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Geriatric conditions Flashcards

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1
Q

`Disability

A

dependency or difficulty in carrying out ADLs

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2
Q

Frailty

A

physiologic state of increased vulnerability to stressors

results from decreased physiologic reserves and dysregulation of multiple physiologic systems

syndrome where at least 3 of the ff are present:
- unintentional weight loss of at least 10 lbs over the past year
- self reported exhaustion
- weakness
- slow walking speed
- low physical activity

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3
Q

Comorbidity

A

concurrent presence of two or more disease processes in the same individual

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4
Q

——– aggravates —–
while ——— predict ———–

A

disability exacerbates frailty and comorbidities

frailty and comorbidities predict disability

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5
Q

primary aging

A

the normal aging without disability or environmental factors

universal changes that occur with aging independent of disease or environmental effects

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6
Q

secondary aging

A

lifestyle and environmental consequences and disease associated with aging

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7
Q

successful aging

A

aging without decrease in organ system function

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8
Q

usual aging

A

progressive but significant declines in physiologic functions

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9
Q

physiology for normal aging

A

decreased:
- ability to adapt to stress
- ability to adapt to environment
- internal homeostatic control
- reserve capacity of organ systems

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10
Q

steep decline of vo2 max after the age of

A

70

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11
Q

vo2 max

A

amount of oxygen a person is able to inhale when doing maximal exercise

an indication of aerobic endurance

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12
Q

—% decline in max breathing capcity

A

60

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13
Q

—% decline in NCV

A

15

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14
Q

Functional implications of organ system aging: hematologic

A

Anemia (<10.5 g/dL)
- usually due to iron deficiency which may be caused by cancer, polymyalgia rheumatica, B12 deficiency, GI blood loss, infection

may result to orthostatic hypotension, dec tolerance to rehab exercise programs, fatigue, confusion

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15
Q

Functional implications of organ system aging: GI system

A

presbyoesophagus
Distal GI system affected
- decreased force of smooth muscle contraction
- impaired rectal perception of feces
- constipation, fecal incontinence, diarrhea

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16
Q

signs of presbyoesophagus

A

decreased peristalsis
decreased esophageal emptying
incomplete sphincter relaxation

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17
Q

Functional implications of organ system aging: hepatic system

A

decreased liver size by 5-15%
decreased hepatic blood flow
- leads to decline in drug elimination, prone to adverse drug reactions

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18
Q

Functional implications of organ system aging: renal system

A

decreased renal mass
decreased number of functioning glomeruli & tubules
decreased renal blood flow
decreased glomerular filtration rate

decreased creatinine clearance of 7.5-10 mL
decreased renal function by about 1% per year
Impaired ability to concentrate & dilate urine, sodium conservation, ability to excrete acid load

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19
Q

due to decreases in renal function, older adults are more prone to the ff metabolic conditions

A

hyponatremia (d/t water intoxication)
hyperkalemia

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20
Q

Functional implications of organ system aging: pulmonary system

A

Decline in the ff
- max voluntary ventilation
- vital capacity
- expiratory flow rate
- forced expiratory ventilation
- VO2 max

Increased Residual volume & FRC

VQ imbalance
- decline in PO2 (lower in supine)
- unchanged PCO2, pH
- O2 sat is normal or slightly reduced
- prone to hypoxia

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21
Q

Remains unchanged in the pulmonary system

A

total lung capacity

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22
Q

changes in pulmonary system are attributed to

A

normal effect of aging on musculoskeletal system
- stiffening of ribcage
- weakening of intercostals and abdominals
- increased airflow resistance d/t decreased elasticity of the respiratory organs

For VO2 max: caused by cardiac and peripheral muscles (especially LE) deconditioning

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23
Q

Functional implications of organ system aging: CV system

A

HRmax decreased

Decreased myocardial contractility, ejection fraction, early diastolic filling, baroreceptor activity

Decreased inotropic response to adrenergic stimulus
- decreased reflex tachycardia upon standing
- coughing and micturition syncope syndrome; excretion of fluids = decrease in BP

Increased risk of CHF, atrial tachycardia, or fibrillation

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24
Q

Functional implications of organ system aging: immunologic system

A

decrease in total no of lymphocytes by 15%

decrease lymphocyte proliferation and antibody production –> decreased ability to fight infections

decrease in antibody production: causes apprehension in terms of their response to vaccines

