Wk 10 pt 2: Older adult PE (incl. in 9%)

Question 1

Blood pressure:
1) With aging, ______ and __________________ increase, whereas __________ decreases (widening pulse pressure)
2) Isolated systolic hypertension (SBP ≥140 mmHg with DBP <90 mmHg) after age 50 and widened pulse pressure >60 increases risk for what 3 things?

Answer 1

1) SBP and peripheral vascular resistance; DBP
2) Stroke, renal failure, and heart disease

Question 2

1) Define orthostatic hypotension
2) What % of older adults does it occur in?
3) List 4 symptoms

Answer 2

1) Drop in SBP of >20 mmHg or DBP of >10 mm Hg, increase of HR of 20 BPM, or dizziness within 3 minutes of standing
2) 20%
3) Lightheadedness, weakness, unsteadiness, and visual blurring

Question 3

Heart rate and rhythm:
1) Resting HR is unchanged, but ___________________ declines, affecting response to exercise and physiologic stress.
2) Why?
3) What abt heart rhythm can change w age?

Answer 3

1) maximal heart rate
-Due to slowing of pacemaker cells in SA node and blunted β-adrenergic response (Beta blockers may also do this)
3) More likely to have abnormal heart rhythms

Question 4

1) Does RR change w age?
2) What do age-related changes in temp. regulation lead to?

Answer 4

1) No; respiratory rate unchanged
2) Susceptibility to hypothermia

Question 5

What is the “5th vital sign” in older adults?

Answer 5

Functional Status

Question 6

1) Assessment of older adults places special emphasis on maintaining what 2 things?
2) Maintaining what is the primary focus?

Answer 6

1) Independence and optimal level of function
2) Functional status

Question 7

1) A number of performance-based assessment instruments for functional status are available, such as what? What does this screening assess?
2) Patients should also undergo risk factor assessment for _______

Answer 7

1) 10-Minute Geriatric Screen; physical, cognitive, and psychosocial factors
2) falls

Question 8

1) What happens to skin in old age?
2) What happens to nails?
3) What abt hair on the head and body?

Answer 8

1) Becomes fragile, loose, and transparent (hands/forearms); purple patches/macules called actinic (or senile) purpura are frequently seen
2) Lose luster, yellow, and thicken, especially toes
3) Loses pigment and hairline recedes; also, loss of hair occurs elsewhere (incl. trunk, pubic area, axillae and limbs, which is normal)

Question 9

What happens to the eyes with old age?

Answer 9

Eyeballs recede into orbit, corneas lose luster, pupils become smaller, dry eyes are a common complaint, and presbyopia occurs in nearly everyone.

Question 10

List the 2 types of macular degeneration.
Which is more common and less severe? Which is neovascular?

Answer 10

Two types:
1) Dry atrophic: more common, less severe
2) Wet exudative: neovascular

Question 11

List 2 symptoms of macular degeneration

Answer 11

1) Poor central vision
2) Blindness

Question 12

What is the leading cause of visual impairment?

Answer 12

Cataracts

Question 13

List some of the multiple risk factors for cataracts

Answer 13

1) Cigarette smoking
2) High alcohol intake
3) Diabetes mellitus (DM)
4) Medications (e.g., steroids)
5) Trauma

Question 14

1) Define glaucoma
2) What does it lead to?

Answer 14

1) Increased intraocular pressure
2) Optic nerve damage

Question 15

1) Acuity of hearing diminishes with age, known as _______________.
2) Define this condition

Answer 15

1) presbycusis
2) Can’t catch upper tones of words while hearing lower ones, causing words to sound distorted

Question 16

What changes happen to the mouth with old age? What can also often account for these?

Answer 16

Diminished salivary secretions (dry mouth) and decreased sense of taste occurs
-Medications and disease often account for this

Question 17

What changes happen to the thorax and lungs w old age? Which has little effect on function?

Answer 17

1) Capacity for exercise decreases
2) Chest wall stiffens
3) Skeletal changes accentuate dorsal curve producing kyphosis, but resulting “barrel chest” has little effect on function

Question 18

In older adults:
1) Systolic bruits heard in middle or upper portions of carotid arteries suggest what? From what?
2) What does having an S3 strongly suggest after age 40?

Answer 18

1) Partial arterial obstruction; atherosclerosis
2) Heart failure and dilatation of the left ventricle from CHF

Question 19

1) S4 can be heard in healthy older people, but often suggests decreased ____________ and impaired _______________.
2) What may occur as a result?

Answer 19

1) ventricular compliance and impaired ventricular filling
2) LVH (left ventricular hypertrophy)

Question 20

1) What aortic condition is common in older ppl?
2) Aortic sclerosis results from what? Does it impede blood flow?
3) What condition results when leaflets become calcified and immobile (which can cause outflow obstruction)?

Answer 20

1) Systolic aortic murmurs
2) Fibrosis and calcification; does not impede
3) Aortic stenosis

Question 21

1) Aortic sclerosis and aortic stenosis increase risk of CV ________ and ___________
2) Mitral regurgitation usually occurs how much later aortic sclerosis? Can it become pathologic? Why/ why not?

Answer 21

1) morbidity and mortality
2) A decade later; may become pathologic as volume overload increases in the left ventricle

Question 22

[Peripheral vasc]:
Diminished or absent pulse may indicate what?

Answer 22

Arterial occlusion

Question 23

[Abd]:
Widened abdominal aorta and pulsatile mass is seen in what condition?

