Gerontology Flashcards
WHO defines a geriatric as a person over what age?
50
An ‘older person’ is defined as greater than ____ years of age.
65
Does the myocardium gain or lose contractility with age?
Lose
Reduced myocardial contractility lowers cardiac output which is compensated for by an increase in HR. This process eventually leads to what condition?
Left ventricular hypertrophy
Reduced elasticity of blood vessels causes increased/decreased peripheral resistance, leading to increased/decreased systolic BP.
Increased; increased.
Reduced cardiac output and increased peripheral resistance put geriatric patients at an increased risk of ____.
Hypoxia.
List some cardiovascular conditions common to geriatric patients.
- ACS
- CHF
- Dysrhythmias
- AF
- PVC’s
- Electrolyte imbalance
- AA’s
- Thoracic aneurysm
- Abdominal aneurysm
- Hypertension
- Primary vs secondary
List some physical changes to the respiratory system common to geriatric patients.
- Stiffening of trachea
- Stiffening of rib cage
- Kyphosis (increases size of rib cage)
- Weakening of respiratory muscles
- Reduced ventilation
- Reduced cough and gag reflex
- Hypertrophy of mucous-producing cells
- Loss of cilia action
- Reduced arterial partial pressure of oxygen
Hypertrophy of mucous-producing cells and loss of cilia action in the respiratory system put geriatric patients at increased risk of ____.
Infection
What are the symptoms of bacterial pneumonia in geriatric patients?
- Altered mental status
- Cough
- Fever
- SOB
- Tachycardia
- Tachypnoea
What are the symptoms of COPD/COAD?
- Limited airflow
- Increased work of breathing
- Dyspnoea
- Ventilation-perfusion mismatch
- Hypoxaemia
- Respiratory acidosis
What are the symptoms of pulmonary emboli?
- Sudden tachypnoea
- AF
- Signs of DVT
- LVF
Does GIT motility increase or decrease with age?
Decrease
Does GIT absorption increase or decrease with age?
Decrease
Name three GIT conditions common to geriatric patients.
- GIT haemorrhage
- Bowel obstruction
- Incontinence
What is haematemesis, and what does it indicate?
Vomiting of blood; indicative of bleeding proximal to the ligament of Treitz (suspensory muscle of the duodenum).
What is melena, and what does it indicate?
Black, odorous stools due to degradation of blood to hematin; indicative of bleeding from the UGI tract, distal small bowel, or right colon.
What is hematochezia, and what does it indicate?
Passing of bright red blood with or without stool; indicative of bleeding in the lower GIT or (less commonly) UGI.
What is occult bleeding?
Bleeding not apparent to the patient.
List five causes of upper GIT haemorrhage.
- Peptic ulcer
- Erosions (gastritis/oesophagitis/duodenitis)
- Varices (gastric/oesophageal)
- Mallory-Weiss tear (tears in mucosa at junction of stomach and oesophagus, usually caused by severe retching/coughing)
- Neoplasms
List four causes of lower GIT haemorrhage.
- Angiodysplasia (vascular malformations/lesions in the cecum and proximal ascending colon)
- Diverticulosis (sac-like protrusion of the colonic wall)
- Colitis (common response to acute mucosal injury; ischaemic and infectious colitis are more common in geriatric patients)
- Neoplasms
True or false: large-bowel obstruction is a medical emergency.
What are the two possible causes of large-bowel obstruction?
- Neoplasms
- Anatomic abnormalities
True or false: urinary incontinence is a normal consequence of ageing.
Age-related changes predispose patients to UI, but it is not caused by age independently.
True or false: nephrons in the kidney decrease in size and number with age.
Kidney size is reduced by ____% in geriatric patients.
20%
Hypotension in geriatric patients is more likely to cause damage to which organ system?
Renal
Decreased renal function puts geriatric patients at higher risk of what two complications?
Metabolic acidosis and fluid imbalance
Decreased thyroid activity in geriatric patients leads to reduced rate of ____.
Metabolism
True or false: Adrenal gland activity is increased in geriatric patients.
Geriatric patients have increased/decreased insulin secretion and increased/decreased insulin resistance.
Decreased; increased.
Impaired glucose metabolism puts geriatric patients at greater risk of _____.
Hyperglycaemia.
List five subtypes of decreased sensory functions in geriatric patients.
- Visual loss
- Reduced peripheral vision
- Hearing loss
- Reduced sense of smell
- Reduced skin sensation (heat/cold/pressure/pain)
Between ages 25 and 95 the size of the brain decreases by ____%.
20%
Decreased cerebral blood flow and reduced effectiveness of the blood-brain barrier result in narcotic drugs having a diminished/greater effect on the central nervous system.
Greater
Name four nervous system illnesses common to geriatric patients.
- Cerebral vascular disease (CVA, TIA)
- Delirium
- Dementia (Alzheimer’s disease)
- Parkinson’s disease
Define a stroke in simple terms.
