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Clin Med IV: Geriatrics and Hospital Medicine > Changes in Sensation & Function in the Elderly > Flashcards

Changes in Sensation & Function in the Elderly Flashcards

1
Q

what do older patients rely on more to determine foot placemement rather than using proprioception

A

Vision

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2
Q

what are motor performance deficits in older people due to

A

dysfunction of central and peripheral nervous system as well as neuromuscular system

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3
Q

What is included in motor performance deficits

A

coordination difficulty
increased variability of movement
slowing of movement
difficulties with balance and gait

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4
Q

If a older patient has slower information processing, what else can it affect

A

Motor performance

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5
Q

What is oropharyngeal dysphagia

A

AKA transfer dysphagia
-refers to initiation of swallow
transfer of food bolus from hypopharynx to esophagus

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6
Q

What is esophageal dysphagia

A

difficulty passing food to the stomach through the body of the esophagus

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7
Q

what can cause swallowing difficulties

A

mechanical obstruction and altered motor function

common in elderly

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8
Q

on average, how many times does a person swallow per day

A

600 times / day

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9
Q

What cranial nerves are involved in the oral phase of swallowing

A

CN V (trigeminal)
CN VII (facial)
CN XII (hypoglossal)

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10
Q

What cranial nerves are involved in the pharyngeal phase of swallowing

A

CN V (trigeminal)
CN X (vagus)
CN XI (accessory
CN XII (hypoglossal)

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11
Q

At what age goes the brain begin to shrink?

A

30-40 years old, rate of decreasing size ramps up by age 60

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12
Q

what part of the brain changes with age?

A

decrease in white matter (myelinated nerve fibers)
this slows cognitive processing and reduces cognitive function

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13
Q

What is the decrease in dopamine transmission in older people correlated with

A

increased anterior-posterior sway - impaired balance
fine motor control
working memory and executive function

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14
Q

What is the ‘compensation hypothesis’

A

healthy older adults can perform complex motor tasks automatically (like younger peers), they appear to require additional brain activity to perform at the same level as young adults

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15
Q

What interentions can we use to help prevent motor deficits

A

Exercise, exercise, motor training, pharmceuticals, exercise

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16
Q

What are the most common chronic health problem in older patients

A

HTN and arthritis
Hearing

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17
Q

Who usually experiences greating hearing loss at an earlier onset?

A

Men

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18
Q

What are normal conversation frequencies for hearing

A

500 to 3,000 Hz at 45 to 60 dB

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19
Q

how is hearing loss classified

A

Conduction or sensorinueral

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20
Q

what is the cause of conductive HL

A

problems in external or middle ear

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21
Q

what is the cause of SNHL

A

problems converting mechanical vibrations to electical potential in the cochlea and/or in auditory nerve transmissionto the brain

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22
Q

What are risk factors for age-related HL

A

genetics/fhx
noise exposure
regular exposure to 85 dB or more
drug use
chemicals
male
DM, renal failure, atherosclerosis, immunosuppression, head injury
meds
tobacco use
vitamin intake

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23
Q

What are the screening tests for HL

A

whispered voice
Single question - 90% self report
screening version of the Hearing Handicap Inventory
Audioscopy

