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Geriatrics > Intro to Geriatrics Pt 1 > Flashcards

Intro to Geriatrics Pt 1 Flashcards

1
Q

Define aging

A

Aging is the time sequential deterioration that occurs in most living beings, including:
• Weakness,
• Increased susceptibility to disease and adverse environmental conditions,
• Loss of mobility and agility, and
• Age-related physiological changes

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2
Q

What age is generally accepted as the definition of old age?

A

65

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3
Q

Define senescence

A

The organic process of aging

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4
Q

Define gerontology

A

The medical science of the aging process

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5
Q

Define geriatrics

A

The study of diseases that afflict the elderly

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6
Q

Common age-related changes

- cardiovascular

A
  • Atrophy of muscle fibers that line the endocardium
  • Atherosclerosis of vessels
  • Increased systolic blood pressure
  • Decreased compliance of the left ventricle
  • Decreased number of pacemaker cells
  • Decreased sensitivity of baroreceptors**
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7
Q

Implications of cardiovascular age-related changes

A
  • Increased blood pressure
  • Increased emphasis on atrial contraction with an S4 heard
  • Increased arrhythmias
  • Increased risk of hypotension with position change
  • Valsalva maneuver may cause a drop in blood pressure
  • Decreased exercise tolerance
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8
Q

Common age-related changes

- Neurological

A
  • Decreased number of neurons and increase in size and number of neuroglial cells **
  • Decline in nerves and nerve fibers
  • Atrophy of the brain and increase in cranial dead space
  • Thickened leptomeninges in spinal cord
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9
Q

Implications of neurological age-related changes

A
  • Increased risk for neurological problems: cerebrovascular accident
  • Parkinsonism
  • Slower conduction of fibers across the synapses
  • Modest decline in short-term memory
  • Alterations in gait pattern: wide based, shorter stepped, and flexed forward**
  • Increased risk of hemorrhage before symptoms are apparent
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10
Q

Common age-related changes

- respiratory

A
  • Decreased lung tissue elasticity
  • Thoracic wall calcification
  • Cilia atrophy
  • Decreased respiratory muscle strength
  • Decreased partial pressure of arterial oxygen (Pao2)
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11
Q

Implications of respiratory age-related changes

A
  • Decreased efficiency of ventilatory exchange
  • Increased susceptibility to infection and atelectasis
  • Increased risk of aspiration
  • Decreased ventilatory response to hypoxia and hypercapnia
  • Increased sensitivity to narcotics
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12
Q

Common age-related changes

- Integumentary

A
  • Loss of dermal and epidermal thickness
  • Flattening of papillae
  • Atrophy of sweat glands **
  • Decreased vascularity
  • Collagen cross-linking
  • Elastin regression
  • Loss of subcutaneous fat
  • Decreased melanocytes
  • Decline in fibroblast proliferation
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13
Q

Implications of integumentary age-related changes

A
  • Thinning of skin and increased susceptibility to tearing
  • Dryness and pruritus**
  • Decreased sweating and ability to regulate body heat**
  • Increased wrinkling and laxity of the skin
  • Loss of fatty pads protecting bone and resulting in pain
  • Increased need for protection from the sun
  • Increased time for healing of wounds
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14
Q

Common age-related changes

- GI

A
  • Decreased liver size
  • Less efficient cholesterol stabilization and absorption
  • Fibrosis and atrophy of salivary glands
  • Decreased muscle tone in bowel
  • Atrophy of and decrease in number of taste buds
  • Slowing in esophageal emptying
  • Decreased hydrochloric acid secretion **
  • Decreased gastric acid secretion**
  • Atrophy of the mucosal lining
  • Decreased absorption of calcium
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15
Q

Implications of GI age-related changes

A
  • Change in intake caused by decreased appetite
  • Discomfort after eating related to slowed passage of food
  • Decreased absorption of calcium and iron
  • Alteration of drug effectiveness**
  • Increased risk of constipation, esophageal spasm, and diverticular disease**
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16
Q

Common age-related changes

- Urinary

A
  • Reduced renal mass
  • Loss of glomeruli
  • Decline in number of functioning nephrons
  • Changes in small vessel walls
  • Decreased bladder muscle tone
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17
Q

Implications of urinary age-related changes

A
  • Decreased GFR
  • Decreased sodium-conserving ability
  • Decreased creatinine clearance
  • Increased BUN
  • Decreased renal blood flow
  • Altered drug clearance
  • Decreased ability to dilute urine
  • Decreased bladder capacity and increased residual urine
  • Increased urgency
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18
Q

Common age-related changes

- Reproductive

A
  • Atrophy and fibrosis of cervical and uterine walls
  • Decreased vaginal elasticity and lubrication
  • Decreased hormones and reduced oocytes
  • Decreased seminiferous tubules
  • Proliferation of stromal and glandular tissue
  • Involution of mammary gland tissue
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19
Q

