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Medicine II: Geriatrics > Introduction of Geriatrics > Flashcards

Introduction of Geriatrics Flashcards

1
Q

How do you classify a patient as “geriatric”?

A

Being of old age or being a “geriatric” is defined as 65 years and over.

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2
Q

What is an interesting fact about medicare and aging?

A

Medicare coverage may begin at 65 – but, medical care does not dramatically rise until after 75.

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3
Q

What is the life span of an average male and female?

A

Life span at birth is age 79 for women and age 74 for men.

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4
Q

What is happening with the geriatric population?

A

Growing exponentially

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5
Q

What percentage of the geriatric population is women?

A

Women make up 58% of those > 65 and ~70% of those > 85.

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6
Q

What is a key fact about the population demographics in the geriatric community?

A

Older population is becoming ethnically diverse.

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7
Q

What state has the highest life expectancy? Lowest?

A

Hawaii, Mississippi

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8
Q

What can influence the life expectancy difference between the states?

A

obesity

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9
Q

Why are we getting massively overweight?

A

Living longer and being overfed and under nourished

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10
Q

T/F: A high proportion of the elderly are living in poverty

A

False, only 10%

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11
Q

What are factors that are extending the lives of the elderly?

A 
Changes in public health:
Cleaner water
Better nutrition
Less poverty
Improved prenatal care
Childhood immunizations
Smoking less
Safety measures
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12
Q

What factors are the most significant to human aging?

A

gender and genetics

as well as lifestyle and genetic expression

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13
Q

What is the bottom line of the aging process?

A

there is a disruption of homeostasis

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14
Q

What would have the greatest effect on the life span after the age of 50?

A

slowing down aging

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15
Q

What are the major causes of death?

A 
chronic diseases are the major causes of death:
CVD
CA
CVA
DM
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16
Q

What is a down fall of living longer?

A

sensory impairments

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17
Q

What are the most common sensory impairments in the elderly?

A

presbycusis
no natural teeth
presbyopia
memory impairment

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18
Q

What are common geriatric syndromes?

A 
falls
urinary incontinence
confusion
immobility
sleep disorders
fatigue
weight loss
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19
Q

What is commonly the association between ethnic diversity and life span?

A

Generally minority group members die earlier from preventable causes.

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20
Q

What is the goal of geriatric care?

A

Older adults will maintain full function and live active lives in their homes and communities.

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21
Q

What is a common myth about the older population?

A

frailty

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22
Q

Where do most of the geriatric population live?

A

in the community. 95%

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23
Q

What are the two foundations of geriatric medicine?

A
  1. Ethical Decision Making

2. Patient-Centered Care

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24
Q

What do we need to remember about decision making, especially in geriatrics?

A

“Can versus Should”
Given choices, ask the patient for their decision.
Give elders the right to control their destiny.

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25
Q

What are the key elements to patient centered care?

A 
FIFE
feelings (hopes and fears)
Ideas about whats going on
Function ("hows is the illness affecting their life?")
Expectations
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26
Q

Is the assessment and approach to caring for a patient the same in geriatrics as it is in primary medicine?

A

NO. Different from disease-oriented approach of history-taking and physical exam of younger patient.

27
Q

What do we need to focus on in our approach to treatment with the elderly?

A

healthy or “successful” aging (“quality of life”)

28
Q

What else should we consider in our assessment of the older adult?

A

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.

29
Q

What is a key concept of the aging adult?

A

as humans age, things fall apart

30
Q

What changes in regards to BP with aging?

A

widened pulse pressure
systolic continues to rise
diastolic stops at 90

31
Q

What changes in regards to HR and rhythm with aging?

A

Rhythms can fluctuate, the max heart rate decreases

32
Q

What changes in regards to respiratory and temperature with aging?

A

RR is unchanged

Often lower basal temperature

33
Q

What changes in regards to the integumentary system with aging?

A

Skin Thins
Grey Hair
Thick nails
Sun damage…catches up!

34
Q

What changes in regards to the eyes with aging?

