Middle & Older Adult Flashcards
Developmental Theory for middle adults
generativity v. self absorption
- helping kids becoming good adults
- Rediscovering or developing new satisfaction with spouse.
- Developing an affectionate but independent relationship with aging parents.
- Reaching the peak in one’s career.
- Achieving mature social and civic responsibility.
- Accepting and adapting to biological changes.
- Maintaining and developing friendships.
- Developing leisure time activities.
Ages of a middle adult?
35-65
Ages of an older adult?
65+
Developmental Theory of older adult
Generativity v. Stagnation
- normalize their aging bodies
What is glaucoma?
a group of eye diseases that gradually result in a loss of vision by permanently damaging the optic nerve
- usually no symptoms until vision loss has begun and it’s too late
- genetic- look at family hx
Who should be screened for glaucoma?
- DM
- African Americans, 50+
- Hispanic Americans, 65+
- Family Hx
How is glaucoma diagnosed?
failure of one visual field
Total Cholesterol levels:
- desirable
- borderline
- high
Total Cholesterol levels:
- desirable: less than 200
- borderline: 200-239
- high: 240+
LDLs:
- Optimal
- Near Optimal
- Borderline High
- High
- Very High
LDLs:
- Optimal: less than 100
- Near Optimal: 100-129
- Borderline High: 130-159
- High: 160-189
- Very High: 190+
HDLs:
- high
- low
HDLs:
- high: 60+ (Want this)
- low: less than 40
Triglycerides:
- Normal
- Borderline High
- High
- Very High
Triglycerides:
- Normal: less than 150
- Borderline High: 150-199
- High: 200-499
- Very High: 500+
How often is the routine screening of triglycerides?
Q5 years
How often should your blood glucose be tested?
- Once at age 45
- Q3 years from 50+
Fasting Blood Glucose levels
- Normal v. Impaired
- Diabetes v. Pre-diabetes
- Normal: 70-100
- Impaired fasting glucose: 100+
- Pre-diabetes: 100-125
- Diabetes: 126+
Who should get screened for lipid disorders?
- Women 20-45: of they have increased risk for CHD
- Women 45+: if they have increased risk for CHD
- Men: 35+
Who should get tested for Type 2 diabetes?
- symptomatic
- family hx
- asymptomatic adult with BP greater than 135/80
Who should be screened routinely for osteoporosis?
Women 60+ who are at increased risk
All women 65+
What is the single best predictor of osteoporosis?
Weight
How is osteoporosis screened?
(DEXA) Dual energy x-ray absorptiometry
- at the femoral neck
What increases the risk of having osteoporosis?
smoking
drinking
sedentary life
What are the goals of osteoporosis?
- prevent fractures
What medications are considered in osteoporosis?
Biphosphonates: alendronate, risedronate, and ibandronate
Estrogen
Raloxifene
Calcitonin
How is osteoporosis treated?
- Balanced diet (rich in calcium, vit. D)
- regular exercise
- maybe take tums before bed
- Ca supplements are NOT given to renal patients
Who is at risk for Abdominal Aortic Aneurysm?
- over 65
- Male
- Smoking (100+ cigarettes)
When should women be screened for abdominal aortic aneurysms?
Should NOT be screened
- Grade: D recc.
When should men be screened for abdominal aortic aneurysms?
One-time screening for men
- age 65-75 who have ever smoked
What happens if the abdominal aortic aneurysm is found to be 5.5cm or larger?
Open repair
What happens if the abdominal aortic aneurysm is found to be 4.0-5.4 cm?
Periodic surveillance
What happens if the abdominal aortic aneurysm is found to be 3.0-3.9 cm?
No intervention, maybe repeat ultrasound
When should routine PSA screening occur?
Should not occur
- Grade: D recc.
Who benefits from PSA screening?
- men 50-70 at average risk
- men 45 and older at increased risk (FMH or African American)
How often should PAP smears be routinely taken?
- Women 21-30: Q3 years
- Women 30-65: Q5 years
- Women 65+: stop (esp. 3 normal neg. PAPs over 10 years)
When should PAP smears begin?
3 years after sexual activity begins
Should a PAP smear be taken after a hysterectomy?
No PAP if no cervix
When should breast cancer screenings be given?
Women, before age 50: shared decision making
Women 50-74: mammogram every 2 years
Who are most likely to benefit from breast cancer screening?
- Family hx of breast cancer in mom or sister
- Previous biopsy with atypical hyperplasia
- First childbirth after age 30
When should colon cancer screening begin and end for men and women?