Implications of reproductive age-related changes

A
  • Vaginal dryness and burning and pain with intercourse
  • Decreased seminal fluid volume and force of ejaculation
  • Reduced elevation of the testes
  • Prostatic hypertrophy
  • Connective breast tissue is replaced by adipose tissue, making breast examinations easier
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20
Q

Common age-related changes

- MSK

A
  • Decreased muscle mass**
  • Decreased myosin adenosine triphosphatase activity
  • Deterioration and drying of joint cartilage
  • Decreased bone mass and osteoblastic activity**
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21
Q

Implications of MSK age-related changes

A
  • Decreased muscle strength**
  • Decreased bone density**
  • Loss of height
  • Joint pain and stiffness
  • Increased risk of fracture**
  • Alterations in gait and posture
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22
Q

Common age-related changes

- Vision (sensory)

A
  • Decreased rod and cone function
  • Pigment accumulation
  • Decreased speed of eye movements
  • Increased intraocular pressure
  • Ciliary muscle atrophy
  • Increased lens size and yellowing of the lens
  • Decreased tear secretion
23
Q

Implications of vision (sensory) age-related changes

A
  • Decreased visual acuity, visual fields, and light/dark adaptation
  • Increased sensitivity to glare
  • Increased incidence of glaucoma
  • Distorted depth perception with increased falls
  • Less able to differentiate blues, greens, and violets
  • Increased eye dryness and irritation
24
Q

Common age-related changes

- Hearing (sensory)

A
  • Loss of auditory neurons
  • Loss of hearing from high to low frequency
  • Increased cerumen
  • Angiosclerosis of ear
25
Q

Implications of hearing (sensory) age-related changes

A
  • Decreased hearing acuity and isolation (specifically, decreased ability to hear consonants)
  • Difficulty hearing, especially when there is background noise, or when speech is rapid
  • Cerumen impaction may cause hearing loss
26
Q

Common age-related changes

- Smell/taste/touch (sensory)

A
  • Decreased number of olfactory nerve fibers
  • Altered ability to taste sweet and salty foods; bitter and sour tastes remain
  • Decreased sensation
27
Q

Implications of Smell/taste/touch (sensory) age-related changes

A
  • Inability to smell noxious odors
  • Decreased food intake
  • Safety risk with regard to recognizing dangers in the environment: hot water, fire alarms, or small objects that result in tripping
28
Q

Common age-related changes

- Endocrine

A
  • Decreased testosterone, GH, insulin, adrenal androgens, aldosterone, and thyroid hormone
  • Decreased thermoregulation**
  • Decreased febrile response
  • Increased nodularity and fibrosis of thyroid
  • Decreased basal metabolic rate
29
Q

Implications of endocrine age-related changes

A
  • Decreased ability to tolerate stressors such as surgery
  • Decreased sweating and shivering and temperature regulation **
  • Lower baseline temperature; infection may not cause an elevation in temperature**
  • Decreased insulin response, glucose tolerance
  • Decreased sensitivity of renal tubules to antidiuretic hormone
  • Weight gain
  • Increased incidence of thyroid disease
30
Q

What % of variance in human life span is attributed to genetics vs. environmental factors?

A
  • <35% genetics

- >65% environmental factors

31
Q

List the three theories of aging

A
  1. Accumulation of damage to informational molecules
  2. Regulation of specific genes
  3. Depletion of stem cells
32
Q

Describe the accumulation of damage to informational molecules theory

A

Suggest that aging is a result of “wearing out” caused by incremental damage over time to fundamental life processes

This damage results from:
• Spontaneous mutagenesis
• Failure in DNA repair systems
• Errors in DNA, RNA, and protein synthesis through translation errors
• Superoxide radicals – the major by-products of oxidative metabolism that can react with DNA, RNA, proteins, and lipids to cause cellular damage and aging

This theory is why some recommend using vitamins C and E as dietary supplements; it is believed that they can protect cells from oxidative damage

33
Q

Describe the regulation of specific genes theory

A
  • Aka “replicative senescence”
  • Some have proposed that downregulation of genes involved in control of mitosis may cause aging
  • Suggests that cells capable of regeneration (e.g., epidermal, gastrointestinal, and hematopoietic) may gradually “slow down” and result in permanent functional deficits
34
Q

Describe the depletion of stem cells theory

A

The mechanisms summarized in the other two theories may result in a depletion of stem cells affecting a number of vital processes in the body, resulting in aging

35
Q

State the 5 principles guiding the care of older adults

A
  1. Decreased physiologic reserve.
  2. Functional and cognitive status importance (more accurate predictors of health, morbidity, mortality, health care utilization than individual diseases)
  3. Goals of care and prognosis in clinical decision making.
  4. Social context of care.
  5. Multiple conditions, multiple medications, multiple settings of care.
36
Q

Define cognitive status as the term applies to geriatric patients

A
  • Ability to execute needed functions (executive function), ex. file taxes or figure out health insurance
  • Mental status (including memory)
  • Clinical decision-making ability
37
Q