A

increased incidence of degenerative disease

presbyopia

35
Q

What changes in regards to the ears with aging?

A

presbycusis

loss of higher tones of words

36
Q

What changes in regards to the thorax with aging?

A

Increased:
Chest wall stiffness
Osteoporosis and kyphosis can reduce the thoracic capacity.

37
Q

What leads to senile emphysema? What are its determinants?

A

Osteoporosis, kyphosis and alveolar stiffness leads to “senile emphysema” with an FEV1/FVC < 70% of the predicted for age and gender.

38
Q

What is associated with all causes of mortality?

A

Respiratory problems are associated with all cause mortality and specifically with:
CVD
COPD
Lung cancer

39
Q

What percentage of deaths are attributed to respiratory problems?

A

43% cause of death in women

60% cause of death in men

40
Q

What changes in regards to the CV system with aging?

A

reduced cardiac output

increased BP and peripheral vascular resistance

41
Q

What changes in regards to the female genitalia with aging?

A

menopause usually between ages 48-55

42
Q

What changes in regards to the male genitalia with aging?

A

ED- common beyond 4th decade

43
Q

What is ED an important marker for?

A

CVD

44
Q

What changes in regards to the prostate with aging?

A

BPH

45
Q

What changes in regards to the MSK system with aging?

A

loss of height and muscle mass
osteoarthritis
osteoporosis

46
Q

What changes in regards to the neurological system with aging?

A

Neuronal loss is normal
Ability to learn remains generally unchanged.
Recall memory declines.
Increased incidence of dementias.

47
Q

What changes in regards to the renal system with aging?

A

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

48
Q

What changes in regards to the GI system with aging?

A

Decreased global functions: secretion/absorption

49
Q

What changes in regards to the endocrine system with aging?

A

Hypothyroidism more common.
DM increased incidence.
Vitamin D absorbtion – parathyroid issues
Androgen/Estrogen lessens.

50
Q

What changes in regards to the immune system with aging?

A

global decrease in immune function and response to antigens

51
Q

T/F: Elderly patients can not undergo most surgical procedures as well as younger patients.

A

False

52
Q

What do we need to do even more so in regards to infections with the elderly?

A

Treat aggressively

53
Q

What does a mental status change in a geriatric patient signify?

A

urgent/emergent disease!

54
Q

What factors do we need to employ in regards to health history and how to approach a patient in the geriatric setting?

A

Demeanor should convey respect and PATIENCE.
KEEP IT WARM
KEEP THE PACE S - L - O - W
ALWAYS “WRITE IT DOWN.”

55
Q

What areas should be reviewed carefully with older patients in particular?

A 
ADLs 
IADLs
Medication history
Nutrition (diet history)
Acute/persistent pain: account for 80% of visits
Smoking and alcohol 
Advance directive and palliative care
56
Q

What are ADLs?

A

Activities of daily living (Basic self-care): bathing, dressing, toileting, transferring, continence, feeding.

57
Q

What are IADLs?

A

Instrumental activities of daily living (Higher-level functions): using the telephone, shopping, preparing food, housekeeping, laundry, transportation, taking medications.

58
Q

How do we assess for EtOH use?

A

EtOH: CAGE questionnaire

59
Q

What does it mean by “stay aware of cultural changes”?

A

understand YOUR patient

60
Q

What should you encourage with your geriatric patient?

A 
Encourage regular health screening exams
Encourage exercise
Encourage immunizations
Encourage household safety
Encourage cancer screening
61
Q

What should we look for specifically with our elderly patients?

A

Assess vision and hearing
Assess for depression
Assess for dementia and mild cognitive impairment
Assess for elder mistreatment

62
Q

When should the patient receive their immunizations?

A

Influenza: ANNUALLY
Pneumococcal: Now SINGLE DOSE at age 65.

63
Q

What allows the physician to pick upon subtle changes early in the disease process with their patients?

A

By developing a close relationship between the physician, elderly patient and the family.

Medicine II: Geriatrics (10 decks)

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