Lecture 6: Gero Flashcards
Intrinsic aging
Changes occur universally (See next slide)
Extrinsic aging
Lifestyle, environmental and occupational influence
Normal aging
Sum of both intrinsic and extrinsic
Intrinsic Age Changes
- Reduced resistance to stress
—-Both from a psychological and endocrine perspective - Poor tolerance of extreme temperatures
- Reduced sensory perceptions
- Greater fluctuation in blood pH
—-Lesser capacity to compensate
Psychosocial Issues
- Developmental tasks of aging
—-Piaget’s stage of reflection - Need for support and relationships
—-Widowed, loss of support systems - Self-worth and perceived well-being
- End-of-life care preferences, competency, and ability to be involved in treatment decisions
Physical Challenges in older adults
- individual ______
- Individual variation in age-related
changes
—-Previous functional levels play a huge role
Distinguish age-related changes from chronic disease.
—-Diabetes, CHF, COPD, etc.
Avoid attributing findings to age if they are caused by an illness.
Often leads to a loss of independence
Auditory Changes: Findings on Physical Examination
1) Evaluate ear canal at regular intervals.
- Tendency thicker, drier to occlude canal
2) May hear pure tones
- Impairment discrimination ability:
3) Difficulty hearing speech
- Difficulty hearing high-frequency sounds
4) Noisy environment hampers ability to hear certain sounds.
5) Occupational exposure
Visual Changes: Findings on Physical Examination
1) Smaller pupils, decreased visual acuity, difficulty with depth perception, decreased peripheral vision, dry eyes
2) Good lighting, avoiding glare, and using contrast colors and large print to facilitate vision
3) Provide information in ways for facilitating vision and compensating for losses
4) Implications regarding medication adherence due to label font, medication dosing
Sleep Changes: Findings and Management
1) Present with inability to fall asleep, inability to stay asleep, or both
2) Evidence sleep deprivation with altered mental status
3) Sleep apnea
4) Good sleep hygiene
- Maintain day–night schedule
5) Conservative use of medication
Skin Changes: Management
Maintain oral intake.
Increase bathing time.
Avoid use of soaps.
Use an emollient after bathing.
Other Sensory Changes
May not feel the effects of lying too long in one position
- Frequent position changes
May develop postural instability
To facilitate taste and improve oral intake
- Frequent oral care: May help prevent nausea
Which of the following findings is related to the age-associated increase in arterial stiffness?
A. Hypertension
B. Atrial fibrillation
C. Bradycardia
D. Postural hypotension
A
Cardiovascular Changes: Findings on Physical Examination 6
1) Hypertension
- Increase in SBP
- Widened pulse pressure
2) Postural hypotension
- Sit before standing upon first ambulation
3) Atrial fibrillation
4) S4 due to reduced ventricular compliance
5) Poor venous return (decrease in preload)
6) ECG changes
Age-Related ECG Changes
1) Prolongation of PR and QT interval
2) Intraventricular conduction abnormalities
3) Reduction in QRS voltage
4) Left axis shift
Question:
Is the following statement true or false?
As a person ages, there tends to be an increase in PaCO2 and a decrease in PaO2.
Respiratory Changes: Findings on Physical Examination 6
1) Chest wall compliance decreases.
- Increased work of breathing
2) FRC increases and lung compliance decreases.
> incidence small airway to collapse
3) Reduction in respiratory muscle strength
4) Greater incidence of barrel chest
5) Dyspnea common complaint
6) Pulmonary infections more common
Renal Changes: Findings 8
1) Decrease in GFR, major
implications with medications
2) Decrease in the ability to concentrate urine
3) Decrease in clearance of BUN/creatinine
4) Changes in renal function tests
5) Altered ability to control electrolytes
6) Prone to dehydration
7) Urinary retention with increase in UTIs
8) Incontinence
Renal Changes: Management 4
1) Adequate fluid intake
2) Electrolyte monitoring and replacement, if needed
3) Assess for urinary retention and UTIs.
- Limit use of Foley catheters!!!
—-Every day the Foley is in place increases the risk of a UTI by 10%
- Early removal
4) Monitor drug clearance and alter doses as needed.
Gastrointestinal Changes: Findings (3)
Decrease in appetite and food intake
Constipation
Abnormal presentations of acute abdomen
- Does not present with typical abdominal pain and distension
Gastrointestinal Changes: Management
- Adequate fluid intake
- Bulk in diet
- Use of natural laxatives
- Active or passive exercise
- Obtaining history of eating habits
- Good oral care
- Assessing indicators of nutritional risks
Which of the following would be indicators of nutritional risks in elderly patients?
