Midterm Flashcards
What are mistakes made with geriatric medicine
- Mistake pure aging for disease or disease for pure aging
- diseases and problems are much more common
- Ignoring increased risk of adverse drug effects
- Forget that there are often multiple underlying disorders that accelerate potential for harm
Aging stats
14% of US pop. uses over 40% of health care resources (ages 70-75)
by 2026 over 20% of pop will be over 65 (10,000 more a day)
What is respite care?
A provision of temporary care by a substitute caregiver to provide relief to a regular caregiver. Can be fulfilled in home, at a facility or hospital
Which are the most vulnerable organ systems in the body?
Renal, cardiac and CNS
Common age related changes
- Decline in all 5 senses
- Lower muscle mass, bone density and ligament elasticity
- Greater likelihood of chronic disease and increased incidence of cancers
What is age caused disease?
The result of sensence:
- cardiovascular inelasticity
- Decline in sensory abilities
- Diminished sight
What is age related disease?
Common with aging:
Depression
Loss of vision
How much of aging is due to extrinsic factors?
85%! (65% environmental)
Less than 35% of aging is due to heritability
What are weight loss terms for the elderly
- Sarcopenia: loss of muscle mass (intrinsic age related condition)
- Cahcexia: Loss of fat-free mass (esp. body cell mass) with little to no weight loss
- Wasting: unintentional loss of weight, including both fat and fat-free components (this develops later AFTER first two)
What are leading causes of death in those over 65?
- Heart disease
- Malignant neoplasm
- Cerebrovascular disorders/stroke
- COPD, pneumonia, atherosclerosis, DM, accidents, kidney issues, chronic liver disease
- Alzheimer’s, Suicide??
What are the top 10 chronic conditions in the elderly?
- Arthritis
- HTN (pseudo, isolated)
- Hearing impairment
- Heart disease
- Deformity or Orthopedic impairment
- Visual impairment
- Diabetes
- Varicose veins
- Abdominal hernia
What % of elderly patients complain of constipation? Why is it a big deal?
30%
Can result in fecal impaction or other life threatening problems, plus its not “normal”
Why do elderly patients get constipation?
- Changes in tone, sensation and motililty
- Psychological issues
- medications
- diet
- lack of exercise
- GI, metabolic or neurologic conditions
Top 3 diagnoses for an elderly patient with radiculopathy?
- DJD with osteophytes
- Stenosis
- Tumor
Disc herniations not as common because discs dry out
What are the most common risk factors for aytpical presentations?
- Increasing age
- Multiple medical conditions (multimorbidity)
- Multiple medications
- Cognitive or functional impairment
What are good potential questions for elderly patients with new symptoms?
- Is the patient usually quiet or is this new?
- Are they are “fidgety” or more hyperactive?
- Any weight loss?
- New meds that correspond with symptoms?
- Past infections? what signs did they have?
- New change in mobility?
What are atypical presentations for infectious diseases?
- Absence of fever
- Sepsis without usual leukocytosis and fever
- Confusion
- Falls
- Decreased appetite or fluid intake
- Change in functional status
What are atypical presentations for “silent” acute abdomen?
- Absence of symptoms (silent presentation)
- Mild discomfort or constipation
- Some tachypnea
- Possibly vague respiratory symptoms
What is the classic atypical presentation of MI in elderly patients?
shortness of breath (more common than chest pain)
Atypical presentation of HYPOthyroid?
- Most common symptoms are nonspecific
- Cognitive dysfunction more common in elderly
- Most specific sign: delayed DTRs (hard to detect in elderly)
Atypical presentation of HYPERthyroidism?
- Patients may appear apathetic (rather than hyperkinetic)
2. Fatigue and “slowing down”
What is a DNR
- Advance directive of what patient wants when they can no longer speak for themselevs
- Moldable, changeable and personal legal document
- Other forms of advanced directives: living will, power of attorney, health care proxy
Can chiro’s sign death certificates?
yes as well as MDs, DOs, NDs and NPs
Why might elderly patients undereport health conditions?
- Health beliefs
- Fear
- Depression
- Altered physical and physiological responses to disease processes
- Cognitive impairment
What are important aspects of social history for elderly patients?
- Living arrangements
- Relationship to family and friends
- Expectations of family or other caregivers
- Economic status
- Abilities to perform ADLs
- Social activities and hobbies
- Mode of transportation
- Advance directives
History and physical exam on elderly patients
- put aside your own prejudices about aging
- Realize patients have their own expectations and prejudices about aging and dying
- Patients may assume symptoms are a normal part of aging or may fear it
- Be aware of the age gap between you and your patients
What are common types of elder abuse?
- Financial exploitation (misuse of funds or property)
- Neglect (personal hygiene, medical care, health hazards, malnutrition)
- Verbal or emotional abuse (threats, harrassment, isolation, withholding emotional support)
- Physical abuse (constraint, meds)
- Abandonment or isolation
- Sexual abuse
What are clues for abuse in the elderly?
Be aware those 75+ especially may deny abuse
- Unkempt, missing hair
- Malnourishment/dehydrated
- untreated medical conditions/bruises in various stages of healing or without good explanations
- Caregiver restricting a person’s contact with others
- Elder not given the chance to speak for themselves
- Family with Hx of drug/alcohol abuse
What is the minimum font type for elderly patients? how can you make things easier to read?
14 point font
Provide reading glasses or magnifying glass
Provide quiet room (limit background noise)
What is a comfortable room temp when wearing a gown?
75 degrees
How is scheduling elderly patients different?
Allow extra time (like a new patient) due to more health issues, slower moving, more complex history and exam
What is happy patient syndrome?
Under-reporting and being socially polite so they don’t seem like a complainer
Baltimore longitudinal study of aging says:
- Consider exercise and physical acitivities
- Pay attention to weight and shape
- Careful about what you eat
- Participate in activities you enjoy
What should you know about sleep disorders in general?
- Half of americans hav difficulty sleeping (25% with serious issues)
- Second to colds in reasons why older patients present to doctors
- People over 60 prescribed sedatives 2x as often
What is sundowning?
disruptive sleep behavior at night (ALZH)
Why does sleep change with age?
- Spend more time awake and in less deep sleep
- Circadian rhythms change to advanced sleep syndrome (8pm-4am)
- meds and their side effects change sleep
- Insomnia more prevalent (44%)
- snoring can become worse with age (and with weight gain)
- RLS, apnea and GERD more common with age
What are conditions almost exclusive to the elderly?
- Urinary incontinence
- Alzheimers disease
- Diastolic heart failure
- Accidental hypothermia
Conditions you should screen for in the elderly because they are more common
- Degenerative OA and OA
- Prostate cancer
- Falls
- Hip fracture
- Stroke
- Dementia
What should you know about the skin of the elderly?
- It is a less effective barrier
- Vulnerable to trauma, tears and bruising, easily irritated
- Be careful with STM and lotions
- Decreased shock absorption
- Slowed healing
- Vascular insufficiency
- Dehydration
The are the functional I’s?
- Immobility (deconditioning?)
- Instability (falls?)
- Incontinence (isolation?)
- Intellectual impairment
- Infection
- Impairment of vision/hearing
- iatrogenic drug interactions
What should you consider about immobility in the elderly?
- Result of pain syndromes from arthritides, trauma or muscular disorders
- Can exacerbate various arthritides leading to further disability and osteoporosis and/or sarcopenia
