GULICK: Medical Screening in Geriatric Pts Flashcards
MSK Changes
General….
- DECs In:
- mm mass & strength
- motor unit recruitment
- speed of mvmt (DEC type II (FT) mm fibers)
- jt flexibility
- bone mass & strength
- Cartilage degen.
Neural Changes
General
- DECs in:
- conduction= altered pain
- enyzmatic activity
- reflexes
- responsiveness
- INCs in:
- postural sway
- Change in sleep patterns
Cardiovascular Changes
General
- INCs In:
- Vascular resistance
- DECs In:
- CO (HR*SV)
- Lipid catabolism
- Vascular elasticity==> INC DBP
- Response to postural stress
Pulmonary Changes
General
- DECs In:
- Recoil w/in lung
- PO2 from 20-70yrs
- VO2 max
- Pulmonary blood flow==> DEC O2sats
- INCs In:
- RV (residual volume)
- Calcification of soft tissue in chest wall
Integumentary Changes
General
- DECs In:
- vascularity== altered thermoreg.
- SubQ tissue== INC risk for hypOthermia
- thickness w/ INC risk breakdown
- Uneven pigmentation
GI Changes
General
- DECs In:
- peristalsis
- enzymatic activity
- motility
Urogenital/Renal Changes
General
- DECs In:
- bladder capacity, bladder elasticity
- kidney mass
- GFR
- creatinine clearance*
- Prostate hyperplasia (BPH)
Special Senses Changes
General
- DECs In:
- visual acuity
- hearing
- smell&taste
- Thymus function* (HUGE role in immunity)
- Ca++ control
- sweating*
Immune Changes
General
- DECs In:
- function/resistance
- T-cells
- Temp regulation
Psychosocial Changes
General
- INCs In:
- depression
- fatigue
- Cognitive deficits
Medications
Rule of Thumb
DEC meds w/ INC age
Due to DEC liver & DEC kidney metabolism
- Polypharmacy→ adverse effects, interactions***
Keeping Track of Medications
*USE Medscape Interaction Checker
All suffixes you will need to KNOW @ some point!!!
SAVE THIS!!!!
- -caine= local anasthetic
- -cillin= antibx
- -dine= anti-ulcer agent
- -done= opioid analgesic
- -ide= oral hypoglycemic
- -iam= anti-anxiety agent
- -micin= diuretic
- -mycin= antibx
- -nium= NM blocking
- -olol= beta blocker
- -oxacin= antibx
- -pam= anti-anxiety
- -pril= ACE inhibitory
- -sone= steroid
- -statin= anti-lipemic (Cholesterol meds)
- -vir= anti-viral
- -zide= diuretic
Risk of Falls
The Vicious Cycle
- >2.5 mill falls end up in ER
- >13K
- 52% Am’s >65yo fall/yr
FALLS→ DEC function→Fear→Isolation→ Inactivity→Weakness→FALLS
Risk of Falls
Some great Outcome Measures
Berg, Tinetti, TUG, Gait Abnorm Rating Scale, Gait Velocity (5th Vital Sign?), 5xSTS, DGI, Activity-Specific Balance Confidence (ABC) Scale
TUG
*Get up, walk 3m, go around obj, walk back and sit down
see pics for #’s
TUG-Cog
*Dual-Tasking
- Stand, walk 3m, return & sit
-
Perform phys task while subtracting 3 for any given # from 66-100
- OR serial 7’s, days of week, etc…
- Cut-Off is 15s***
Gait Velocity
Gait Speed as a Predictor of Hospitalization
see pics
Slow walkers 4x MORE LIKELY have hospitalization w/in 12-mos
5xSTS
Description + Norm Values
see pics
“Balance” Borg Scale
Like RPE for BALANCE*
SEE PICS
Questionnaire to Calculate Falls Risk
jscalc.io/calc/Y53w0rSwoRCx0fuE
Warning Signs of Elder Abuse
see pics***
YOU MUST SAY SOMETHING!!!
TOP Reasons for ER Visits in Elderly…
- Injuries→ Falls/Accidents
- PNA
- Comps after Sx
- Chest pain
- SEs from meds
- Dehydration
- Stroke
- Back/Abdominal pain
Systems Review: MSK
Arthritis
Osteoporosis
- Arthritis→ see pics for loc’s
-
Osteoporosis
- ~12% women 50-70 have vertebral compression fx’s
- ~20% >70yo
- NOTE: Ginger + Cinnamon for OA*** ½ tsp, 2-3x/day
Systems Review: MSK Patho
Patellar-Pubic Percussion Test (Geriatrics) → Screening Test
Sn= 94 (-LR)=0.06 Sp= 95 (+LR)= 20.4
- Technique: Pt in SUPINE, scope on symphysis pubis & tuning fork on patella; listen for change in sound qual w/ both LEs
- (+)= Osseous problem, i.e. fx, cx
Tech. for Fx ID
Use of 128-Hz vibrating tuning fork & stethoscope to ID Fx’s
Dx accuracy= 81%
Systems Review: MSK
Influence of Fluoroquinolone (FQ): Gram (-) antibx for Resp, Uro, GI Infx’s
- HIGH affinity for connective tissue
- FQ toxic to type I collagen synthesis (esp. Achilles) & promotes collagen degen.
