Intro to geriatrics

Question 1

65+ y/o are 12.5% of the population, but they consume how much of the meds, and account for how much of the hospital bed days?

Answer 1

25% meds

44% hospital bed days

Question 2

What increased the life expectancy in the 1900s-1950s?

Answer 2

+20 years due to
Socioeconomic stuff
Public health measures

+10 years
medical stuff

Question 3

Biggest contributor to morbidity

Answer 3

obesity

Question 4

Why isnt Serum creatinine no longer adequate for considering renal fxn?

Answer 4

Need to also look at GFR

GFR decreases ~ 1cc / year (10ml per decade)

((140-age)x weight kg / 72 x Cr) x 0.85 for women

Question 5

What cardiac changes occur in the elderly?

Answer 5

↓ B-adrenergic receptor responsiveness
↓Max HR and CO

↑ LV+arterial stiffness
↑ Systolic pulse and pressure
↑ diastolic stiffness (↑ reliance on atrial kick)
↑ risk of postural HYPOtension

Question 6

What pulmonary changes occur in elderly?

Answer 6

↓ Elasticity (compliance)
↓ vital capacity
↓ closing pressure

↑ Residual capacity
↑Atelectasis

Question 7

Sarcopenia

Answer 7

loss of muscle tissue as a natural part of the aging process.

• replaced with fat infiltrates
• higher in women than men
• higher in hispanics than whites

Question 8

Obesity (central) is a key factor in (5)

Answer 8

1. insulin resistance/hyperinsulinemia
2. Glucose intolerance and T2Dm
3. HTN
4. Dyslipidemia
5. Abnormal fibrinolysis

Question 9

Second to smoking, #1 morbidity and m ortality in old

Answer 9

Sedentary lifestyle

physical inactivity

Question 10

1 symptom of old

Answer 10

dyspnea

- think about acute MI

Question 11

How quick does loss of muscle mass occur?

Answer 11

w/in 24 hours supine pos.

Question 12

Approaches to make pts more mobile

Answer 12

d/c bladder catheters, IV lines, encourage activity

Order PT early & confirm pt participation

ambulate in hallway

Question 13

HYVET trial

• what is it
• pro
• con

Answer 13

hypertention in elderly
ave age: 84

BP 170. Treated to 120. PTs did better.

• but: everyone was generally healthy
• everyone’s BP had to be high
• had to not be dizzy when stood up
• not terrible Cr 3 conditions

Question 14

If pts can do the Activities of daily living (ADLs) they can go home. List

Answer 14

1. Bathing
2. Dressing
3. Transferring (bed to chair)
4. Toileting
5. Grooming
6. Feeding

*first to go:bathing
last to go: feeding

Question 15

Get up and go test

Answer 15

Rise from chair w/o arms - walk 10 feet and return

Time> 10sec = increased fall risk

Time >20 sec = therapy referral

Question 16

Are you more likely to get depressed as you get older?

Answer 16

No
- just AS likely as when your 20

maybe more minor depression, but not major

Question 17

How many women >65 will have fracture before they die?

Answer 17

50% post menopausal will have Osteoporosis fracture.

• screen ALL WOMEN >65% (or 60 if they have risk factors)
• fix vit D, get Ca2+ up