CM: Atypical in Elderly Flashcards Preview

Block 9 - Neuro > CM: Atypical in Elderly > Flashcards

Flashcards in CM: Atypical in Elderly Deck (23):
1

What is the concept of homeostenosis?

as we age, less reserves to respond to stressor and more in use just to maintain homeostasis combine to make us more susceptible to dzs and conditions

2

What changes when collecting a history from an elderly patient?

family hx loses value
social hx is expanded and more important

3

What changes are made to the PE when done on an elderly person?

assess cognitive fxn, performance based eval of musculoskeletal system, get up and go test

4

What is the major goal in the care of the elderly?

improve fxnal status so they can maintain independent living

5

What are the ADLs in order of loss in elderly?

bathing, dressing, toileting, transfer from bed, continence, feeding

6

What are the IADLs?

using telephone or transportation, shopping, preparing meals, housework, handyman work, laundry, managing meds, money or finance

7

What are some important treatment strategies for elderly?

improve fxn and maintain independence
provide care even if no cure
family/caregiver involvement and education

8

What are individual patient characteristics in the elderly that contribute to atypical presentation of disease?

comorbidities
meds
communication difficulties, hearing/vision impairment (harder to communicate or recognize problems)
stoicism
delay seeking help

9

What factors does aging affect in immune senescence?

decreases phagocytic capacity, antigen presenting activity and bactericidal fxn

10

What are changes in B cell immunity during aging?

production and titers of Abs decreases
less affinity of Abs
decreased response to inf/vaccination
increase in autoAbs - may not signify actual dz

11

What are Ig changes that occur during aging?

increased IgA and IgG
decrease in IgE and histamine can actually decrease allergies

12

What are changes in cellular immunity that occur as we age?

thymic hormones decrease
decrease in T helper fxn
T cells and NK increase in #, but decrease in fxn
decreased lymphocyte proliferative response
decrease in lymphocyte cytotoxicity
decrease in IL-2
PMNs intracellular killing decreases
skin thins and dries

13

What are the changes in the renal system that occur during aging?

decrease in GFR, decrease CCr, reduced release of and response to ADH, RAAS response to volume depleted states reduced, reduced perception of thirst, reduced renal blood flow

14

How is temperature different in elderly patients than younger?

often absent in older ppl w infection, even if serious
look if 2 degrees above baseline or use cutoff of 99
many present with hypothermia instead

15

Why is fever less common in older pts who have infection?

blunted thermogenesis by brown adipose tissue
reduced hypothalamic response to endogenous pyrogens
reduced ability to conserve and maintain body heat

16

What are the changes in blood pressure seen in the elderly?

more susceptible to orthostasis - if they're on meds or have untreated HTN a normal appearing BP may not actually be normal

17

What are the changes in pulse seen in the elderly?

blunted response in HR and contractility to catecholamines released by exercise and acute illness
may not present w tachycardia
max HR decreases

18

How do RR and blood gases change in the elderly?

particularly useful in diagnosing pneumonia - look for rate >24* (>30 very significant)
V/Q mismatch causing decline in PO2 and increase in A-a O2 gradient, pH and PaCO2 don't change

19

How is the presentation of abdominal pain different in the elderly?

decreased visceral pain perception - perfs don't always have rigidity
may diagnose peritonitis if car ride painful
eval by have them cough, put hands on either side of pelvic brim and rock them, jar the bed, percussion
may not have fever, leukocytosis, rebound tenderness, etc.

20

How is the presentation of thyroid dz different in the elderly?

lack classic hyperadrenergic symptoms - look instead for weight loss, anorexia, fatigue, depression, CHF or A fib

21

How is the presentation of cardiac dz and MI different in the elderly?

S3 always indicates heart failure, diastolic murmurs always abnormal
MI may not present w chest pain - present w dyspnea/SOB = "silent MI"
angina may present w epigastric pain, back pain, shoulder pain, CHF, falls and sometimes delirium

22

How is the presentation of pneumonia different in the elderly?

often no fever, lower peak temp, higher mortality, lower WBC

23

What are two geriatric syndromes that elderly patients present with when they become acutely ill?

falls and delirium