A disturbance in cerebral blood supply due to a clot or haemorrhage.
Define a transient ischaemic attack in simple terms.
A temporary fall in blood supply to the brain that results in a lack of oxygen.
Define a subarachnoid haemorrhage in simple terms.
A less common cause of stroke where blood leaks out of the brain’s blood vessels into the subarachnoid space.
Define vascular dementia in simple terms.
Decreased cerebral circulation results in areas of the brain not receiving adequate blood and oxygen.
Delirium is a disorder of ____ ____.
Cognitive function.
True or false: delirium is an acute disturbance of attention and cognition.
Delirium effects up to ____% of older people admitted to hospital.
56%
True or false: delirium may be the only symptom of illness.
Why does delirium pose a problem for clinicians?
- No single, clear presentation
- Controversy over identifying risk factors
- Commonly leads to hospitalisation
- Increases morbidity and mortality
- Predictive of physical, functional, and cognitive decline
What is dementia?
A collection of symptoms caused by disorders affecting the brain that impacts thinking, behaviour, and the ability to perform everyday tasks enough to interfere with normal social or working life.
Dementia can happen to anybody, but is more common after what age?
65
List eight common types of dementia.
- Alzheimer’s disease
- Vascular dementia
- Parkinson’s disease
- Lewy body dementia
- Fronto Temporal Lobar Degeneration (FTLD)
- Huntington’s disease
- Korsakoff’s syndrome (alcohol-related dementia)
- Creutzfeldt-Jacob disease
List five early signs of dementia.
- Progressive and frequent memory loss
- Confusion
- Personality change
- Apathy and withdrawal
- Loss of ability to perform everyday tasks
What is Alzheimer’s disease?
A physical disease which attacks the brain resulting in impaired memory, thinking, and behaviour.
Describe the events leading to brain cell death that prevents information recall in Alzheimer’s disease.
- Substance of brain shrinks as brain cells die with age
- Abnormal material builds up as ‘tangles’ within brain cells and ‘plaques’ outside brain cells
- The build-up disrupts messages within the brain and damages connections between brain cells
- This leads to brain cell death and prevents information recall
Which is typically the first affected in Alzheimer’s disease, short term or long term memory?
Short term memory
Name the two types of Alzheimer’s disease.
Sporadic Alzheimer’s disease and Familial Alzheimer’s disease.
Which type of Alzheimer’s disease is more common?
Sporadic Alzheimer’s disease.
Sporadic Alzheimer’s can affect adults at any age but usually occurs after what age?
65
A child has ____% chance of inheriting the mutated gene for Familial Alzheimer’s if one parent has it.
50%
What will occur if a person has the gene mutation for Familial Alzheimer’s disease?
They will eventually develop Alzheimer’s disease, usually in their 40’s or 50’s.
What is Parkinson’s disease?
A progressively degenerative neurological disorder which affects the control of body movements.
Describe the pathophysiology behind the symptoms of Parkinson’s disease.
- Progressive degeneration of neuronal cells in the substantia nigra
- This causes a deficiency in dopamine availability (a neurotransmitter necessary for production of smooth controlled movements)
- Symptoms appear when ~70% of dopamine-producing cells cease to function normally
What three symptoms are used to diagnose Parkinson’s disease?
- Tremor, usually beginning in one hand and spreading to the leg before crossing to the other side, most noticeable at rest/when stressed/tired and disappearing during movement and sleep
- Rigidity/stiffness of muscles, where muscles seem unable to relax and are tight even at rest
- Bradykinesia, a slowness of movement
List some symptoms of Parkinson’s disease (not including those used for dx).
- Reduced fine motor coordination
- Freezing/periods of immobility
- Pain/discomfort in limbs
- Anxiety/depression
- Slowness of thinking
- Memory problems
- Tiredness/disturbed sleep
- Constipation
- Bladder problems/increased urgency and frequency of urination
- Sexual difficulties
- Speech and swallowing problems
Has a cause of Parkinson’s disease been identified?
Negative - no known cause and so Parkinson’s is termed ‘idiopathic’.
Is Parkinson’s disease genetic?
It is not considered genetic, though 10% of cases have familial incidence.
At what age does Parkinson’s disease present?
Usually betweed 50 and 75, though up to 20% of cases are diagnosed between 30 and 50.
What are the three main changes in the muskuloskeletal system in geriatric patients?
-
Muscle atrophy
- Muscle fibres decrease and are repplaced by fibrous tissue
- Decreased muscle strength and movement
- Muscle tone loss is activity related
- Tendons shrink and harden
-
Bone mass decreases
- Decreased Ca absorption through GIT
- Brittle bones; increased # risk
List five general principles of geriatric patient assessment.
