Goebel - Intro to Geriatrics Flashcards
Which is true about life expectancy?
- Men live longer than women
- Black men live the longest
- Hispanic women live the longest
- White women live the longest
Hispanic women live the longest
Name 2 Medical Issues of Aging
- Homeostenosis
- Normal physiologic changes of aging
Name term.
- medical issues of aging
- decreased reserve with aging
- as we age, we engage more and more of our physiological reserves just to maintain homeostasis, therefore there are less reserves left to address challenges
Homeostenosis
Medical Issues of Aging: Normal Physiologic Aging
-Body Composition Changes with Aging
Loss of Lean Body Mass
_________ in skeletal muscle mass
_________ in bone mass
_________ in total body adipose tittuse - more fat, not necessarily more weight. Accumulates in muscles and organs.
Decrease
Decrease
Increase
What happens to the half-life of lipophilic drugs with the aging population?
Increases dramatically = serious cmoplications can arise from normal drug doses
Fact: Normal Physiologic Changes
- *•Temperature**
- > Risk increased for hyper- and hypothermia
- > Notable difficulty in mounting a fever response to infection
(i. e. may have a raging pneumonia with no fever) - *•Body fluid regulation**
- >Total body water decreased
- >Thirst sensation diminished
- *•Blood pressure regulation**
- > Higher BPs or orthostatic hypotension
Changes that occur in the Senses
- Dark adaptation ___________
- Near vision ___________ (presbyopia)
- High frequency hearing ___________ (presbycusis)
- Sense of smell ___________ after age 50
- Decreases
- Declines
- declines
- declines
Cardiovascular changes in aging population.
______ wall thickness vessels + __________ elastin = Inc. “stiff pipes”
Both systolic & diastolic BP _________, but normally remain below the clinical threshold for HTN.
Adipose infiltration near SA node with marked ________ in pacemaker cells.
Variable amount of _________ deposition in cardiac skeleton (i.e. aortic sclerosis)
Increased thickness + decreased elastin
increase
decrease of pacemaker cells = more Afib
Calcium –> Murmurs
Cardiovascular Changes in aging population.
B-Adrenergic stimulation: basal and stress-induced levels of epinephrine and NE are _________ (higher/lower) in elderly
Tissue response to B-adrenergic modulation is ___________ (increased/diminished)
higher
diminished
What is the KEY WORD to remember with neurological changes in the elderly?
SLOWER!!
- Encoding (converting new information to be stored) – May be slower, but with sufficient time, probably not diminished overall
- Storage and retrieval – recall may be slowed
- Decreased ability to multi task
- Reduction in number and size of spinal cord motor neurons
- Decrease in nerve terminal numbers and neurotransmitter release
- Neuropathy –decreased sensation in the feet, lack of ankle reflexes
Why are the elderly more likely to fall?
Neurological changes involve Neuropathy (decreased sensation in the feet), along with a decrease in vision sense.
“Multi-sensory Deficit Syndrome”
Respiratory Changes in Aging.
- *Increase or Decrease in:**
- > Elasticity
- > FEV1
- > O2 Sat
Decrease
What are 2 Gastrointestinal Changes you see in the elderly?
- Esophagus?
- Liver?
- Presbyesophagus may occur - hard to swallow
- Hepatic metabolic function my decline affects drug metabolism
With declining renal function in the elderly (not all), drug metabolism becomes a very important concern.
What should be checked prior to prescribing a renally excreted drug?
GFR
Immune System changes in the elderly.
_______ involution occurs so less naive lymphocytes to respond to new threats.
_______ T-cell proliferative response to mitogens
_______ in some cytokines
CLINICALLY: DECREASED ANTIBODY RESPONSE TO VACCINES!!!
Thymic
Decreased
Decrease
Fact: Skeletal Changes with Aging.
- Loss of Cortical Thickness
- Increase in cortical porosity
- Thinning of trabeculae, with loss of trabecular connections
Why do people get shorter with age?
Also, changes in posture usually d/t arthritis but can be d/t osteoporosis - not normal aging but diseases
Wear of the discs between the bones - normal aging
Reproductive System changes.
Women: Decreased _________ (hormone) leads to dryness.
Men: ____________ (condition) leads to symptoms of urinary frequency, hesitancy, dribbling
*Beware of drugs like alpha agonists or decongestants –> can make this worse!
estrogen
BPH
With aging, body composition changes so that there is More adipose tissue and less lean body mass. The most clinically important aspect of this change is:
- People get shorter because bone tissue is lost.
