliefs of older adults and their caregivers.
What is the time-sequential deterioration that occurs in most living beings, including weakness, increased susceptibility to disease and adverse environmental conditions, loss of mobility and agility, and age-related physiological changes?
Aging
How is aging defined?
The time-sequential deterioration that occurs in most living beings, including weakness, increased susceptibility to disease and adverse environmental conditions, loss of mobility and agility, and age-related physiological changes
What is life expectancy?
The proportion of possible maximum age a person may live
What is life span?
A biological limit to how many years a species can expect to survive.
What does geriatrics have the most to contribute to? Improving lifespan or life expectancy?
In general improving life expectancy, but new geriatric breakthroughs may ultimately affect life span as well.
What is chronological aging?
Age measured by the time that something or someone has existed.
What is gerontological aging?
Calculated on the basis of the risk of dying, the so-called force of mortality.
Can two people of the same chronological age have biologically very different ages depending on their state of health?
Yes
What are the common age related changes for the cardiovascular system?
Atrophy of muscle fibers that line the endocardium
Atherosclerosis of vessels
Increased SBP
Decreased compliance of the left ventricle
Decreased number of pacemaker cells
Decreased sensitivity of baroreceptors
What are the implications of changes of the cardiovascular system?
Increased BP
Increased emphasis on atrial contraction with an S4 heard
Increased arrhythmias
Increased risk of hypotension with position change
Valsalva maneuver may cause a drop in BP
Decreased exercise tolerance
What are the common age related changes for the neurological system?
Decreased number of neurons and increase in size and number of neuroglial cells
Decline in nerves and nerve fibers
Atrophy of the brain ad increase in cranial dead space
Thickened leptomeninges in spinal cord
What are the implications of changes of the neurological system?
Increased risk for neurological problems- cerebrovascular accident
Parkinsonism
Slower conduction of fibers across the synapses
Modest decline in short-term memory
Alteration in gait pattern: wide based, shorter stepped, and flexed forward
Increased risk of hemorrhage before sx are apparent.
What are the common age related changes for the respiratory system?
Decreased lung tisse elasticity Thoracic wall calcification Cilia atrophy Decreased respiratory muscle strength Decreased partial pressure of arterial oxygen (Pao2)
What are the implications of changes of the respiratory system?
Decreased efficiency of ventilatory exchange
Increased susceptibility to infection and atelectasis
Increased risk of aspiration
Decreased ventilatory response to hypoxia and hypercapnia
Increased sensitivity to narcotics.
What are the common age related changes for the integumentary system?
Loss of dermal and epidermal thickness Flattening of the papillae Atrophy of sweat glands Decreased vascularity Collagen cross-linking Elastin regression Loss of subcutaneous fat Decreased melanocytes Decline in fibroblast proliferation
What are the implication of changes of the integumentary system?
Thinning of skin and increased susceptibility to tearing
Dryness and pruritis
Decreased sweating and ability to regulate body heat
Increased wrinkling and laxity of skin
Loss of fatty pads protecting bone and resulting in pain
Increased need for protection from the sun
Increased time for healing of wounds
What are the common vital sign physical findings?
Elevated BP Postural changes in BP Irregular pulse Tachypnea Weight changes
What is the potential significance of the physical finding of elevated blood pressure?
Increased risk for cardiovascular morbidity; therapy should be considered if repeated measurements are high
What is the potential significance of the physical finding of postural changes in blood pressure?
May be asymptomatic and occur in the absence of volume depletion
Aging changes, deconditioning, and drugs may play a role
Can be exaggerated after meals
Can be worsened and become symptomatic with antihypertensive, vasodilator, and tricyclic antidepressant therapy
What is the potential significance of the physical finding of irregular pulse?
Arrhythmias are relatively common in otherwise asymptomatic elderly; seldom need specific evaluation or tx
What is the potential significance of the physical finding of tachypnea?
Baseline rate should be accurately recorded to help assess future complaints (such as dyspnea) or conditions (such as pneumonia or heart failure)
What is the potential significance of the physical finding of weight changes?
Weight gain should prompt search for edema or ascites
Gradual weight loss of small amounts of weight is common; losses in excess of 5% of usual body weigh over 12 months or less should prompt search of underlying dz
What are the common physical findings of general appearance and behavior?
Poor personal grooming and hygiene (eg, poorly shaven, unkempt hair, soiled clothing)
Slow though process and speech
Ulcerations
Diminished turgor
What is the potential significance of the physical finding of poor personal grooming and hygiene?
Can be signs of poor overall function, caregiver neglect, and/or depression; often indicated a need for intervention
What is the potential significance of the physical finding of slow though process and speech?
Usually represents an aging change; parkinson disease and depression can also cause these signs
What is the potential significance of the physical finding of ulcerations?
Lower extremity vascular and neuropathic ulcers common
Pressure ulcers common and easily overlooked in immobile patients
What is the potential significance of the physical finding of diminished turgor?
Often results from atrophy of subcutaneous tissue rather than volume depletion; when dehydration suspected, skin turgor over chest and abdomen most reliable
What is the common physical findings of the ears?
Diminished hearing
What is the potential significance of the physical finding of diminished hearing?
High frequency hearing loss is common; patients with difficulty hearing normal conversation or a whispered phrase next to the ear should be evaluated further
Portable audioscopes can be helpful in screening impariment