Answer 23

Abdominal aortic aneurysm (AAA)

Question 24

1) In the aging female, breasts diminish in size as glandular tissue atrophies and is replaced by ______.
2) Ducts surrounding nipples become more palpable or less palpable? Explain.

Answer 24

1) fat
2) More palpable as firm, stringy strands

Question 25

In older adults:
1) Fat tends to accumulate in the ______________ and _________________, although total body weight remains stable.
2) Manifestations of acute abdominal disease are often in the _________ abd; pain is __[more/ less]__ severe and fever __[more/ less]__ pronounced.

Answer 25

1) lower; near the hips
2) blunted; less

Question 26

In older men:
1) True or false: Sexual interest remains intact with aging but frequency declines
1a) Erection is __________ dependent on tactile stimulation.
1b) Erectile dysfunction affects what fraction of older men?

Answer 26

1) True
1a) More
1b) Half

Question 27

1) Menstrual periods typically cease between what ages? What is the median?
2) Women often experience hot flashes for up to how many years? What are 3 other symptoms they may have?
3) Within how long are the ovaries usually no longer palpable?

Answer 27

1) 48-55; median 51 years
2) Five year; vaginal dryness, urge incontinence, or dyspareunia
3) 10 years

Question 28

1) Proliferation of prostate epithelial and stromal tissue (aka benign prostatic hyperplasia (BPH)) begins in what decade?
2) What decade does it continue to and what happens then?
3) How many men w BPH have symptoms?

Answer 28

1) Third decade
2) Until the seventh, then plateaus
3) Only half

Question 29

[MSK in old age]:
1) Sig. shortening becomes obvious in old age; most loss of height occurs in the trunk bc of what two things? Why?
2) What happens to skeletal muscles w old age?
3) What happens to ROM? Why?

Answer 29

1) IV discs become thinner and vertebral bodies shorten/collapse from osteoporosis; s
2) Decrease in bulk and power
3) Decreases; osteoarthritis

Question 30

[Nervous syst.]:
1) True or false: aging may affect all aspects of the nervous system, from mental status to motor and sensory function and reflexes.
2) What do most elders do well on? Explain what the caveat to this is and give an example.
3) Is it difficult to distinguish nervous changes of normal aging from age-related or other diseases?

Answer 30

1) True
2) Mental status exam; selected impairments become evident, ex: “benign forgetfulness” causes difficulty in recalling names, objects, and certain details
3) Yes, difficult

Question 31

(Nervous system in old age)
1) What should you pursue if any deficits are noted?
2) What 2 things should you focus on especially?
3) What 2 abnormalities correlate w risk of falls?

Answer 31

1) Further examination
2) Memory and affect
3) Gait and balance

Question 32

[General survey in older adults]:
What 4 things suggest frailty?

Answer 32

Undernutrition, slowed motor performance, loss of muscle mass, and weakness

Question 33

List clues for detecting alcohol abuse [in older adults]

Answer 33

1) Memory loss
2) Depression, anxiety
3) Neglect of hygiene, appearance
4) Poor appetite, nutritional deficits
5) Sleep disruption
6) Hypertension refractory to therapy
7) Blood glucose control problems
8) Seizures refractory to therapy
9) Impaired balance and gait, falls
10) Recurrent gastritis and esophagitis
11) Difficulty managing warfarin (Coumadin) dosing
12) Use of other addictive substances such as sedatives or narcotic analgesics, illicit drugs, nicotine.

Question 34

True or false: Signs and symptoms of alcohol abuse/ use disorder may be subtler in older adults

Answer 34

True

Question 35

starred
Screening tools for alcohol

Answer 35

CAGE Questionnaire
≥1-2 affirmative answer(s) is a positive test
Single-item screening:
Q: “How many times in the past year have you had five (four for women) or more drinks in a day?”
Positive for unhealthy alcohol use if answer is >0

Question 36

List the 4 CAGE questions

Answer 36

1) Have you ever felt you shouldCut downon your drinking?
2) Have peopleAnnoyedyou by criticizing your drinking?
3) Have you ever felt bad orGuiltyabout your drinking?
4) Have you ever taken a drink first thing in the morning (Eye-opener) to steady your nerves or get rid of a hangover?

Question 37

1) What test is preferred over CAGE?
2) What does this test identify?
3) How many questions and what’s the scoring?

Answer 37

1) Alcohol Use Disorders Identification Test-Concise (AUDIT-C)
2) Not just harmful drinkers detected by CAGE, but also hazardous drinkers who have not yet reached that level of harm (early intervention to reduce consumption)
3) 3 Questions, scored from 0-12

Question 38

What are the 3 questions for the Alcohol Use Disorders Identification Test-Concise (AUDIT-C)?

Answer 38

1) How often did you have a drink containing alcohol in the past year?
2) How many drinks did you have on a typical day when you were drinking in the past year?
3) How often did you have 6 or more drinks on one occasion in the past year?

Question 39

What 5 questions should you ask abt military hx?
(per VA Military Health History Pocket Card for Health Professions)

Answer 39

1) Gen. Qs.: Mil. Exp., when/where, what, effects
2) PTSD: See combat, enemy fire, casualties; feel numb, detached, nightmares, over-watchful, startled, work hard not to think about it?
3) Service-connected condition/ blood transfusion
4) Exposure: Chem, Biolog., Rad., smoke, noise? (when, how long, are you concerned about it?)
5) Living conditions, safety, soc./econ. status?