IRAT 4 GERIATRICS/PEDIATRICS Flashcards
Geriatric
Over 65
__ of most DC practices are geriatrics
12-15%
Population over 65 purchases ___ of Rx drugs
1/3
Represents 3M and is fastest growing segment of the population
Greater than 85
Average age of death is ___ in the US
75
Only ___ of geriatrics utilize DC services
4.6%
Goal of treatment of geriatrics
Prevent or delay functional decline and restore or maintain function to allow as much independent living as possible
3 categories of geriatrics
Young-old
Middle-old
Old-odl
Maintained a level of fitness that allows participation in recreational activities
Young-old
Independent with daily activities but need assistance with demanding needs
Middle-old
Require nursing care
Old-old
10 most common chronic conditions in primary care
OA Hypertension Hearing Cardiac Ortho impairment Chronic sinusitis Vision Diabetes Varicose veins Abdominal hernia
Cardiac disease, cancer, and stroke account for __ of deaths in geriatrics
75%
Suicide in geriatrics is ___ the national average
5x
Death from complications of hip fracture is ___
15%
Abrupt onset of signs and symptoms will usually represent a disease rather than
Normal again
Geriatrics often suffer side effects of
Multi-drug Rxs
Seniors have less reserve to deal with
Infections
Geriatrics are prone to
Depression and alcoholism
Often geriatrics are victims of
Verbal or physical abuse
Common musculoskeletal conditions in geriatrics
OA, RA, DISH, gout
Osteoporosis
Paget’s
Common neuro conditions geriatrics
Alzheimers
Parkinsons
Depression
Common EENT conditions geriatrics
Vision loss
Presbycusis
Tinnitus
Chornic sinusitis
Common endocrine conditions geriatrics
Diabetes
Hyperparathyroidism
Cardio/renal common conditions geriatrics
CHF MI Hypertension Stroke Aneurism Temporal arteritis Renal failure Incontinence
Common reproductive condtions geriatrics
Breast CA
Ovarian CA
Prostatic CA
Common GI conditions geriatrics
Hiatal hernia GERD Constipation Diverticulitis Colorectal CA
Strategy for symptomatic patient evaluation
Most common conditions in elderly
Atypical presentations
Drug side effects or interactions
Cancer
Geriatrics management
Establish an annual physical
Provide info with regard to reducing risk of disease
Provide info with regard to falling
Provide info regarding support groups if applicable
For patients with a diagnosed condition managment
Refer to presecriber if drug related
Refer for further evaluation if necessary
Manage or comanage hypertension, obesity, diabetes, musculoskeletal conditions, pain
Adjusting recommendations geriatrics
Light force for osteoporosis
Avoid excessive rotational techniques
Avoid extreme spinal flexion with osteoporosis
Adjust headpiece for comfort
Distract joint when adjusting extremities
Geriatrics normal aging spine
Spinal canal - cord compression likely
Geriatrics normal aging cardio
Blood vessels inc atherosclerosis/HBP Heart - stroke volume Resp - difficulty breathing GI - GERD, B12 Colon - constipation Kidney - excretion Bladder - nocturia/incontinence Endocrine - BPH/CA Blood glucose - 5 mg/dL per decade after age 50 Bone - osteopenia/osteoporosis Muscle - strength Brain - dementia Peripheral nerves - reaction time Eyes/ears - acuity
Geriatrics normal aging eyes/ears
8% visually impaired
Visual impairment places pt at risk for falls, MVAs, etc
60% of patients 70+ have hearing deficit
Most common condiiton is presbycusis
Geriatrics radiograph
Value is high
Must correlate findings with complaints
Bone scans useful for primary CA or mets
May be the decision point for a nursing home
Falls
Leads to dependence
Falls
1/3 of pts greater than 65 report __ falls per year
1+
Women fall more than men. T/F
Ture
Major causes of falling
Accidents Gait disturbance Vertigo Confusion Postural hypotension Visual impairment Syncope
Ddx requires
Breast and pelvic exam
For many complaints a clinical impression may still be gained through appropriate questioning resulting in either a limited trial of treatment or
A referral for further testing or managment
Public health task force on women’s health issues established
1983
National institute of health (NIH) established the office of research on women’s health
1990
Women’s helath initiative (WHI) was developed - this is a prevention based study