- Risk is dose dependent
- “Black Box Warning”== Severe SEs, but still on market bc value
- Mean onset== 6d
- Look for→ Heel pain, Calf pain, Heel lifts
Influence of Fluoroquinolone (FQ):
Risk of Tendon Damage INCs if:
- >60yo
- Concurrent corticosteroid use (46-fold INC)*
- Renal failure
- DM
- Hx of tendon rupture
Influence of FQ:
On tendons and esp. Achilles Tendon
- 89.9% Achilles Tendon
-
S/S:
- Pain 2-3cm prox. to calcaneal attach.
- Swelling/inflammation
- “Snap”, “Pop” w/ bruise
- (+) Thompson Sign
Influence of FQ:
Avoiding ruptures
S/S can occur up to 2wks BEFORE rupture
-
Avoid rupture:
- tendon protected from WB
- Heel lift used
- Crutches/Bracing
- May need to protect tendon up to 6mos
Systems Review: Neuromuscular
These 2 pathos have Bi-Modal Distribution:
Myasthenia Gravis, Guillian-Barre Syndrome (GBS)
Myasthenia Gravis
S/S you DEFINITELY NEED TO REMEMBER
MOST COMMON***
Diplopia & Ptosis== MOST COMMON SX’S
Myasthenia Gravis
S/S
- MOST COMMON→ Diplopia & Ptosis (droopy eyelid)
- PROX mm weakness, CN weakness, Prob controlling eye mvmt & facial expresses
- Diff swallow/chewing
- Dysarthria (slurred speech)
- Change voice qual.
- NO sensory/DTRs changes***
Guillian-Barre Syndrome (GBS)
S/S
- *Weakness→ symmetrical LE > UE > Resp.
- Parasthesias start in toes & progress PROX. (NO loss sensation)
- Asymmetrical facia weak, dysphasia, dysarthrias
- CNs can be affected
- UNSTABLE VITAL SIGNS***
- DEC reflexes & hypOtonia
- Fever, nausea, fatigue
- PAIN= LB & buttocks
Systems Review: Neuromuscular
Normal Pressure Hydrocephalus
3 Things occur w/ this Patho
- System of draining/absorbing CSF is disrupted
- Can occur after a head injury, TIA, meningitis, infx, or tumor, or unknown
- Pressure slowly INCs→ NPH is misleading**
NPH
Dx how?
CT/MRI
NPH: Sx’s
3 Parts of Brain MOST often affected
Legs, Bladder, Cognition
NPH: Sx’s
3 Parts of Brain MOST often affected
Legs vs Bladder vs Cognition
-
Legs→ Gait disturbs, Wide BOS, Slow/Shuffling steps
- *retain arm swing unlike PD
- Bladder→ Urinary freq (every 1-2hrs)=> incont.
-
Cognition→ Dementia, forgetful, STM loss
- *may fluctuate bc pressure changes- unlike Alzheimer’s
NPH: Clinical Traid (SLOW Progression)
3 W’s
Wobbly, Wozzy, Wet
-
Wobbly on foot
- “feet glued to floor”
- NO loss of arm swing like PD
-
Wozzy in head
- Beware misDx w/ hearing loss
-
Wet on bottom
- Beware of meds
GREAT Tx for NPH:
In video viewed in class, DRASTIC IMPROVEMENTS IN Gait
Shunt
NPH Scale
For reference
3 Cats: Gait, Cognitive, Sphincter
Parkinson’s Disease
Cardinal Motor Symptoms (remember PWPD are TRAPPED)
Most common onset= 60-70yo
-
Cardinal Motor Sx’s
- Tremor @ rest
- Rigidity
- Bradykinesia
- Gait & Balance probs
PD
Tremor DOES NOT have to be present to make Dx****
******
It is most common initial sx in PD though
PD
Craniofacial, Sensory, Autonomic, Neuropsychiatric Features
- Craniofacial→ Masked face, Sialorrhea (drool), Anosmia (lose smell), soft speech*, Dysarthria, Dysphagia
- Sensory→ Parasthesia
- Autonomic→ Urinary urgency, Constipation, Sexual dysf
- Neuropsychiatric→ Depression/Anxiety, Apathy, Dementia*, Psychosis*
PD
FYI
Talking about making Dx
- PD is a clinical dx (acting out dreams)
- Levodopa Test→ NOT 100% accurate, NOT used to definitively dx PD
- MRI/CT findings unremarkable
- NO lab biomarkers exist for PD
PD an Flavonoid-rich foods***
- May help improve life-expect.
- Greater consumption berries and red wine (rich in flavonoids)→ assocd w/ LOWER mortality
see pics for foods*
A note on Cognition…
Even w/ inc’ing obesity, DM rates, aging pop, incidence of dementia has declined by 20% every decade over 30yrs
Limtd to those w/ @ least high school edu.
Healthy Brain vs. Alzheimer’s Pts
Tau PROs
When Tau no longer stabilizes axons, neuron shrivels and dies, leaving behind its tangled carcass
Precivity Alzheimer’s Disease (AD)
- Rx blood test
- Measures PROs linked to toxic amyloid plaque buildup in brain→ TAU PROs
- 94% as accurate as PET scans
- Adults 60yo w/ memory loss