Introduction Flashcards
What might lead to slower cardiac conduction in older patients?
Fibrosis or ischemia
What is meant by the term “irritable” conduction system?
Easily excitable, for example an anxious episode could cause tachyarrhythmias
What is seen on the arterial side of an older patient’s CV system?
Stiffness (less compliance)
Atherosclerosis
What is seen on the venular side of an older patient’s CV system?
Valve failure
Thrombosis, PE
What causes carotid TIA/CVA?
Occlusion
What causes vertebral TIA/CVA?
Hypotension
What are some CNS changes seen in older patients?
- ↓ neuronal conduction rate
- ↓ strength of transmission
- ↓ adaptation to physiologic stressors
- Threshold for arousal blurred
- ↑ recovery time in autonomic system (return to baseline)
What are problems/causes with aging kidneys?
- Inadequate fluid intake
- Fluid loss due to vomiting/diarrhea
- Shock due to hemorrhage
- Cardiac failure
- Sepsis
- Injudicious use of diuretics
- Sodium phosphate enemas
What are causes of gynecologic problems in older women?
- Estrogen deprivation
- Atrophy
- Decreased secretions
What are some gynecologic problems in older women?
- Urinary incontinence
- Dyspareunia
- S/S menopause
What are issues with testosterone supplementation?
- Cardiovascular disease*
- Diabetes
What is the leading cause of death in people age >65?
Heart disease
2nd place is malignant neoplasms
What is homeostenosis?
Diminished homeostatic reserve capacity of all organ systems
What are some examples of geriatric syndromes?
- Dementia
- Delirium
- Urinary incontinence
- Falls
- Pressure ulcers
- Polypharmacy
- Iatrogenesis
What are features of deliurium?
- Sudden onset, definite beginning
- Days to weeks
- Secondary to something (UTI, withdrawal, dehydration, etc…)
- Reversible
- Usually worse at night
- Impaired attention, consciousness, orientation (usually), language, memory
- Medical attention needed RIGHT AWAY!!!
What are some features of dementia?
- Slow and gradual, uncertain beginning
- Usually permanent
- Chronic brain disorder
- Usually worse at night
- Unimpaired attention, consciousness (until severe)
- Impaired orientation/memory and mild language difficulty
- Need for medical attention is not as urgent
What are characteristics of frailty?
- Weight loss
- Self-reported exhaustion
- Low energy expenditure
- Slow gait speed
- Weak grip strength
What describes the relationship between medications and frailty?
There is a significant association between an increased number of medications and frailty. The causal relationship is unclear and bidirectional.
What is a rule made for elderly symptoms made by the Brown University LTC Quality Letter?
Any symptom in an elderly patient should be considered a drug side effect until proven otherwise
What is the consequence of drug therapy in older persons that it aims to prevent?
Iatrogenic cascade
What are the categories to consider in geriatric medication assessment (think TIMER tool)?
- Cost and coverage
- Adherence
- Safety
- Attaining therapeutic goals
What are the 5 M’s of geriatrics?
Mind
Mobility
Medications
Multi-complexity
Matters most
What are the 3 H’s for elderly quality of life?
Healthy
Happy
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