Begin: 50+ years for men and women
End: 75-85 years for men and women
What are the different types of colon cancer screening tools?
- Fecal Occult Blood Testing (FOBT)
- Flexible Sigmoidoscopy
- FOBT + Flexible Sigmoidoscopy
- Colonoscopy
- Double Contrast Barium Enema
How often should the flexible sigmoidoscopy be given?
- Every 5 years
- if abnormal, will need colonoscopy
Sigmoidoscopy procedure
Night before: take laxatives the day before or the morning of the test to clean out your colon.
Day of:
- You will be awake during the test, and you will probably be able to go back to work after the test.
- Your provider will insert a thin, lighted tube into your rectum. The tube is connected to a video camera so we can look at your rectum and the lower part of your colon.
How often should the colonoscopy be given?
Every 10 years
Pros and Cons of a sigmoidoscopy
Pros: Cheaper than colonoscopy and back to work same day
Cons: less accurate and if abnormal, will need a colonoscopy
Colonoscopy procedure
Night before: take laxatives the day before the test to clean out your colon.
Day of:
- Will be asleep during the test
- The provider will insert a thin tube connected to a video camera into your rectum to look at your whole colon
- If polyps are found, they will be removed right then
- Will miss a day of work and will need someone to drive you home
Pros and Cons of a colonoscopy
Pros: most accurate test, will remove polyps on the spot
Cons: most expensive, causes more injuries, miss a day of work
Which colon cancer screening has the greatest reduction in mortality?
FOBT- done annually, includes 3 specimens
What is the recommendation grade for ovarian cancer screening?
Grade: D- dont
When should ASA prophylaxis be initiated?
Men: 45-79
Women 55-79
- If MI risk outweighs harm of potential GI hemorrhage
- If younger, grade: D recc.
What is osteoarthritis?
Pain and stiffness in one or more joints, swelling of joints, decreased mobility, nocturnal pain, and parethesias.
Primary signs of osteoarthritis?
- pain, stiffness,
- enlargement or swelling,
- tenderness,
- limited range of motion,
- muscle wasting,
- partial dislocation
- deformity (heberden and bouchard nodes).
What peripheral joints are generally affected with osteoarthritis?
hands, wrists, knees, and feet.
What central joints are generally affected with osteoarthritis?
lower cervical spine, lumbosacral spine shoulders, and hips.
What is the conservative treatment for osteoarthritis?
- rest of the involved joint
- range of motion exercises
- assistive devices
- weight loss if obesity is present
- analgesic andanti inflammatory drug therapy.
Why would surgery be suggested?
- improve joint movement
- correct a deformity or malalignment
- create a new joint with artificial implants
Osteoarthritis referrals
- Rheumatologist, orthopedist,
- physical therapist, occupational therapist,
- dietitian,
- licensed acupuncture therapist
- social worker
What is Rheumatoid Arthritis?
- Insidious onset beginning with general systemic manifestations of inflammation, fever, fatigue, weakness, anorexia, weight loss, and generalized aching and stiffness.
- Gradual local manifestations of painful, tender, stiff joints.
What are the diagnostic criteria for rheumatoid arthritis?
Presence of 4+ of the following, for 6 weeks:
- Morning stiffness for longer than 1 hour
- Arthritis of 3+ joint areas
- Arthritis of hand joints
- Symmetric arthritis
- Rheumatoid nodules over extensor surfaces or bony prominences
- Serum rheumatoid factor present in abnormal amount
- Radiographic changes
Delirium
Clouded consciousness with abrupt onset
- usually do to medication, metabolic problem, infection
Dementia
Syndrome where you loose your intellectual capacity
Delirium v. Dementia
Delirium- acute, reversible, corrected when underlying cause is removed
Dementia- gradual, irreversible, gradual loss of intellectual capacity
What are some common causes of delirium?
- Systemic dysfunction – hypothyroidism, Vitamin B12 deficiency, folic acid deficiency, niacin deficiency, hypercalcemia, neurosyphillis, and HIV
- Substance induced – polypharmacy and inappropriate prescribing of medications, alcohol abuse
What should be screened for annually in a patient with dementia?
Depression- esp. with family hx or depression
Check TSH as well
What drug therapies are used in dementia?
- cholinesterase inhibitors (e.g. Aricept, Elexon, and Razaydne) these work by increasing the availability of acetylcholine in the brain
- Memantine (Namenda) controls calcium and other internuronal messengers to preserve capacity and functionality
