Older Adult Flashcards
by 2030 how much of the US population will be 65 years or older
20% (70 million)
in 2020 what was the life expectancy
78.93 Years
what percentage of 65 year olds or older live within the community
95%
what percentage of 85 years or older live in institutions
10%
what is important to focus on for the older adults assessment
healthy or “successful” aging
- understand and mobilize family, social and community supports
-importance of functional assessment
-promote older adult’s long-term health and safety
what are the goals of care for the older adults
Not just maximize life span, but maximize HEALTH span (maintain function, fulfilling, active lives, promote healthy aging)
what are the patients goals?
what are changes in physiologic reserve that occur over time called?
primary aging
what are the changes in vital signs with aging
Blood pressure: HTN or auscultatory gap
HR and rhythm: decline in function of pacemaker cells, affects response to physiologic stress
temp: changes in temperature regulations leads to susceptibility
what occurs due to loss of subcutaneous tissue (esp fat) with aging
actinic (solar or senile) purpura
what is “onion skin”
fragile, loose or transparent (hands/forearms) skin
what is presbyopia
age related vision loss; need for reading glasses
what are age related eye changes
eyeballs recede into orbit
corneas lose luster
pupils become smaller
dry eyes are common (less secretions from lacrimal glands)
presbyopia
increase risk of glaucoma, macular degeneration, cataracts
what is presbycusis
decreased hearing - lose higher tones
what are the thorax and lung changes with age?
decrease in exercise capacity - can be cardiac, pulmonary or both
chest wall stiffens - increased work to breath
kyphosis due to osteoporosis
what is S3 after age 40 suggestive of?
strongly suggests heart failure
what is S4 suggestive of
can be heard in healthy older people, but usually suggests decreased ventricular compliance and impaired ventricular filling
what increases risk of CV morbidity and mortality
aortic sclerosis and aortic stenosis
what is aortic sclerosis
fibrosis and calcification
dose not impede blood flow
what is aortic stenosis
leaflets become calcified and immobile
outflow obstruction
what are breast changes with age
diminish in size - glandular tissue atrophies and is replaced by fat
ducts surrounding nipples become more palpable and firm, stringy stands (calcification deposits)
what are the abdomen changes with age
fat accumulates in lower abdomen and near the hips
signs of acute abdominal disease is blunted
what are the Male GU changes
Intercourse: sexual interest remains intact, frequency declines, erection is more dependent on tactile stimulation and ED in 1.2 of older men
prostate: Bengin prostatic hyperplasia (BPH)
what is BPH changes in men with age
benign prostatic hyperplasia
proliferation of prostate epithelial and stromal tissue
typically begins in the third decade
continues until the 7th and then plateaus
only half of men with BPH have symptoms
what are the female GU changes with age
Menopause: loss of estrogen tone
periods cease between age 48-55
hot flashes for up to 3 years
vaginal dryness
urge incontinence
dyspareunia
within 10 years, ovaries are usually no longer palpable
where is most of the height loss occurring from
the trunk due to thinning of the intervertebral discs
what is benign forgetfulness
can occur at any age
difficulty in recalling names, objects and certain details
what are geriatric syndromes
cognitive impairment
delirium
incontinence
malnutrition
falls
gait d/o
frailty
sleep d/o
sensory deficits
fatigue
dizziness
Depression
what are multidimensional problems
hearing
vision
polypharmacy
mobility
what is dyspareunia
painful sex
what are special areas to assess with the older populations
function status
polypharmacy
fall risk
cognitive problems
moods/depression
nutrition
incontinence
vision/hearing
social supports
financial concerns
goals of care
advance directives
what is absolutely vital to assess in the older populations
functional status
-ADLs
-Instrumental activities of daily living (IADLs)
What are IADLs
instrumental activities of daily living
food shopping, driving or using public transportation, using the phone, housework/home repair, making meals, laundry
taking meds, handling fincances
what is the Katz Index used for
assesses independence in activities of daily living
6= independent 0= very dependent
what is Lawton-brody used for
assessing instrumental activities of daily living scale
what is the risk of adverse reactions in older adults increases with the number of meds
13% with 2 meds
58% with 5 meds
82% with 7 or more
what is the prescribing cascade
adverse drug reaction is misinterpreted as a new medical condition, and so a new medication is prescribed
what is an independent risk factor for hip fractures
polypharmacy - use of drugs affecting CNS
what is Beers Criteria
used to assess inappropriate drug prescribing in older adults
*list of medications considered potentially inappropriate for use in older patients, mostly due to higher risk for adverse events
what are the 5 categories of the Beers Criteria
drugs that are potentially inappropriate in most older adults
drugs that should typically be avoided in older adults with certain conditions
drugs to use caution
drug-drug interactions
drug dose adjustment based on kidney function
what is the most modifiable risk factor for falls
medication use
what are falls associated with
decline in functional status
increased chance of nursing home placement
increased risk of death-immediate or subsequent
greater use of medical services
what are factors that play into falls
biological: weakness, mobility issues, balance, vision
Behavioral: psychoactive med, 4+ meds, risky behaviors, inactivity
Environmental: clutter and tripping hazards, no stair railings or grab bars, poor lighting
What is the TUG screen
Timed Up and Go
evaluates gait, strength and balance
greater than or equal to 12 seconds to complete is at risk of falling
What are the tools used for cognitive issues/assessment
MOCA - early decline
MMS (mini-mental status) - monitoring
Mini-cog - yes/no for further screening
what are the nutritional concerns with the older populations
malnutrition is associated with increased mortality - weight loss can predict mortality
>70% of hospitalized older adults are at nutritional risk or are malnourished
how do we assess nutrition with older populations
serial measurement of body weight
‘have you lost 10lbs over the past 6 months without trying?’
multiple tools
what is the affect on urinary incontinence
major cause of social and emotional distress - can play a role in nursing home placement
increased risk in diabetics
multifactorial
what are the factors that can play a role in fecal incontinence
decreased strength of external sphincter
increased rectal compliance
medications
lactose intolerance
poor mobility
how often should the older populations obtain Tetanus immunizations
every 10 years (one dose of Tdap if never recieved)
What are the cancer screenings done for the older populations
colorectal: age 45-75
Breast: Biennial mammo ages 50-74
Lung cancer: age 55-80, 30 pack years, current smoker or quit in last 15 years
Prostate cancer: individual discussion with patient
cervical: can stop at age 65 if previous screening was adequate and negative
when is osteoporosis screened fo
postmenopausal women < 65 yo at higher risk
all women age 65 and older
when does colorectal cancer screening begin
average risk adults: begin screening at age 45
multiple test can be used to screen patients
what are the different colorectal screening tests
High sensitivity guaiac-based fecal occult blood (gFOBT)- 3 stool specimens, 2 samples
Fecal immunochemical testing for hemoglobin (FIT)
FIT-DNA testing (cologuard)
Flexible sigmoidoscopy (“flex-sig”)
colonoscopy
CT colonography
when should advanced care planning be done
should be done at all ages, not just older adults
want to ensure that pt gets care that is consistent with their own goals, values and preferences.
what are the benefits of advance care planning
increase chance that the provider and families will comply with pts wishes
decrease hospitalization at the end of the life
receive and needs less intensive treatments at end of life
increased use of hospice
better chance that the pt will die in their preferred place
higher satisfaction with Quality of care
what are Advanced directives?
done while pt still can make decisions
ONLY acted upon if pt loses ability to make decisions for themselves
