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CSB339 > Gerontology > Flashcards

Gerontology Flashcards

1
Q

WHO defines a geriatric as a person over what age?

A

50

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2
Q

An ‘older person’ is defined as greater than ____ years of age.

A

65

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3
Q

Does the myocardium gain or lose contractility with age?

A

Lose

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4
Q

Reduced myocardial contractility lowers cardiac output which is compensated for by an increase in HR. This process eventually leads to what condition?

A

Left ventricular hypertrophy

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5
Q

Reduced elasticity of blood vessels causes increased/decreased peripheral resistance, leading to increased/decreased systolic BP.

A

Increased; increased.

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6
Q

Reduced cardiac output and increased peripheral resistance put geriatric patients at an increased risk of ____.

A

Hypoxia.

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7
Q

List some cardiovascular conditions common to geriatric patients.

A
  • ACS
  • CHF
  • Dysrhythmias
    • AF
    • PVC’s
    • Electrolyte imbalance
  • AA’s
    • Thoracic aneurysm
    • Abdominal aneurysm
  • Hypertension
    • Primary vs secondary
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8
Q

List some physical changes to the respiratory system common to geriatric patients.

A
  • 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
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9
Q

Hypertrophy of mucous-producing cells and loss of cilia action in the respiratory system put geriatric patients at increased risk of ____.

A

Infection

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10
Q

What are the symptoms of bacterial pneumonia in geriatric patients?

A
  • Altered mental status
  • Cough
  • Fever
  • SOB
  • Tachycardia
  • Tachypnoea
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11
Q

What are the symptoms of COPD/COAD?

A
  • Limited airflow
  • Increased work of breathing
  • Dyspnoea
  • Ventilation-perfusion mismatch
  • Hypoxaemia
  • Respiratory acidosis
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12
Q

What are the symptoms of pulmonary emboli?

A
  • Sudden tachypnoea
  • AF
  • Signs of DVT
  • LVF
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13
Q

Does GIT motility increase or decrease with age?

A

Decrease

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14
Q

Does GIT absorption increase or decrease with age?

A

Decrease

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15
Q

Name three GIT conditions common to geriatric patients.

A
  • GIT haemorrhage
  • Bowel obstruction
  • Incontinence
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16
Q

What is haematemesis, and what does it indicate?

A

Vomiting of blood; indicative of bleeding proximal to the ligament of Treitz (suspensory muscle of the duodenum).

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17
Q

What is melena, and what does it indicate?

A

Black, odorous stools due to degradation of blood to hematin; indicative of bleeding from the UGI tract, distal small bowel, or right colon.

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18
Q

What is hematochezia, and what does it indicate?

A

Passing of bright red blood with or without stool; indicative of bleeding in the lower GIT or (less commonly) UGI.

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19
Q

What is occult bleeding?

A

Bleeding not apparent to the patient.

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20
Q

List five causes of upper GIT haemorrhage.

A
  • 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
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21
Q

List four causes of lower GIT haemorrhage.

A
  • 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
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22
Q

True or false: large-bowel obstruction is a medical emergency.

A
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23
Q

What are the two possible causes of large-bowel obstruction?

A
  • Neoplasms
  • Anatomic abnormalities
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24
Q

True or false: urinary incontinence is a normal consequence of ageing.

A

Age-related changes predispose patients to UI, but it is not caused by age independently.

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25
Q

True or false: nephrons in the kidney decrease in size and number with age.

A
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26
Q

Kidney size is reduced by ____% in geriatric patients.

A

20%

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27
Q

Hypotension in geriatric patients is more likely to cause damage to which organ system?

A

Renal

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28
Q

Decreased renal function puts geriatric patients at higher risk of what two complications?

A

Metabolic acidosis and fluid imbalance

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29
Q

Decreased thyroid activity in geriatric patients leads to reduced rate of ____.

A

Metabolism

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30
Q

True or false: Adrenal gland activity is increased in geriatric patients.

A
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31
Q

Geriatric patients have increased/decreased insulin secretion and increased/decreased insulin resistance.

A

Decreased; increased.

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32
Q

Impaired glucose metabolism puts geriatric patients at greater risk of _____.

