the geriatric patient part 3

Question 1

what is gerontology

Answer 1

Gerontology is the study of aging, including biologic, sociologic, and psychologic changes.

Question 2

what is typically considered the age that is considered “old age”

Answer 2

age >65 because this determines eligibility for medicare insurance in the US

Question 3

what are the top 15 causes of death in people >65

Answer 3

1. diseases of the heart
2. malignant neoplasms
3. COVID-19
4. cerebrovascular diseases
5. alzheimer’s disease
6. chronic lower respiratory disease.
7. Diabetes mellitus
8. accidents (unintentional injuries)
9. nephritis, nephrotic syndrome and nephrosis
10. influenza and pneumonia
11. parkinson disease
12. essential hypertension and hypertensive renal disease.
13. septicemia
14. chronic liver disease and cirrhosis
15. pneumonitis due to solids and liquids

Question 4

what is the pathological process of aging

Answer 4

the inevitable, irreversible decline in organ function that occurs over time even in the absence of injury, illness, environmental risks or poor lifestyle choices.

Question 5

what are the most affected systems in the pathological process of aging

Answer 5

• CV
• renal
• CNS

occurs from inflamation, tumor growth, thrombosis, necrosis, fibrosis, atrophy, pathological hypertrophy, dysplasia or metaplasia.

Has abnormal or deleterious effect at the sub cellular, cellular, multicellular or organismal level

Question 6

what are four things that clinicians should assure to NOT do when observing/treating elderly patients

Answer 6

• mistake pure aging for disease
• mistake disease for pure aging
• ignore the increased risk of adverse drug effects on weak link systems stressed by illness
• forget that older adults have multiple underlying disorders that accelerate the potential for harm

Question 7

flip this for the chart that breaks down agings affects of physical and cognitive frailty

Answer 7

Question 8

what does frail mean?

Answer 8

weak/delicate

Question 9

what is frailty in elderly populations

Answer 9

A vicious cycle of declining energetics and reserves that leads to a progressive decline in health and function

Question 10

what are the primary causes of physiologic decline at the molecular level

Answer 10

• biological mechanisms
• pathophysiologic biomarkers
• clinical presentation (cog and physical impairments

Question 11

what are examples of biological mechanisms for physiologic decline

Answer 11

• mitochondrial dysfunction
• telomere shortening
• Stem cell exhaustion
• DNA damage
• DNA methylation
• impaired autophagy
• oxidative stress
• senescence

Question 12

What are examples of pathophysiologic biomarkers

Answer 12

• inflammation
• weight loss
• poor endurance
• weakness
• neurodegeneration
• energy imbalance
• anabolic hormone deficit

Question 13

What are the clinical presentation cognitive and physical impairments that occur in physiologic decline

Answer 13

• cognitive impairment
• reduced mobility
• slowness
• low physical activity
• depression
• impaired physical function
• multiple chronic diseases
• Loss of independence

Question 14

what is the difference between homeostasis and homeostenosis

Answer 14

in homeostasis the body CAN recover from stress

in homeostenosis the body CANNOT recover from stress

Question 15

what are presentation and diagnosis aging considerations for the elderly population

Answer 15

• atypical presentations of medical conditions
• older people may not have spiking fevers or elevated white blood cell counts with an infection
• heart disease may be silent
• Cognitive and affective disorders are common and may be undiagnosed in early stages
• Reversible and treatable conditions can be under-diagnosed and under-evaluated

Question 16

what are testing and imaging aging considerations for the elderly populaiton

Answer 16

• imaging may reveal abnormalities that may/may not be related to sx’s
• consider no subsequent testing and treatment among individuals who will not suffer morbidity and mortality from the disease because of limited life expectancy
• physiologic changes associated with aging can affect the results of common diagnostic tests; interpret with caution
• cardiac monitoring can identify arrhythmias; must be linked to symptoms or adverse outcomes before considering potentially toxic medications or invasive procedures

Question 17

what are common geriatric concerns

Answer 17

• polypharmacy
• cognitive impairment
• urinary incontinence or overactive bladder
• sleep disorders
• elder abuse and neglect
• covid
• end of life and pallative care
• hip fractures
• falls
• pressure ulcers
• gait problems
• delerium
• malnutrition
• dizziness & syncope
• self-neglect

Question 18

what are Key principles for effective care of the geriatric population

Answer 18

• Aging is not a disease, it is due to homeostenosis
• medical conditions are often multiple and multifactorial in origin
• many reversible and treatable conditions are under-diagnosed and under-evaluated
• cognitive and affective disorders are common
• iatrogenic illnesses are common (illness related to exam or treatment)
• functional ability and quality of life are key goals of care
• social hx, social support and patient preferences are critical
• effective geriatric care requires interprofessional collaboration
• geriatric care is provided largely outside the hospital
• ethical issues, palliative care, and end-of-life care are critical aspects of caring for the elderly