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24
Q

what does unilateral hearing loss suggest

A

local pathology, obstruction or idiopathic sudden SNHL

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25
What does a rapid onset of HL suggest
possible perforation of TM, trauma or idiopathic sudden SNHL
26
What is idiopathic Sudden SNHL (isSNHL)
develops in less than 72 hoursl usually unilat sound is 'harsh and distorted', accompanied by aural fullness emergency and requires prompt referral MRI with Gadolinium is recommended
27
what is the most common cause of conductive HL
cerumen impaction
28
how can we treat cerumen impaction
curetting, HOH-based solution, warm water irrigation, prescription cerumenolytics
29
what is vision loss in older population associated with
increased fall risk, loss of independecne, depression, increased all-cause mortality
30
how is low vision defined
central visual acuity of 20/70 or worse in better-seeing eye with best correction or total visual field loss of 140 degrees
31
how is legal blindness defined
Cental visual acuity of 20/200 or worse in better sing eye with best correction or a visual field of 20 degrees or less
32
What are major causes of severe vision loss and blindness in older adults
age-related macular degeneration ocular complications of DM Glaucoma age-related cataracts
33
What are risk factors for macular degeneration
smoking, obesity, untreated HTN, age, female, fhx, sun exposure
34
What is the treatment of macular degeneration
vitamin supplements vascular endothelial growth factor inhibitors - injections used for 'wet' MD
35
what does glaucoma cause
progressive damage to optic nerve, leading to visual field loss and irreversible blindness
36
how is glaucoma diagnosed
measurement of IOP in conjuction with optic disc eval and automated visual field test
37
38
what is the treatment of glaucoma
medicated eyedrops to decrease IOP laser trabeculplasty for primary open-angle glaucoma
39
what is assessed with age-related cataracts
red reflex
40
what are risk factors for accelerated cataract formation
UV light exposure smoking
41
what is the treatment of cataracts
no treatment needed surgery is the only effective treatment
42
what causes peripheral neuropathies
m/c is idiopathic followed by DM
43
what is the medial survival time after dementia diagnosis
4.5 years
44
what is the greatest risk for dementia
older age
45
What is the diagnosis criteria for dementia
'major neurocognitive disoers' require deomnstation of significant cognitive decline in atleaset one of the following domains: - complex attention - executive function - language - learning and memory - perceptual-motor - social cognition decline must be based on both subjective and objective findigns, and interfere with IADLs
46
What are examples of IADLs
(Instrumental Activities of Daily Living) managing finances managing transportation shopping and meal prep house clearning/maintenance managing communication managing meds
47
what are the cognitive domains of dementia
complex attention executive function language learning and memory perceptual-motor social cognition
48
What is the screening tools used for dementia
mini-cog, MMSE, MoCA
49
What is included in the mini-cog
- 3 word reptition - clock-drawing - 3 word recall requires < 5 min to complete
50
When are MMSE and MoCA completed
for patient who have a positive Mini-cog MMSE is most commonly used
51
What is the definition of delirium
acute, flunctuating syndrome of altered attention, awareness and cognition precipitated by an underlying condition or event in vulnerable persons ## Footnote AKA 'AMS', 'acute confusional state', 'sundowning', 'encephalopathy', 'acute organic brain syndrome'
52
what is delirium associated with for immediate and long-term outcomes
increased fall risk lengthened hospital stay increase hospital costs increased duration of mechanical vent increased degree of cognitive impairment long-term facility placement mortality
53
what are the subtypes of delirium
hypoactive hyperactive mixed
54
what are behaviors seen with hyperactive delirium
(atleast three ofthe following) hypervigilance, restlessness, fast/loud speach, irritability, comativeness, impatience, swearing, singing, laughing, etx.
55
how should we workup delirium
older persons with delirium require basic workup: CBC, CMP, UA, EKG CT head is recommended if new neuro deficits, hx head trauma or fever associated iwth encephalopathy
56
How is delirium managed
prevention is key avoid constipation/dehydration, assess hypoxia, assess for and treat infection, promote good sleep patterns, supplementation between meals, continually assess for verbal and non-verbal signs of pain pharmacotherapy reserved for patient who are a threat to their own safety or others saftety (haloperidol)
57
what are the most common psychiatric problems among older adults
depression and anxiety
58
what are risk factors for anxiety/depression
female unmarried (esp. for men) lower income having functional limitations believing in an external locus of control fhx of depression/anxiety death of a partner
58
what is the first line pharmacotherapy for MDD
SSRIs
58
what is short and disturbed sleep associated with
poor cognitive and health outcomes
59
what defines apnea
repetitive events while asleep of complete cessation of airflow lsting at least 10 seconds
60
What is classicially associated with OSA
obesity
61
what is CSA
central sleep apnea due to defect in central control of breathing (no respiratory effort) - classically associated with HF
62
What is Cheynes-Stokes respiration
alternating between hypo- and hyper-ventilation
63
what is the gold standard testing for OSA or CSA
polysomnography - sleep testing HSAT (home sleep apnea test) - challenging for some older adults to place sensors
64
what is the first line managmeent of OSA
positive airway pressure therapy (CPAP)
65
What is PLMS
periodic leg movements in sleep - atleast 4 cycles or sterotyped movements in a row
66
What is PLMD
periodic limb movement disorder -diagnosis requires 15 PLMS per house, causes sleep disturbance requires sleep study for dx cause unknown
67
what is circadian rhythm
24 hour biological rhythms that govern hormone secretion, core body temp and sleep-wake cycle
68
what is the suprachiasmatic nucleus (SCN)
internal circadian pacemaker
69
what drives sleep-wake cycles
melatonin secretion
70
what is the treatment of circadian rhythm disorders
appropriately timed bright light therapy can augment with melatonin increased daytime activity quiet environment and dark room at night, cooler temps
71
what is the definition of insomnia
inability to FALL asleep and/or inability to STAY asleep and/or waking up TOO EARLY -has a negative impact on QOL
72
what medical problems are associated with Insomnia
HTN CAD arthritis lung disease GERD CVA and neurodegenerative d/o
73
what are the treatment options for restless leg
iron supplementation if needed (often IV) dopamine agonists - ropinirole, pramipexole calcium channel ligands - gabapentin, pregabalin
74
what is the best tool for evaluating circadian rhythm disorders
comprehensive sleep hisotry (official sleep study not generally needed)
75
what is the first line management for insomnia
CBT (sleep diary for 2 weeks)
76
what are the pharmacologic managements for insomnia
benzodiazephines(Tiazolam, temazepam, lorazepam) - increase risk of falls/confusion non-benzos (zolpidem, zaleplon) - concern for sleep eating/driving melatonin receptor agonists (ramelton) Dual orexin receport agnoists (DORA) - Lemborexant and Suvorexant
76
what is ETOH effect on sleep
creates feeling of relaxation and sleepiness but interferes with sleep length and quality
77
What vitamins/minerals need to be increased in patients > 70 yo
Calcium (1200mg/day) and vitamin D (800 IU/day)
78
what are medical causes of unintentional weight loss
malignancy CHF COPD malabsorption dementia endocrine (DM, hyperthryoidism) end stage liver or renal failure poor dentition, poorly fitting or lack of dentures
79
What are psychological causes of unintentional weight loss
depression, dementia, bereavement, anxiety, parinoia
80
what medication classes can affect appetite and olfactory/taste sensation
antidepressants anti-inflammatories anti HTN, cardiac meds lipid lowering meds antihistamines antimicrobials antineoplastics bronchodilators or other asthma meds muscle relaxants parkinsonism meds anticonvulsants vasodilators

Clin Med IV: Geriatrics and Hospital Medicine (8 decks)

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