Introduction of Geriatrics Flashcards
How do you classify a patient as “geriatric”?
Being of old age or being a “geriatric” is defined as 65 years and over.
What is an interesting fact about medicare and aging?
Medicare coverage may begin at 65 – but, medical care does not dramatically rise until after 75.
What is the life span of an average male and female?
Life span at birth is age 79 for women and age 74 for men.
What is happening with the geriatric population?
Growing exponentially
What percentage of the geriatric population is women?
Women make up 58% of those > 65 and ~70% of those > 85.
What is a key fact about the population demographics in the geriatric community?
Older population is becoming ethnically diverse.
What state has the highest life expectancy? Lowest?
Hawaii, Mississippi
What can influence the life expectancy difference between the states?
obesity
Why are we getting massively overweight?
Living longer and being overfed and under nourished
T/F: A high proportion of the elderly are living in poverty
False, only 10%
What are factors that are extending the lives of the elderly?
Changes in public health: Cleaner water Better nutrition Less poverty Improved prenatal care Childhood immunizations Smoking less Safety measures
What factors are the most significant to human aging?
gender and genetics
as well as lifestyle and genetic expression
What is the bottom line of the aging process?
there is a disruption of homeostasis
What would have the greatest effect on the life span after the age of 50?
slowing down aging
What are the major causes of death?
chronic diseases are the major causes of death: CVD CA CVA DM
What is a down fall of living longer?
sensory impairments
What are the most common sensory impairments in the elderly?
presbycusis
no natural teeth
presbyopia
memory impairment
What are common geriatric syndromes?
falls urinary incontinence confusion immobility sleep disorders fatigue weight loss
What is commonly the association between ethnic diversity and life span?
Generally minority group members die earlier from preventable causes.
What is the goal of geriatric care?
Older adults will maintain full function and live active lives in their homes and communities.
What is a common myth about the older population?
frailty
Where do most of the geriatric population live?
in the community. 95%
What are the two foundations of geriatric medicine?
- Ethical Decision Making
2. Patient-Centered Care
What do we need to remember about decision making, especially in geriatrics?
“Can versus Should”
Given choices, ask the patient for their decision.
Give elders the right to control their destiny.
What are the key elements to patient centered care?
FIFE
feelings (hopes and fears)
Ideas about whats going on
Function ("hows is the illness affecting their life?")
ExpectationsIs the assessment and approach to caring for a patient the same in geriatrics as it is in primary medicine?
NO. Different from disease-oriented approach of history-taking and physical exam of younger patient.
What do we need to focus on in our approach to treatment with the elderly?
healthy or “successful” aging (“quality of life”)
What else should we consider in our assessment of the older adult?
Understand and mobilize family, social, and community supports.
Importance of skill directed to functional assessment
Opportunities for promoting older adult’s long-term health and safety.
What is a key concept of the aging adult?
as humans age, things fall apart
What changes in regards to BP with aging?
widened pulse pressure
systolic continues to rise
diastolic stops at 90
What changes in regards to HR and rhythm with aging?
Rhythms can fluctuate, the max heart rate decreases
What changes in regards to respiratory and temperature with aging?
RR is unchanged
Often lower basal temperature
What changes in regards to the integumentary system with aging?
Skin Thins
Grey Hair
Thick nails
Sun damage…catches up!
What changes in regards to the eyes with aging?
increased incidence of degenerative disease
presbyopia
What changes in regards to the ears with aging?
presbycusis
loss of higher tones of words
What changes in regards to the thorax with aging?
Increased:
Chest wall stiffness
Osteoporosis and kyphosis can reduce the thoracic capacity.
What leads to senile emphysema? What are its determinants?
Osteoporosis, kyphosis and alveolar stiffness leads to “senile emphysema” with an FEV1/FVC < 70% of the predicted for age and gender.
What is associated with all causes of mortality?
Respiratory problems are associated with all cause mortality and specifically with:
CVD
COPD
Lung cancer
What percentage of deaths are attributed to respiratory problems?
43% cause of death in women
60% cause of death in men
What changes in regards to the CV system with aging?
reduced cardiac output
increased BP and peripheral vascular resistance
What changes in regards to the female genitalia with aging?
menopause usually between ages 48-55
What changes in regards to the male genitalia with aging?
ED- common beyond 4th decade
What is ED an important marker for?
CVD
What changes in regards to the prostate with aging?
BPH
What changes in regards to the MSK system with aging?
loss of height and muscle mass
osteoarthritis
osteoporosis
What changes in regards to the neurological system with aging?
Neuronal loss is normal
Ability to learn remains generally unchanged.
Recall memory declines.
Increased incidence of dementias.
What changes in regards to the renal system with aging?
Decreased renal mass and size:
Kidneys get smaller (loss of renal cortex - 40% less glomeruli by age 80)
Reduced Renal Blood Flow
10% reduction per decade after age 20 (ie @ 70, 50% less blood flow!)
Less urine concentration
What changes in regards to the GI system with aging?
Decreased global functions: secretion/absorption
What changes in regards to the endocrine system with aging?
Hypothyroidism more common.
DM increased incidence.
Vitamin D absorbtion – parathyroid issues
Androgen/Estrogen lessens.
What changes in regards to the immune system with aging?
global decrease in immune function and response to antigens
T/F: Elderly patients can not undergo most surgical procedures as well as younger patients.
False
What do we need to do even more so in regards to infections with the elderly?
Treat aggressively
What does a mental status change in a geriatric patient signify?
urgent/emergent disease!
What factors do we need to employ in regards to health history and how to approach a patient in the geriatric setting?
Demeanor should convey respect and PATIENCE.
KEEP IT WARM
KEEP THE PACE S - L - O - W
ALWAYS “WRITE IT DOWN.”
What areas should be reviewed carefully with older patients in particular?
ADLs IADLs Medication history Nutrition (diet history) Acute/persistent pain: account for 80% of visits Smoking and alcohol Advance directive and palliative care
What are ADLs?
Activities of daily living (Basic self-care): bathing, dressing, toileting, transferring, continence, feeding.
What are IADLs?
Instrumental activities of daily living (Higher-level functions): using the telephone, shopping, preparing food, housekeeping, laundry, transportation, taking medications.
How do we assess for EtOH use?
EtOH: CAGE questionnaire
What does it mean by “stay aware of cultural changes”?
understand YOUR patient
What should you encourage with your geriatric patient?
Encourage regular health screening exams Encourage exercise Encourage immunizations Encourage household safety Encourage cancer screening
What should we look for specifically with our elderly patients?
Assess vision and hearing
Assess for depression
Assess for dementia and mild cognitive impairment
Assess for elder mistreatment
When should the patient receive their immunizations?
Influenza: ANNUALLY
Pneumococcal: Now SINGLE DOSE at age 65.
What allows the physician to pick upon subtle changes early in the disease process with their patients?
By developing a close relationship between the physician, elderly patient and the family.