- Multiple health complaints
- Chronic illness
- Signs and symptoms may be atypical
- Altered physiological response to illness/injury
- Pain levels may be altered
- Clinicians often underestimate severity
- Social and emotional factors have significant impact on health status
- Fears
- Losing autonomy
- Hospital
- Financial hardship
List some techniques for hx-taking with geriatric patients.
- Clearly identify yourself
- Speak at eye level
- Assist in location of hearing aids/reading glasses/dentures if needed
- Ensure adequate lighting
- Speak slowly, distinctly, and respectfully
- Use pt’s surname unless invited otherwise
- Listen carefully and patiently
- Preserve the pt’s dignity
- Be gentle in your assessment
List some techniques for physical examination of geriatric patients.
- Consider they may tire easily
- Respect modesty and privacy
- Explain procedures before examination
- Be aware of symptom denial/minimalisation due to fears
- Distinguish chronic illness from acute exacerbation/illness/injury
What are the three major causes of trauma in pt’s over 65?
- Falls
- RTC’s
- Burns
What are the four contributing factors to the higher risk of mortality in geriatric trauma patients?
- Osteoporosis
- Reduced cardiac reserve
- Decreased respiratory function
- Impaired renal function
For every 1-year increase in age over 65, the odds of dying after trauma increases by over ____%.
6%
What is the most common body site of injury due to trauma in geriatric patients?
Head and face, followed by the extremities.
Which cause of trauma is linked to the majority of deaths in pts over 65?
Falls
What kind of injury leading to less motility and greater dependence is common in post-fall geriatric patients?
Hip #
Overall fall mortality in geriatric patients is approximately ____%.
11%
True or false: any mechanism of chest injury can be fatal for geriatric patients.
Name four cardiac complications of blunt chest trauma in geriatric patients.
- Myocardial contusion leading to cardiac failure
- Cardiac rupture
- Valvular injury
- AAA
Why is a high index of suspicion warranted for abdominal injuries in geriatric patients?
May have serious consequences but are less obvious and can result in perforation or infection leading to sepsis.
Give four reasons the mortality rate for musculoskeletal trauma is increased in geriatric patients.
- Delayed complications
- Sepsis
- Renal failure
- PE
What is the significance of (normal) skin degradation in geriatric patients with burns?
Increases burn depth.
What must be carefully considered when assessing burns in a geriatric patient?
The patient’s fluid status.
Note: don’t memorise, just understand concepts.
List some considerations in geriatric patient trauma management.
- Recent ACS?
- HR and SV may be decreased
- Higher SBP may be present
- Rapid fluid therapy may cause fluid overload
- PaO2 decreases with age
- Organs are less tolerant to hypoxia
- Consider COPD when regarding ventilatory support
- Acid/base balance is compromised
- Be aware of posturing that can promote pressure areas
- Spinal immobilisation may be complicated by kyphosis
- Splinting/packaging should have extra padding
- Consider chance of hypothermia
List some forms of elder abuse.
- Physical abuse
- Sexual abuse
- Emotional abuse
- Psychological abuse
- Unreasonable confinement
- Wilful deprivation of services
- Abandonment
- Financial exploitation
- Neglect
Due to poor thermoregulation, elevation in temperature of ____ºC should be considered febrile in geriatric patients.
1.1ºC
Fevers higher than ____ºC can indicate severe infections in older adults.
38.3ºC
List six atypical signs of infection that a geriatric patient might present with.
- Cognitive impairment/altered mental status
- Anorexia
- Functional decline
- Falls
- Weight loss
- Increased respiratory rate
Diminished cough and airway patency cause geriatric patients to be more susceptible to whih infection?
Pneumonia
True or false: the signs and symptoms of influenza in older adults are similar to those in younger adults.
What additional symptom may affect older adults?
True; older adults may also develop persistent weakness for several weeks.
What is the most common infection type and source of bacteraemia in older adults?
UTI’s
Name two factors that predispose geriatric patients to UTI’s.
- Urethral or condom catheters
- Neurogenic bladders with increased residual urine
What contributes to UTI predisposition in male geriatric patients?
Prostate enlargement
What contributes to UTI predisposition in female geriatric patients?
- Increased vaginal pH
- Vaginal atrophy due to postmenopausal oestrogen depletion
- Incomplete emptying of the bladder
What two resistant infections are common in residential aged care facilities?
MRSA and VRE
What is polypharmacy?
Use of multiple medications and/or administration of more medications than are clinically indicated, amounting to unnecessary drug use.
What are some care issues created by polypharmacy?
- Adherence
- Inappropriate prescribing
- Adverse drug reactions/drug interactions
- Increased risk of falls
- Increased morbidity and mortality
List four techniques/considerations when identifying polypharmacy.
- Ask if the pt takes any tablets/pills/liquids for their health
- Remember OTC medications can contribute to polypharmacy issues
- Ask about home remedies
- Ask about alcohol intake