A

Hyperglycaemia.

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33
Q

List five subtypes of decreased sensory functions in geriatric patients.

A
  • Visual loss
  • Reduced peripheral vision
  • Hearing loss
  • Reduced sense of smell
  • Reduced skin sensation (heat/cold/pressure/pain)
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34
Q

Between ages 25 and 95 the size of the brain decreases by ____%.

A

20%

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35
Q

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.

A

Greater

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36
Q

Name four nervous system illnesses common to geriatric patients.

A
  • Cerebral vascular disease (CVA, TIA)
  • Delirium
  • Dementia (Alzheimer’s disease)
  • Parkinson’s disease
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37
Q

Define a stroke in simple terms.

A

A disturbance in cerebral blood supply due to a clot or haemorrhage.

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38
Q

Define a transient ischaemic attack in simple terms.

A

A temporary fall in blood supply to the brain that results in a lack of oxygen.

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39
Q

Define a subarachnoid haemorrhage in simple terms.

A

A less common cause of stroke where blood leaks out of the brain’s blood vessels into the subarachnoid space.

40
Q

Define vascular dementia in simple terms.

A

Decreased cerebral circulation results in areas of the brain not receiving adequate blood and oxygen.

41
Q

Delirium is a disorder of ____ ____.

A

Cognitive function.

42
Q

True or false: delirium is an acute disturbance of attention and cognition.

A
43
Q

Delirium effects up to ____% of older people admitted to hospital.

A

56%

44
Q

True or false: delirium may be the only symptom of illness.

A
45
Q

Why does delirium pose a problem for clinicians?

A
  • No single, clear presentation
  • Controversy over identifying risk factors
  • Commonly leads to hospitalisation
  • Increases morbidity and mortality
  • Predictive of physical, functional, and cognitive decline
46
Q

What is dementia?

A

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.

47
Q

Dementia can happen to anybody, but is more common after what age?

A

65

48
Q

List eight common types of dementia.

A
  • 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
49
Q

List five early signs of dementia.

A
  • Progressive and frequent memory loss
  • Confusion
  • Personality change
  • Apathy and withdrawal
  • Loss of ability to perform everyday tasks
50
Q

What is Alzheimer’s disease?

A

A physical disease which attacks the brain resulting in impaired memory, thinking, and behaviour.

51
Q

Describe the events leading to brain cell death that prevents information recall in Alzheimer’s disease.

A
  • 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
52
Q

Which is typically the first affected in Alzheimer’s disease, short term or long term memory?

A

Short term memory

53
Q

Name the two types of Alzheimer’s disease.

A

Sporadic Alzheimer’s disease and Familial Alzheimer’s disease.

54
Q

Which type of Alzheimer’s disease is more common?

A

Sporadic Alzheimer’s disease.

55
Q

Sporadic Alzheimer’s can affect adults at any age but usually occurs after what age?

A

65

56
Q

A child has ____% chance of inheriting the mutated gene for Familial Alzheimer’s if one parent has it.

A

50%

57
Q

What will occur if a person has the gene mutation for Familial Alzheimer’s disease?

A

They will eventually develop Alzheimer’s disease, usually in their 40’s or 50’s.

58
Q

What is Parkinson’s disease?

A

A progressively degenerative neurological disorder which affects the control of body movements.

59
Q

Describe the pathophysiology behind the symptoms of Parkinson’s disease.

A
  • 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
60
Q

What three symptoms are used to diagnose Parkinson’s disease?

A
  • 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
61
Q

List some symptoms of Parkinson’s disease (not including those used for dx).

A
  • 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
62
Q

Has a cause of Parkinson’s disease been identified?

A

Negative - no known cause and so Parkinson’s is termed ‘idiopathic’.

63
Q

Is Parkinson’s disease genetic?

A

It is not considered genetic, though 10% of cases have familial incidence.

64
Q

At what age does Parkinson’s disease present?

A

Usually betweed 50 and 75, though up to 20% of cases are diagnosed between 30 and 50.

65
Q

What are the three main changes in the muskuloskeletal system in geriatric patients?