- Hydrophilic drugs have longer half-lives
- Lipophilic drugs have longer half-lives
- The fat mass increases so old people are more obese.
- Lipophilic drugs have longer half-lives (i.e. Valium - BAD!)
Expected physiologic changes of aging in the eyes, rather than pathologic diseases, cause which of the following clinical scenarios?
- A ninety year old woman develops cataracts.
- A sixty-five year old woman needs to stop working because of macular degeneration.
- A sixty-three year old man notices that he must place a nightlight in his bedroom.
- An eighty year old man has to stop driving because his distant visual acuity has declined severely.
- An eighty-two year old patient has recurrent “red eye” due to glaucoma
- A sixty-three year old man notices that he must place a nightlight in his bedroom. –> NIGHT VISION diminishes
Fact: Blunting of pain sensation may occur with aging and many elderly persons will minimize their complaints.
When an elderly person complains of pain, it must be considered more urgent!
What 5 Conditions should you consider when an older person complains of a NEW COMPLAINT of HEADACHE?
- Temporal Arteritis –> Blindness
- Trigeminal Neuralgia –> Facial pain
- Herpes Zoster –> Hutchinson’s Sign on the nose
- Subdural Hematoma –> waxing/waning mental status problems with a history of a fall a week ago
- Metastatic Disease –> to the brain
Fact: Chest Pain
Elderly may not experience typically MI pain, may present with nausea or shortness of breathe.
Pain-causing musculoskeletal disorders more common (arthritis).
Zoster (shingles) may cause significant pain before the rash appears.
Abdominal Pain is __________ (more likely/less likely) to be d/t life-threatening disease in elderly patients.
MORE LIKELY!
Fact: All conditions causing fever in younger persons may present without fever in elderly.
Example: Pneumonia may present without fever or cough, just a change in _________ or _________ .
mental status or delirium
In the elderly, weakness/fatigue may represent what type of thyroidism?
Apathetic hyperthroidism - listless, weight loss
Symptom: Anorexia/Weight Loss
What kind of conditions should you consider for the elderly?
Malignancy and Inflammatory Disorder - TOP OF LIST
Congestive HF or Chronic Lung Disease
Drug Side Effects
Depression
Memory Loss
Hyperthyroidism
An 82 year old woman comes to the office for a post discharge visit after she was in the hospital for a week for a DVT, complicated by a hospital-acquired UTI. She’s been home for 10 days, and is complaining bitterly that she is still generally weak, and can’t do her housework. What do you advise her?
- She needs a stress test because the elderly have atypical presentation for heart disease.
- She should be readmitted to evaluate why she is still weak and CT Abd and pelvis performed looking for occult cancer.
- She should be seen by a neurologist to see if she has a muscle disease or had a stroke.
- She was in bed for nearly a week; she shouldn’t be surprised if it takes her 3 weeks or more to recover her strength.
- She was in bed for nearly a week; she shouldn’t be surprised if it takes her 3 weeks or more to recover her strength.
You see two patients today in your clinic who have Grade II/VI systolic murmurs heard over the aortic area. One is a 55 year old man who is complaining of mild to moderate chest pain, dizziness, and dyspnea only when he is jogging, and the other is a slightly frail but asymptomatic 75 year old. You should do the following:
- Do the same routine evaluation for both, including non-urgent echocardiogram
- Do the same urgent evaluation for both, including referral the same day to cardiology
- Order a routine echo for the 75 year old who seems frail, and nothing for the 55 year old
- Order an urgent echocardiogram and urgent cardiology referral for the 55 year old, and a routine echo only for the 75 year old
- Order an urgent echocardiogram and urgent cardiology referral for the 55 year old, and a routine echo only for the 75 year old
Name term.
discrimination based on age, especially prejudice against the elderly
Examples:
- Seeing aging as a disease state –> IT’S NOT!
- Withholding medical resources at a certain age (“why bother?”)
- Failure to pursue uncomfortable subjects – like sexual history
Ageism
Tips: Strategies for “Getting connected” with demented patient
- Get their attention
- Learn to be a good listener
- Speak in a calm tone of voice
- Use “yes” and “no” questions
- Repeat, rephrase
- Don’t argue
What is the best way to address your elderly female patient named Gladys Smith?
- How are you today Gladys?
- How’s it goin?
- How are you little lady?
- How are you today Mrs. Smith?
- How are you sugar?
4.How are you today Mrs. Smith?