1991
Women live longer than men. T/F
True
On average women develop cardiac disease ___ than men
10 years later
Women have a higher incidence of some sports injuries at the
Knee
Women have a higher incidence of
Migraine HA Depression Eating disorders Urinary incontinence Obesity Progressive scoliosis Osteoporosis
Leading cause of death for women 24-34
Accidents
Homicide
Suicide
Leading cause of death for women 45-54
Heart disease
Lung CA
Leading cause of death in women age 65-74
Heart disease
Lung CA
Cerebrovascular disease
Breast CA
Leading cause of death in women with mortality rate 5-6x higher than lung or breast CA
Heart disease
Top ten CA’s in women
Breast Lung Colorectal Cervical Urinary tract Lymphoma Melanoma Thyroid Ovarian Leukemia
Study at Creighton medical school showed vitamin D could cut the risk of CA by
60%
Vitmain D3 recommended
Female patients
Female patient evaluation
Screen for family hx of
CA Heart disease Hypertension Osteoporosis Depression Rheumatic disease HA Obesity/diabetes
BP done every
2 years if normal
Breast exam every
3 years for 20-39 then annually
Mammogram every
1-2 years for 40-49 then annually til 69
Pelvic exam
Annually
Papanicolaou smear from 18 to sexually active then
Annually until 3 negative results then dr’s discretion, discontinue at 65
Eye exam
1x between puberty and 40 then every 2-4 years til 64 then annually
Fasting blood glucose every
3 years
Cholesterol every
5 years
Colonoscopy ever
5-10 years after age 50
Skin exam by dermatologist every
3 years after age 40
Female patient evaluation for the symptomatic patient
Consider most common conditions that are seen in females
Consider cardiac dz
Be vigilant for symptoms of abuse
Female patient evaluation for athletic patient
Screen for regional weakness
Screen for joint instability
Screen for patellar tracking abnormalities
Watch for indicators of female athelte triad
Examine for nutritional deficiencies
Watch for signs of stress fx
Female athlete triad
Eating disorder
Amenorrhea
Osteoporosis
Female patient evaluation for pregnant patient
Reinforce need for regular prenatal chekc-ups
Counsel on avoidance of alcohol, smoking, control of diabetes, safe exercise
Monitor patient’s blood pressure
Be alert to post partum depression
Female patient evaluation for the postmenopausal patinet
Pay attention to signs of osteoporosis
Screen for indicators of diminishing cognitive function
Reinforce breast CA screenings
Reinforce colon CA screenings
For all femal patients management
Stress importance of monthly breast exams
Provide counseling on age-related concerns
Advice regarding exercise, nurtition, heart dz
Advise regarding osteoporosis
Modify adjusting procedures with regard to age and pregnancy
Natual menopause represents an age-related
Ovarian failure
A progressive FSH results in
Shorter menstrual cycles and fewer ovulations and a decrease in progesterone
During transitional phase, referred to as the climactic or premenopausal period, frequency of bleeding is
Irregular and less frequent
When menses has not occurred for one year
Female has reached menopause
In USA menopause occurs on average of
50-51 years old
Majority of problems occur in female athletes or with women in occupations where a thin appearnce is required
Eating disorders
The 2 priamry disorders in females
Anorexia nervosa
Bulimia nervosea
A disorder associated with self-imposed weight loss due to a distorted body image and other psychologically related problems
Anorexia nervose
85% anorexia nervosa are
Young affluent white females
Often a perfectionist
Anorexia nervosa
Weight is maintainted at least 15% below that expected as normal based on height and gender
Anorexia nervosa
Intense fear of gaining weight even though obviously underweight
Anorexia nervosa
Distorted sense of self
Anorexia nervosa
Absence of at least 3 consecutive menstrual cycles without any other known cause
Anorexia nervosa
Characterized by a binge-purge cycle in order to avoid weight gain
Bulimia nervosa
Seen in about 50% of AN patients
Bulimia nervosa
Usually cocurs when the pt is depressed bored or lonely
Bulimia nervosa
Seen in 20% of college sutdents
Bulimia nervosa
4% report weekly events
Bulimia nervosa