A
  • 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
66
Q

List five general principles of geriatric patient assessment.

A
  • 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
67
Q

List some techniques for hx-taking with geriatric patients.

A
  • 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
68
Q

List some techniques for physical examination of geriatric patients.

A
  • 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
69
Q

What are the three major causes of trauma in pt’s over 65?

A
  • Falls
  • RTC’s
  • Burns
70
Q

What are the four contributing factors to the higher risk of mortality in geriatric trauma patients?

A
  • Osteoporosis
  • Reduced cardiac reserve
  • Decreased respiratory function
  • Impaired renal function
71
Q

For every 1-year increase in age over 65, the odds of dying after trauma increases by over ____%.

A

6%

72
Q

What is the most common body site of injury due to trauma in geriatric patients?

A

Head and face, followed by the extremities.

73
Q

Which cause of trauma is linked to the majority of deaths in pts over 65?

A

Falls

74
Q

What kind of injury leading to less motility and greater dependence is common in post-fall geriatric patients?

A

Hip #

75
Q

Overall fall mortality in geriatric patients is approximately ____%.

A

11%

76
Q

True or false: any mechanism of chest injury can be fatal for geriatric patients.

A
77
Q

Name four cardiac complications of blunt chest trauma in geriatric patients.

A
  • Myocardial contusion leading to cardiac failure
  • Cardiac rupture
  • Valvular injury
  • AAA
78
Q

Why is a high index of suspicion warranted for abdominal injuries in geriatric patients?

A

May have serious consequences but are less obvious and can result in perforation or infection leading to sepsis.

79
Q

Give four reasons the mortality rate for musculoskeletal trauma is increased in geriatric patients.

A
  • Delayed complications
  • Sepsis
  • Renal failure
  • PE
80
Q

What is the significance of (normal) skin degradation in geriatric patients with burns?

A

Increases burn depth.

81
Q

What must be carefully considered when assessing burns in a geriatric patient?

A

The patient’s fluid status.

82
Q

Note: don’t memorise, just understand concepts.

List some considerations in geriatric patient trauma management.

A
  • 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
83
Q

List some forms of elder abuse.

A
  • Physical abuse
  • Sexual abuse
  • Emotional abuse
  • Psychological abuse
  • Unreasonable confinement
  • Wilful deprivation of services
  • Abandonment
  • Financial exploitation
  • Neglect
84
Q

Due to poor thermoregulation, elevation in temperature of ____ºC should be considered febrile in geriatric patients.

A

1.1ºC

85
Q

Fevers higher than ____ºC can indicate severe infections in older adults.

A

38.3ºC

86
Q

List six atypical signs of infection that a geriatric patient might present with.

A
  • Cognitive impairment/altered mental status
  • Anorexia
  • Functional decline
  • Falls
  • Weight loss
  • Increased respiratory rate
87
Q

Diminished cough and airway patency cause geriatric patients to be more susceptible to whih infection?

A

Pneumonia

88
Q

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?

A

True; older adults may also develop persistent weakness for several weeks.

89
Q

What is the most common infection type and source of bacteraemia in older adults?

A

UTI’s

90
Q

Name two factors that predispose geriatric patients to UTI’s.

A
  • Urethral or condom catheters
  • Neurogenic bladders with increased residual urine
91
Q

What contributes to UTI predisposition in male geriatric patients?

A

Prostate enlargement

92
Q

What contributes to UTI predisposition in female geriatric patients?

A
  • Increased vaginal pH
  • Vaginal atrophy due to postmenopausal oestrogen depletion
  • Incomplete emptying of the bladder
93
Q

What two resistant infections are common in residential aged care facilities?

A

MRSA and VRE

94
Q

What is polypharmacy?

A

Use of multiple medications and/or administration of more medications than are clinically indicated, amounting to unnecessary drug use.

95
Q

What are some care issues created by polypharmacy?

A
  • Adherence
  • Inappropriate prescribing
  • Adverse drug reactions/drug interactions
  • Increased risk of falls
  • Increased morbidity and mortality
96
Q

List four techniques/considerations when identifying polypharmacy.

A
  • 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

CSB339 (7 decks)

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