LO7 Geriatrics Flashcards
Older people are at increased risk of acquiring infectious disease due to the following factors:
Decreased pulmonary function and cough reflex
Decrease gastric acidity and GI motility (activity)
Heart disease
Thin, easily traumatized skin (skin ulcers)
Impaired immune mechanisms
Older people are at risk of developing potentially life- threatening disturbances of temperature regulation due to
normal age related changes
- Twice the time to return to normal body core temperature post exposure
- Diminish ability to thermoregulate
- Decreased ability to perspire
Older people are increased risk of aquiring infectious disease due to the following factors:
Inadequate nutrition and hydration
Chronic disease and chronic use of medications
Urinary retention or incontinence
Institutional living
Need for invasive medical devices- eg catheters
Gastrointestinal bleeding
Gastrointestinal bleeding is associated with increased morbidity and mortality in older adults partly due to:
Increased comorbidities
Greater use of ulcerogenic medications, such as
Aspirin
Drugs (NSAIDS)
VITAMINS C and D
Vascular Inflammation Toxins, trauma, tumors Autoimmune Metabolic Infection Narcotics Systemic Congenital
Cardiovascular emergencies
Diabetes present differently
Neuropathy due to diabetes, age or other comorbidities can disguise an underlying cardiovascular emergency in the older patient
Drug interactions can also create cardiovascular emergencies
Falls
People 75 years and older are 4 to 5 times more likely than those 65 to 74 years to be admitted to a long-term care facility for a year or longer.
Traumatic brain injuries account for 46% of fatal falls among older adults.
One percent of falls result in hip fractures; 5% of falls result in other types of fractures.
Changes in the cardiovascular system
The heart in larges with age probably in response to chronically increased afterload imposed by stiffened blood vessels
Cardiac output declines mostly as a result of decreasing stroke volume
Arterial sclerosis contributes to systolic hypertension in many older patients
Change in compliance with vascular walls
The result of vascular stiffening is a widening pulse pressure, decreased coronary artery perfusion and changes in cardiac ejection deficiency
Many geriatric patients also exhibit and S4 heart sound
The changes in conduction system leads to bradycardia
Changes in the respiratory system
Decrease in elasticity of the lungs and in the size and strength of respiratory muscles
Vital capacity which is the amount of air that can be exhaled following a maximal inhalation decreases
The residual volume which is the amount of air left in the lungs at the end of a maximal exhalation increases
Gas exchange progressively declines
respiratory rates increase approximately to 16 to 25 breaths a minute with breathing also become an shallower
Musculskeletal changes such as kyphosis may affect pulmonary function by limiting lung volume and maximal inspiratory pressure
Chest expansion is also limited by decreased pulmonary muscle strength and mass
Some patients will develop barrel chest which makes the lung sounds diminished or distant
The cough and gag reflex is decrease with age, increasing the risk of aspiration and the ciliary mechanisms that normally help remove bronchial secretions are markedly slower
Changes in the nervous system
Changes in thinking speed, memory, postural stability are the most common normal findings in older people
The brain weight may shrink 10 to 20% by age of 80 years
The performance of most of the sense organs declines with increasing age
The two most common causes of visual disturbances in older adults are cataracts and glaucoma
The possibility of hearing loss increases with age a common cause of hearing impairment in geriatric patients is presbycusis
Presbycusis
Progressive hearing loss particularly in high frequencies along with less than ability to discriminate between a particular sound and the background noise
Meniere disease
the typical symptoms include vertigo, hearing loss, tinnitus and pressure in the ear
Changes in the digestive system
Diminishing older person senses of taste and smell which may intern interfere the enjoyment of food which may lead to mount nutrition
Reduction in the volume of saliva
Dental loss is not a normal result of the ageing process
Activity of the enzyme system is concerned with the detoxification of medication declines as a person ages the decrease in hepatic function can complicate medication absorption resulting in medication toxicity
Changes in the renal system
Kidneys are responsible for maintaining the bodies fluid and electrolyte balance and have important role in maintaining the bodies long-term acid base balance in eliminating medication from the body
Although the kidneys an older adult may be capable of dealing with day-to-day demands of a persons body they may not be able to meet unusual changes such as those imposed by illness
Older adults are at considerable risk of overhydration if they are exposed to large amounts of sodium
Geriatric patients are susceptible to hyperkalaemia they can reach serious levels if the patient becomes acidotic or if the potassium load is increased from any source
Incontinence is not a normal part of ageing and can lead to skin irritation, skin breakdown and urinary tract infections
Capacity of bladder decreases
Stress incontinence:
occurs during activities such as coughing, laughing, sneezing, lifting and exercise
Urge incontinence
triggered by hot and cold fluids, running water and sometimes the simple thought of going to the bathroom
Changes in the integumentary system
Sebaceous glands produce less oil
Sweat glands less activity
Thinner hair and different color
Although chest pain is a common presentation for acute MI in older patients it may be
decreased in intensity or atypical pain may even be absent with a patient instead reporting dyspnea, syncope, weakness, confusion, nausea, vomiting or fatigue
Dysrhythmias of the heart occur when
are generally a result of
Dysrhythmias of the heart occur when the electrical system controlling the heartbeat experiences an interruption or malfunction
Dysrhythmias in older people are generally a result of age related changes in the heart, existing cardiac disease, adverse medication effects or a combination of these factors
A-fib is the most common and increases risk of stroke and heart failure by encouraging clots formation
signal early cerebral bleeding from an aneurysm
An aneurysm is a weakness in any artery that produces a balloon defect weakening at the arterial wall
A new headache or a change in chronic headache patterns may signal early cerebral bleeding from an aneurysm all too often
patho Gastrointestinal system disorders
Constipation is a frequent and significant problem in older people
Higher incidence of peptic ulcer disease
Many older adults have diverticulosis
Kyphosis
outward curvature of the thoracic spine
Osteoporosis
is characterized by a decrease in bone mass leading to reduction in bone strength and greater susceptibility to fracture
Osteoarthritis
is a progressive disease of the joints that destroys cartilage, promotes the formation of bone spurs in joints and leads to joint stiffness
Rheumatoid arthritis
long term autoimmune disorder that is characterized by inflammation of the joints and the surrounding tissues
Symptoms are usually bilateral
Cervical spondylosis
degenerative changes in the cervical spine causing arthritic spurs and narrowing of the vertebral canal
GEMS
G
Geriatric- recognize pt is geriatric and mind needs to be geared to the possible problems of an aging patient
GEMS
E
Environmental- assessment of the environment helps give clues to the patients condition or the cause of the emergency
GEMS
M
Medical assessment- older patients tend to have a variety of medical problems may be taking numerous prescriptions, over the counter, and herbal medications
GEMS
S
Social assessment- older people may have less of a social network, death of spouse =, family members or friends
pneumonia symptoms in older pets
Often do not have the classic presentation of chill, fever and productive cough if they take NSAIDS regularly
