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DT4- Exam 3 > Goebel- Geriatrics- Melissa > Flashcards

Goebel- Geriatrics- Melissa Flashcards

1
Q

Which demographics live the longest and the shortest?

A
  • Hispanic women live longest!

- Black males live the shortest.

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2
Q

What is the life expectancy at birth for men and women? How does this change if you live to be 65?

A

Women= 81
Man = 76
If you make it to 65 you have a good chance to live another 19 years

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3
Q

What is homeostenosis?

A

As age increases, you use more of your physiologic reserves to maintain homeostasis.

So, It takes much less of insult to compromise your health/ independence/ need for assistance…

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4
Q

Describe some of the general changes that occur in physiologic aging regarding lean muscle mass and fat composition?

A
  • decrease in skeletal mm mass and bone mass
  • increase in fat throughout tissues; fat accumulates in organs, especially the liver

***These patients are not overweight, but have more fat on their bodies.

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5
Q

Why is it important to consider changes in lean muscle mass and fat composition when prescribing drugs? Which drug is the most important one to consider here?

A
  • Half life will increase in fat soluble drugs

- VALIUM: patients may sleep for three days instead of one night!!!

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6
Q

Describe changes in body temperature regulation with aging?

How about immune system?

A
  • Body temp regulation: ^ risk hyper and hypothermia
  • Difficulty mounting fever response
  • Thymic involution (T cells depleted…) / weakened response to VACCINES
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7
Q

Describe one difficulty that can cause incontinence in elderly patients? How does their total body water change? How does their thirst response change?

A
  • Total body water is decreased and thirst response is decreased!
  • Patients may also be resistant to drinking more water due to incontinence
  • DRINKING WATER WILL ACTUALLY HELP INCONTINENCE!!!
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8
Q

Describe changes in patient blood pressure with aging

A

Patient’s blood pressure typically will increase, and patients will have more orthostatic HypoTN

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9
Q

How does vision change in the elderly?

How about hearing, taste, and sense of smell?

A
  • Lose accommodation in mid 60’s
  • Difficulty with night vision; need night light to get to bathroom, will also need reading glasses
  • High frequency hearing
  • Taste and sense of smell decline
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10
Q

Describe how normal aging changes the vasculature.

How about the heart valves; what is this change called?

How is heart conductivity changed; for what condition are elderly patients at risk?

A
  • Vasculature: ^ thickness, DECREASE elastin–> vessels become like thick pipes
  • Ca++ in heart valves will yield murmur (aortic sclerosis)
  • fatty infiltrate into electrical syndrome (sick sinus syndrome)
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11
Q

How will stimulant drugs affect elderly hearts?

A
  • ^ Epi and NE at baseline

- Giving these patients stimulants will not increase HR as much in younger patient

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12
Q

Describe the general cognitive impairments associated with normal aging

A

Difficulty with encoding, retrieval and storage of info, multitasking

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13
Q

How does normal aging affect mobility and peripheral nerves?

A
  • Resumption in spinal cord motor neurons, less nerve terminals and NT release
  • Peripheral neuropathy (age related)
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14
Q

What are the normal aging changes in the lung –what obviously will exacerbate these changes?

A

Decreased elasticity and FEV1; Curve exacerbated by smoking

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15
Q

How is the GI tract changed with normal aging; what condition is common in elderly patients?

A

Intermittent dysphasia is common and often due to Presby’s esophagus (spasms and looks like corkscrew on barium swallow)

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16
Q

How is the renal system impacted by normal aging and what are the clinical implications of these changes?

A
  • Many patients have stage III CKD
  • GFR = 30-60 T
  • This is important for drug metabolism!
17
Q

For which drug is it exceptionally important to really adjust in cases of CKD?

A

Gabapentin: can only take 2x per day if you have kidney disease (vs. typical 3x per day)

18
Q

Three take home points/ changes regarding normal aging:

A
  • Decrease reserve capacity for homeostenosis
  • Decrease ability to respond to stress
  • General INCREASE in vulnerability
19
Q

How do elderly patients present with pain?

A

Sensation may be blunted and patients may minimize complaints

20
Q

What are some things you should consider in an elderly patient with new onset headache?
Is this common?

A

**HA as a new complaint is uncommon

Consider:

  • Temporal arteritis
  • Trigeminal neuralgia
  • VZ/ Shingles, subdural hematoma w hx of fall, metastatic disease w hx of cancer
21
Q

What should you always examine in SOB complaint? What is common in elderly patients with new or worsened SOB?

A
  • more arthritis in chest

- examine the skin: **shingles

22
Q

Abdominal pain in the elderly is…

A

More likely to be serious; elderly more likely to get super sick from appendicitis and stuff

23
Q

***All conditions causing fever in young patients may present how in elderly patients?

A

Wthout fever in the elderly; like pneumonia!!!

24
Q

Never ignore which two complaints in elderly patients?

A

weakness and fatigue; may be ominous– pay special attention to new or worsened weakness of fatigue

25
Q

True MSK weakness will present how?
How can HYPERthyroidism affect elderly patients?
How will insults (hospital stays, etc.) affect elderly patients?

A
  • True MSK weakness then they will be asymmetrical
  • HYPERthyroidism patients may be tired!!!
  • Take longer to recover from hospital stays/ bedridden situations… spring back more slowly
26
Q

How do we address anorexia and weight loss in the elderly? What should we examine/ look into?

A
  • Check for anemia and DM, CHF, chronic lung disease (burn lots of cals just trying to breathe!)
  • Check meds for ADRs
  • Work up for depression, memory loss (forget to eat), and hyperthyroidism
27
Q

Acute confusion, delirium, weakness and dizziness, not eating well, exhaustion, and failure to thrive, falls are all…

A

things to expect in elderly patients

28
Q

Define Agism:

A

Withholding treatment or discriminating based on age: i.e. assuming they’re not sexually active

29
Q

Things to aspire to when communicating with demented patients; what should you never do and what kind of questions should you ask?

A

Calmness, yes or no answers, listen well, repeat and rephrase—may not understand words, don’t ARGUE with them

30
Q

How are elderly patients a bit more demanding on a doctor’s schedule?

A

Elderly patients may require longer office visits; you have to do things like write down directions, etc. (Goebel spends 30 min with each patient)

DT4- Exam 3 (14 decks)

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