how do illnesses generally present in the elderly compared to younger people?
not as apparent
may be vague and indistinct
sxs may be dampened or altered
characteristic ssxs may be missing or be replaced with ones that are more nonspecific
what can affect disease presentation?
multiple and chronic organ system dz impaired homeostatic mechs decrease in general physiologic reserve altered pain perception polypharmacy
what %age of elderly pts won’t have fever, cough or pleuritic sxs with pneumonia?
50%!
T/F: it is common for an elderly patient to be afebrile even when septic
TRUE
when auscultating the lungs with suspected pneumonia in an elderly pt, what will you hear?
may not necessarily hear bronchial breath sounds, egophony or consolidation
but may hear dullness to percussion over areas of consolidation and they may be tachypneic
insidious or nonspecific ssxs of pneumonia in elderly?
confusion, decreased appetite, falling
sudden deterioration or slow recovery from pre-existing primary dz
characteristics of pneumonia in the elderly?
more likely to be bacterial
more likely to develop complications such as empyema or meningitis
more likely to die as a result of pneumonia
common ssxs of UTI in elderly woman? how might urosepsis present?
urinary frequency and urge incontinence, dysuria less common
urosepsis: confusion or altered mental status in absence of systemic signs or infxns such as fever or chills
more common sxs of cardiac ischemia in elderly?
dyspnea commonly seen more than angina pectoris
if elderly pt w/cardiac ischemia were to experience angina where would the pain be?
back of the shoulders or in the epigastric area
what %age of elderly pts experiencing an MI will have no sxs at the time of the event?
greater than 25%!
what is the atypical presentation of an MI in an elderly pt?
vomiting w/or w/o abd pain vertigo confusion syncope or near-syncope falling acute CHF exacerbation of previously stable CHF acute renal failure
what %age of elderly pts will have “silent” ulcers? if pain is present where will it be?
30-50%
if do have pain will be nondescript, poorly localized, not necessarily burning pain, often not relieved by eating, may have misleading patterns of radiation
MC sign of geriatric pts HOSPITALIZED w/duodenal ulcer? next most common presentations?
melena= #1
dyspepsia and TTP on abdominal exam are next 2 MC
first presentation of PUD in the elderly? other ssxs?
may involve a major complication of gastric or duodenal ulceration such as GI bleeding or perforation of an ulcer
others: anorexia, wt loss, confusion
is it easy to dx a perforated ulcer in an elderly pt?
NO- can have poorly localized abd tenderness, no rebound tenderness or absent abd rigidity
when should you suspect PUD w/possible perforation?
unexplained abd pain accompanied by sepsis or GI bleeding
what can lead to fecal impaction in elderly?
low fiber diets low fluid intake decreased motor activity of SM of bowel polypharmacy decreased sensory fxn of rectum and anus decreased physical activity and ambulation
ssxs of fecal impaction in elderly?
anorexia, n/v
paradoxical diarrhea and incontinence of stool
abn pain (maybe)
urinary retention, urinary frequency, overflow incontinence
MC thyroid dz in elderly?
hypothryoidism–> AI thyroiditis
why has it historically been difficult to dx hypothyroidism in the elderly?
fatigue, weakness, cold intolerance, dry skin, constipation, lethargy –> usu all falsely attributed to “old age”
common ssxs of hypothyroidism?
failure to thrive wt loss constipation falling muscle weakness congestive heart failure anemia depression dementia coma recent onset edema carpal tunnel syndrome
initial presentation of hyperthyroidism in the elderly?
paradoxical apathy- apathy and inactivity
also see depression, lethargy, CHF, constipation, muscle weakness
is thyrotoxicosis common in the elderly?
NO
when should you consider running a thyroid panel?
when an elderly pt has unexplained changes in his or her mental, emotional or physical state
most common ssx of hyperparathyroidism??
GI complaints such as: n/v anorexia wt loss abd pain dyspepsia constipation possibly can also present w/depression, anxiety, decreased memory, personality change, delirium, acute psychosis
causes of delirium in the elderly?
medications pneumonia CHF MI pulmonary embolus sepsis (mostly urosepsis) surgical abd/fecal impaction endocrine d/os dehydration electrolyte abnormalities hypoxemia
*by definition need at least 2 of the following to form a dx of dementia:
change in memory, language, personality, emotions, motor skills
