Chapter 20: The Older Adult Flashcards
(33 cards)
What is the average life span for men and women?
Women: 84 years
Men: 82 years
Where do most Americans 65 and older live?
In the community (vs only 4% in care facilities)
Percentage of 65 and over with 3 chronic diseases
Arthritis/diabetes/hypertension: 28.2 % Arthritis/cancer/ht: 27.5 Arthritis/CHD/ht: 27.2 CHD/diabetes/ht: 17.8 Cancer/CHD/ht: 14.6
Activities of daily living (ADLs) (6)
Bathing Dressing Toileting Transferring (between activities) Continence Feeding
Instrumental Activities of Daily Living (IADLs)
Telephone Meal preparation Taking medicine Laundry Housework Shopping Transportation Managing money
Adaptive interview: visually impaired
Orient patient to surroundings
Announce all who are present in room
Use words (not non-verbal cues)
Adaptive interview: Hearing impaired
Speak at regular tone or lower frequency, face patient directly
Don’t allow voice to trail off
Eliminate background noise
Write out oral instructions
Adaptive interview: cognitively impaired
May require surrogate/durable power of attorney
Assess relationship of surrogate with patient
Adaptations of history for geriatric patient
CC: often includes many problems
PMHx: Immunizations (eg Herpes zoster, influenza). Be sure to check how long they’ve had each disease and ask about medication and compliance.
FH: Is there a history of Alzheimer?
Social History: Most important! Who is taking care of them? Will anyone be able to?
What is the 10 minute geriatric screener (8 parts)? Mnemonic is: very happy late comers never mope during dancing
A test for functional assessment. Includes vision, hearing, leg mobility, urinary incontinence, nutrition, memory, depression, and physical disability.
Incontinence assessment (DIAPERS)
Delirium, Infection, Atrophic urethritis, Pharmacotherapy, Excess urine out due to disorder (eg pituitary), Restricted mobility, Stool impaction
Incontinence assessment (DDRRIIPP)
Delirium, Drug side effects, Retention of feces, Restricted mobility, Infection of urinary system, Inflammation, Polyuria, Psychogenic
Screening for fall risk
- Two or more falls in prior 12 months
- Presents with acute fall
- Reports difficulty with walking or balance
OR
Reports single fall in past 12 months and shows unsteadiness/abnormalities in gait assessment
Answering yes to any of these is a positive screen. Obtain relevant history, physical, cognitive, and functional assessment. Determine multi-factorial fall risk.
Components of multifactorial fall risk
- History of falls
- Medications
- Gait, balance, mobility
- visual acuity
- other neurological impairments
- muscle strength
- Heart rate and rhythm
- postural hypotension
- Feet and footwear
- Environmental hazards
Multifactorial interventions to address identified risks and prevent falls
- Minimize medications
- Provide tailored exercise program
- Treat vision impairment (inc cataracts)
- Manage postural hypotension
- Manage abnormalities of heart rate/rhythm
- Supplement vitamin D
- Manage foot/footwear problems
- Modify home environment
- Provide education and information
Screening for dementia: mini-cog
Ask patient to listen and repeat 3 unrelated words (eg, book, car, shirt).
Ask patient to draw the face of a clock (either on blank sheet or sheet with circle on it), then add the hands of the clock to indicate a specific time (distractor).
Ask patient to repeat the three words and give patient 1 point for each recalled word.
0= Demented
3= non-demented
1-2: Evaluate based on clock. If clock is OK (all numbers present in correct sequence with correct time displayed), then not-demented. If clock is abnormal, then demented.
Delirium vs dementia
Dementia has slow onset, has a progressive course, and presents with normal level of consciousness until late stage. Orientation ok until late. Attention is usually normal until late. Recent memory is usually impaired, and presents with Aphasic speech. Often presents with depression.
Delirium is acute, and fluctuates with lucid intervals. Presents with medical illness or drug toxicity. Level of consciousness is disturbed with difficulty focusing attention. Orientation is usually disrupted (except to time).
Changes in BP of geriatric patient
Systolic pressure increases through life, diastolic decreases.
More prone to orthostatic changes (often dehydrated because they don’t get thirsty and are concerned about incontinence)
Changes in Temperature of geriatric patient
Lower body temp due to decreased metabolic state. Often afebrile even when septic.
Two types of epidural hyperkeratosis
- Senile (solar) keratosis- normal
2. Actinic keratosis- pre-cancerous
Always inspect skin of elderly adult for
Pressure sores
Ecchymosis suggesting fall or abuse
Evidence of pruritus
Malignant changes in lesions
Changes in vision in elderly patient
General decrease in acuity over age 70 Presbyopia from lens and iris changes Cataracts and refractive errors Age-related macular degeneration (ARMD) Glaucoma
Things to be aware of in pulmonary PE:
Breath sounds are less audible and adventitious sounds are more difficult to hear. Don’t order unnecessary tests.
Things to be aware of in neuro exam of elderly
Decreased vibration sense is common. Reflexes are reduced. The key is to watch for asymmetry as screen for stroke, myelopathy, or nerve root compression.
Also look for motor rigidity (Parkinson’s)
Romberg and gait for balance.
