Geriatrics - SRS Flashcards
What are the definitions of geriatrics?
Over 65 per social security act of 1935
Young old 65-74
Middle old 75-84
Old old beyond 85 and up
What are some unique aspects of taking a geriatric history?
–Always review medications
–Assess activities of daily living
–Often have concomitant and complex medical problems
–Depression
–Cognitive impairment
–Difficulty with communications
What are some reasons that the elderly patient might have trouble communicating?
- Hearing, vision, speech (CVA)
- Inability to afford physician visits
- Underreporting – intimidated by a busy practice
- Fear – afraid to find out something is wrong
- Slower to respond
- Atypical presentations
What things should we be on the look out for regarding pulse and BP?
–Atherosclerosis and tissue perfusion
–Often have orthostatic changes
What are some things to be aware of as far as HEENT exam goes?
–Temporal arteritis
–Decreased lens accommodation
–Presbycusis
–Poor dentition/false teeth
–Decreased olfaction
What are some things to be aware of regarding the lung and chest exam?
–Kyphotic changes
• Decreased lung capacity
–Increased incidence of breast cancer
What percentage of octogenarians have a systolic murmur?
1/3
•Aortic stenosis, aortic sclerosis , mitral regurgitation, atrial septal defects, tricuspid regurgitation
What should we be looking for in the abdominal exam?
–Often present atypical/asymptomatic
•Perforation, ischemia, inflammatory
•Bleeding
Genitourinary exam of the elderly should look for what?
–Prostatic hypertrophy
–Vaginal and labial atrophy
•Squamous cell cancer
•Vaginal bleeding
What problems related to the musculoskeletal exam are common in the elderly?
–Deformities related to arthritis
–Compression fractions and kyphosis
What are some elements of the neuro exam that are high points for the elderly patient?
–Olfaction
–Cognition
–Gag/speech – aspiration
–Gait
What are the focuses of geriatric care?
- Reduce nursing home placement
- Reduce hospitalization
- Quality vs. quantity of life
- Socio-economic issues
Falls, or gait disturbances are multifactorial in etiology. How do we evaluate this functional impairment?
- HP
- Gait and balance
- Neuro Exam
- Cardiac exam
- lab tests
- PT evaluation
To test gait and balance, what do you do?
“get up and go test”
What are the consequences of falls?
- Subdural hematoma – mental decline
- Fracture (hip fractures are associated with up to a 50% mortality at 1 year)
- Nursing home placement
Urinary incontinece is more common in females (short urethra, child birth), it increases with age, common factor leading to institutionalization/social isolation.
What are the four types?
»Stress incontinence
»Urge incontinence
»Overflow incontinence
»Functional incontinence