A. Recent weight loss
B. Albumin level less than 3.5 g/dL
C. Lymphocyte count less than 1500/mm3
D. All of the above
D
Musculoskeletal Changes: Findings
- Joint pain and stiffness (Passive ROM)
- Decrease in muscle mass and strength
- Loss of skeletal calcium (bone loss) (May have spontaneous fractures)
Musculoskeletal Changes: Management (7)
- Encourage resistive exercises to reverse decline in muscle strength.
- Encourage calcium and vitamin D intake.
- Carefully reposition or pull the patient up in bed to prevent fractures.
- Assist with ambulation.
- Maintain good nutrition.
- Use a splint to prevent deformity if in coma.
- “Get up and Go” test
Endocrine Changes: Findings (4)
- Alteration in insulin, thyroid-stimulating hormone, aldosterone, growth hormone, and cortisol (Insulin resistance (increase blood glucose levels)
- Decreased thermoregulation (Decreased sweating and shivering, Lower baseline temperature)
- Decreased febrile response
- Decreased basal metabolic rate
Endocrine Changes: Management 4
1) Evaluate HbA1c to evaluate for DM in older patient.
- Closely monitor blood glucose levels in elderly diabetics.
2) Monitor temperature, maintain normal room temperatures, and provide adequate blankets.
3) Be aware, may not elevate temperature with infections.
4) Assess thyroid function.
- Atypical presentation
Immunological Changes: Findings (4) and Management (1)
- Decline in T-cell and B-cell function
- Decreased production of IgE
- Usual findings of an infection may be absent.
(Look for acute changes in cognition, function, or behavior) - Most common areas of infection are lungs, urinary tract, and skin.
- Use strict aseptic techniques with invasive procedures.
Cognitive Changes 5
- Cognitive changes are not universal with age.
- Assess on admission and monitor routinely.
- Influences on cognition in the ICU:
- Physiological deficits, medications, stress, dementia, delirium, depression - Mini-Cog tool
- For functional changes use the “Get up and go” test
Reversible Causes of Dementia and Delirium
(HINT: DEMENTIA)
D: Drugs
E: Emotional illness (depression)
M: Metabolic/endocrine disorders
E: Eye/Ear/Environment
N: Nutritional/neurological disorders
T: Tumors/trauma
I: Infection
A: Alcoholism/anemia/atheroscelorsis
ICU Delirium
- what is it called?
- directly related to?
- what 3 affects are re[prted up to 10 years after admission
Prevention: ABCDEF bundle
A-
B-
C-
D-
E-
F-
“Acquired Dementia”
- Directly related to amount of sedation received
- Cognitive, psychological and emotional effects reported up to 10 years after admission
Prevention: ‘ABCDEF Bundle’
A- assess, prevent, manage pain
B- Both spontaneous breathing and awakening trials
C- Choice of analgesia and sedation
D- Delirium: Assess, prevent, manage
E- Early mobility/Exercise
F- Family involvement
Learning
1) May take longer to learn new material
2) May be more hesitant to take on new tasks
3) Motivation important
4) Take into account the person’s sensory and cognitive abilities.
5) Allow time for completion of tasks.
> short-term than long-term memory loss
- Use remote memory recall in learning.
Depression 6
Common syndrome
Leading cause of suicide in elderly
Criteria for major depression
- At least five symptoms almost daily for at least 2 weeks
Causes multifaceted
Geriatric Depression Scale
Be aware: antidepressant side effects
Symptoms of Depression 9
Depressed mood
Decreased interest in activities
Weight changes
Sleep changes
Psychomotor changes
Fatigue
Feelings of worthlessness or guilt
Decreased concentration
Suicidal Ideation
Abuse of Older Patient
1) Affects greater than 4% of older adults in the United States
2) May be physical, psychological, or material (financial)
3) May be neglect, exploitation, or abandonment
4) Be alert for signs of abuse and follow-up.
5) Inconsistencies need to be further explored.
6) Screen alcohol use
- Use appropriate screening tools
Signs of Elder Abuse
- Being emotionally upset or agitated.
- Being extremely withdrawn, non-communicative, or non-responsive.
- Unusual behavior, such as sucking, biting, rocking.
- Witnessing a caregiver controlling or isolating an older adult.
- Exhibiting a change in sleeping patterns or eating habits.
Challenges in Medication Use
Rule of thumb, “start low, go slow”
Careful medication history
- Include OTC medications
Altered drug absorption
Altered drug distribution
Altered drug metabolism
