Goebel- Geriatrics- Melissa Flashcards
Which demographics live the longest and the shortest?
- Hispanic women live longest!
- Black males live the shortest.
What is the life expectancy at birth for men and women? How does this change if you live to be 65?
Women= 81
Man = 76
If you make it to 65 you have a good chance to live another 19 years
What is homeostenosis?
As age increases, you use more of your physiologic reserves to maintain homeostasis.
So, It takes much less of insult to compromise your health/ independence/ need for assistance…
Describe some of the general changes that occur in physiologic aging regarding lean muscle mass and fat composition?
- decrease in skeletal mm mass and bone mass
- increase in fat throughout tissues; fat accumulates in organs, especially the liver
***These patients are not overweight, but have more fat on their bodies.
Why is it important to consider changes in lean muscle mass and fat composition when prescribing drugs? Which drug is the most important one to consider here?
- Half life will increase in fat soluble drugs
- VALIUM: patients may sleep for three days instead of one night!!!
Describe changes in body temperature regulation with aging?
How about immune system?
- Body temp regulation: ^ risk hyper and hypothermia
- Difficulty mounting fever response
- Thymic involution (T cells depleted…) / weakened response to VACCINES
Describe one difficulty that can cause incontinence in elderly patients? How does their total body water change? How does their thirst response change?
- Total body water is decreased and thirst response is decreased!
- Patients may also be resistant to drinking more water due to incontinence
- DRINKING WATER WILL ACTUALLY HELP INCONTINENCE!!!
Describe changes in patient blood pressure with aging
Patient’s blood pressure typically will increase, and patients will have more orthostatic HypoTN
How does vision change in the elderly?
How about hearing, taste, and sense of smell?
- Lose accommodation in mid 60’s
- Difficulty with night vision; need night light to get to bathroom, will also need reading glasses
- High frequency hearing
- Taste and sense of smell decline
Describe how normal aging changes the vasculature.
How about the heart valves; what is this change called?
How is heart conductivity changed; for what condition are elderly patients at risk?
- Vasculature: ^ thickness, DECREASE elastin–> vessels become like thick pipes
- Ca++ in heart valves will yield murmur (aortic sclerosis)
- fatty infiltrate into electrical syndrome (sick sinus syndrome)
How will stimulant drugs affect elderly hearts?
- ^ Epi and NE at baseline
- Giving these patients stimulants will not increase HR as much in younger patient
Describe the general cognitive impairments associated with normal aging
Difficulty with encoding, retrieval and storage of info, multitasking
How does normal aging affect mobility and peripheral nerves?
- Resumption in spinal cord motor neurons, less nerve terminals and NT release
- Peripheral neuropathy (age related)
What are the normal aging changes in the lung –what obviously will exacerbate these changes?
Decreased elasticity and FEV1; Curve exacerbated by smoking
How is the GI tract changed with normal aging; what condition is common in elderly patients?
Intermittent dysphasia is common and often due to Presby’s esophagus (spasms and looks like corkscrew on barium swallow)
How is the renal system impacted by normal aging and what are the clinical implications of these changes?
- Many patients have stage III CKD
- GFR = 30-60 T
- This is important for drug metabolism!
For which drug is it exceptionally important to really adjust in cases of CKD?
Gabapentin: can only take 2x per day if you have kidney disease (vs. typical 3x per day)
Three take home points/ changes regarding normal aging:
- Decrease reserve capacity for homeostenosis
- Decrease ability to respond to stress
- General INCREASE in vulnerability
How do elderly patients present with pain?
Sensation may be blunted and patients may minimize complaints
What are some things you should consider in an elderly patient with new onset headache?
Is this common?
**HA as a new complaint is uncommon
Consider:
- Temporal arteritis
- Trigeminal neuralgia
- VZ/ Shingles, subdural hematoma w hx of fall, metastatic disease w hx of cancer
What should you always examine in SOB complaint? What is common in elderly patients with new or worsened SOB?
- more arthritis in chest
- examine the skin: **shingles
Abdominal pain in the elderly is…
More likely to be serious; elderly more likely to get super sick from appendicitis and stuff
***All conditions causing fever in young patients may present how in elderly patients?
Wthout fever in the elderly; like pneumonia!!!
Never ignore which two complaints in elderly patients?
weakness and fatigue; may be ominous– pay special attention to new or worsened weakness of fatigue
True MSK weakness will present how?
How can HYPERthyroidism affect elderly patients?
How will insults (hospital stays, etc.) affect elderly patients?
- True MSK weakness then they will be asymmetrical
- HYPERthyroidism patients may be tired!!!
- Take longer to recover from hospital stays/ bedridden situations… spring back more slowly
How do we address anorexia and weight loss in the elderly? What should we examine/ look into?
- Check for anemia and DM, CHF, chronic lung disease (burn lots of cals just trying to breathe!)
- Check meds for ADRs
- Work up for depression, memory loss (forget to eat), and hyperthyroidism
Acute confusion, delirium, weakness and dizziness, not eating well, exhaustion, and failure to thrive, falls are all…
things to expect in elderly patients
Define Agism:
Withholding treatment or discriminating based on age: i.e. assuming they’re not sexually active
Things to aspire to when communicating with demented patients; what should you never do and what kind of questions should you ask?
Calmness, yes or no answers, listen well, repeat and rephrase—may not understand words, don’t ARGUE with them
How are elderly patients a bit more demanding on a doctor’s schedule?
Elderly patients may require longer office visits; you have to do things like write down directions, etc. (Goebel spends 30 min with each patient)