Potential problems or consequences for geriatric pts who have decreased cognitive abilities

A
  • Put a person at risk for medication errors
  • Can create stress on caregivers
  • Increase the risk for elder abuse (e.g., financial or traumatic)
  • Make it difficult to obtain an accurate history and determine a diagnosis
38
Q

Define functional status as the term applies to geriatric patients

A
  • Includes the physical requirements needed to maintain independence in one’s own environment
  • Is assessed by considering activities of daily living (ADLs) and instrumental activities of daily living (IADLs)
39
Q

Potential problems or consequences for geriatric pts who have decreased functional abilities

A

In the hospital setting increases the likelihood of nursing home placement and death after discharge

40
Q

4 elements that must be addressed when evaluating a geriatric patient, regardless of setting

A
  1. physical status
  2. psychological status
  3. Socioeconomic status
  4. Functional status (cognitive and physical)
41
Q

What are four difficulties related to taking geriatric histories?

A
  1. Communication
  2. Underreporting of symptoms
  3. Vague or non-specific symptoms
  4. Multiple complaints
42
Q

Factors and solutions for difficulty of communication while taking a geriatric history

A
  • Diminished vision → use a well lit room
  • Diminished hearing → eliminate extra noise, speak slowly in a deep tone, face the patient/let them see your lips, use simple amplification device
  • Slowed psychomotor performance → write questions in a large print, leave enough time for patient to answer
43
Q

Factors related to difficulty of underreporting sx when taking a geriatric history

A
  • Health beliefs
  • Fear
  • Depression
  • Altered physical and physiological responses to disease process
  • Cognitive impairment
44
Q

Solutions to the difficulty of underreporting sx when taking a pt history

A
  • Ask specific questions about potentially important symptoms
  • Use other sources of information (relatives, friends, caregivers) to complete history.
45
Q

Factors related to difficulty of vague or nonspecific sx when taking a geriatric history

A
  • Altered physical and physiological responses to disease process
  • Altered presentation of specific diseases
  • Cognitive impairment
46
Q

Solutions to the difficulty of vague or nonspecific sx when taking a pt history

A
  • Evaluate for treatable diseases, even if the sx/s are not typical or specific when there has been a rapid change in function
  • Use other sources of info to build history
47
Q

Factors related to difficulty of multiple complaints when taking a geriatric history

A
  • Prevalence of multiple coexisting diseases

* Somatization of emotions – “masked depression”

48
Q

Solutions to the difficulty of multiple complaints when taking a pt history

A
  • Attend to all somatic sx, ruling out treatable conditions
  • Get to know the patient’s complaints, pay special attention to new or changing sx
  • Interview the pt on several occasions to complete the history
49
Q

Other potential solutions to improve difficulties when taking a geriatric patient’s history

A
  • Patience is important in obtaining the history because older patients often have slower thought and verbal processes
  • May need to go away from open-ended questions to get max info in the time available.
  • Somatic complaints may be manifestations of underlying emotional distress rather than symptoms of physical illness, and symptoms of physical conditions may be exaggerated by emotional distress.
  • Be careful not to focus only on what a caregiver says. Focusing on that individual rather than the patient communicates that the patient is a dependent, may diminish the patient’s self-image, and may miss important information that only the patient knows.
  • Gather all the information listed above in several sessions instead of in one session.
  • Some topics are often avoided because they are embarrassing or hard to ask about: fecal impaction, urinary incontinence, sexual dysfunction, or depression.
50
Q

Important social history

A
  • Living arrangements
  • Relationships with family and friends
  • Expectations of family or other caregivers
  • Economic status
  • Abilities to perform activities of daily living (see table of activities below)
  • Social activities and hobbies
  • Mode of transportation
  • Advance directives
51
Q

Key sx of respiratory dz that should be asked in ROS

A
  • Increasing dyspnea

* Persistent cough

52
Q

Key sx of cardiovascular dz that should be asked in ROS

A
  • Orthopnea
  • Edema
  • Angina
  • Claudication
  • Palpitations
  • Dizziness
  • Syncope
53
Q

Describe the brown bag technique

A

• The brown bag technique is helpful in getting a complete medication history.
- Empty the patient’s medicine cabinet, including all prescriptions, over-the-counter medications, herbs, vitamins, supplements, and home remedies. and bring to the clinic

54
Q

Tips and advice for conducting a history with a geriatric patient

A
  • The development of a close-knit interdisciplinary team with minimal redundancy in the assessments performed
  • Use of carefully designed questionnaires that reliable patients and/or caregivers can complete before an appointment
  • Incorporation of screening tools that target the need for further, more in-depth assessment
  • Use of assessment forms that can be readily incorporated into a computerized relational database
  • Integration of the evaluation process with case management activities that target services based on the results of the assessment.

Geriatrics (14 decks)

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