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25
Elderly are less or more symptomatic during infection
less because active leukocytosis and total WBC is not increased
26
Functional implications of organ system aging: endocrine system
decreased glucose tolerance; higher insulin resistance decreased serum testosterone levels in men postmenopausal declines in estrogen UNCHANGED FBS Untreated hyperglycemia may result to coma or ketoacidosis
27
Functional implications of organ system aging: thermoregulatory system
hypohydrosis: diminished sweating may result to heat strokes and heat exhaustion vulnerable to both hypothermia and hyperthermia
28
Functional implications of organ system aging: sensory system
deterioration of vision: - presbyopia - miosis cataracts in 95% of adults greater than the age of 65 glaucoma is common loss of visual acuity, decline in dark adaptation, higher minimal threshold for light perception --> high incidence of falls at night presbycusis conductive hearing loss
29
presbyopia
inability to increase curvature and thickness of the lens to focus on an object
30
miosis
excessive constriction of pupil
31
cataract affects ---- vision
central vision may be a sequelae of DM
32
glaucoma
optic nerve damaged d/t high pressure in eye causes blindness in elderlies affects peripheral may be sequelae of DM
33
presbycusis
gradual loss of hearing
34
Functional implications of organ system aging: neurologic system
decline in STM loss of speed of motor activities changes in posture, proprioception, and gait decline in cognitive functioning increased reaction time RETENTION OF immediate & primary memory
35
Functional implications of organ system aging: musculoskeletal system
progressive loss of muscle strength - decrease in muscle cross sectional area and muscle mass 14-16%/decade for LE 12% (M) and 2% (F) for UE muscles Gains in muscle strength noted in older adults with high intensity resistance exercise program: can prescribe in the absence of serious illnesses osteoporosis and DJD common
36
Functional implications of organ system aging: Genitourinary system (urinary)
benign prostatic hyperplasia common in M >60 yrs (prostate gland enlargement) incontinence caused by underlying diseases, NOT AGING decreased bladder capacity, ability to postpone voiding, detrusor contractility, & urinary flow rate - frequent urination - decreased urine retention - decreased force by detrusor muscle --> incomplete emptying post void residual volumes increased --> increased frequency of urination later in the day
37
Functional implications of organ system aging: genitourinary system (genital part)
RETAIN sexual functioning and desire older men with reduced psychogenic erections ejaculatory force is less less intense sensation of orgasm impotence caused by underlying diseases increased fragility of vaginal wall decreased vaginal lubrication, attenuation of excitement phase women maintain ability to engage in sexual intercourse throughout life cycle
38
Effects of acute hospitalization
disorientation increased incidence of medical and iatrogenic complications anxiety and confusion depression functional dependency deconditioning
39
classifications devised by spirduso
physically elite physically fit physically independent physically frail physically dependent
40
physically elite
high risk and power sports enthusiasts
41
physically fit
individuals engaging in moderate physical work (endurance sports and common hobbies)
42
physically indepndent
engage in very light physical work and all instrumental ADLs
43
physically frail
those who are still able to do all ADLs and some instrumental ADLs but are home bound
44
physically dependent
can no longer engage in simple ADLs
45
predictor of CV and all cause mortality in older adults
deconditioning or decrease in physical activity
46
primary prevention
preventing onset of diseases prophylactic
47
secondary prevention
diagnosis and treatment of asymptomatic diseases to prevent development of symptoms
48
tertiary prevention
treatment of symptomatic diseases
49
Siebens Domain Management Model
clinical framework for organizing care for adults four domains: - medsurg issues - mental status/emotions/coping - physical function - living environment
50
Common geriatric syndromes
incontinence sleep disorders pain falls
51
timed voiding program
offers toileting opportunities at regular intervals initially short intervals; every 15-20 mins --> progress to longer intervals
52
when are long term indwelling catheters used
overflow incontinence due to detrusor overstretch; no urge to void even if bladder is full patient voids excess fluid; incomplete emptying of bladder
53
helps in addressing bowel incontinence
biofeedback
54
acute insomnia
<1 month related to stressors treated with support and short term intermittent meds
55
chronic insomnia
>1 month due to underlying diseases
56
management for chronic insomnia
regular sleep schedule keep pt out of bed until bedtime; cannot do activities in bed snacks before bedtime mental imagery deep breathing relaxation; jacobson's relaxation exercises
57
most common causes of pain in the elferly
OA DJD cancer herpes zoster temporal arteritis --> manifestations of polymyalgia rheumatica polymyalgia rheumatica PVD
58
common disabling conditions in older adults
hip fracture arthritis and joint replacements stroke amputation SCI TBI
59
ageism coined by
robert butler
60
programmed theory
aging is regulated by biological clocks operating throughout the lifespan regulation would depend on changes in gene expression that affect the systems responsible for maintenance, repair, and defense responses
61
stress theoru
DNA damage theory proposes that aging is a consequence of unrepaired DNA damage accumulation
62
mutation theory
aging is a non-adaptive trait natural selection is negligent of events that occur in a few long-lived animals that provide little additional contribution to offspring numbers
63
free radical theory
elderly = 65 y/o & older old old = 75-85 oldest old >85 organisms age because cells accumulate free radical damage over time
64
free radical is a
any atom or molecule that has a single unpaired electron in an outer shell; use anti-oxidants
65
Body composition: increase
fat
66
body composition: decrease
gradual loss of lean tissue muscle mass limb muscle volume muscle fiber number and area bone density
67
respiratory system: increase
residual volume functional residual capacity lung dead space sleep related disorder minute volume with exercise
68
respiratory system: decrease
vo2 max vital capacity maximal breathing capacity force and volume of airflow
69
CV system: increase
systolic and diastolic BP orthostatic hypotension thrombosis serum lipid HD lipoproteins
70
CV system: decrease
cardiac output orthostatic tolerance maximal o2 consumption maximal exercise HR capacity to work arterial elasticity contractile function cardiac reserve
71
MSK system: increase
osteoporosis degenerative diseases poor posture
72
Msk system: decrease
muscle strength by 20-30% work rate/power output calcium
73
neurological system: increase
choice of reaction time
74
neurological system: decrease
fluid intelligence ability for new learning NCV coordination and balance
75
sensory system: decrease
vision hearing vibratory perception touch and pain sensitivity
76
skin: increase
susceptibility to pressure sores and infection
77
skin: decrease
moisture content epidermal renewal elasticity blood supply
78
increase or decrease: risk of dehydration
increase
79
increase or decrease: susceptibility of hyper or hypothermia
increase
80
increase or decrease: thirst perception
decrease
81
increase or decrease: febrile response to infection
decrease
82
increase or decrease: body water
decrease
83
increase or decrease: glucose tolerance
decrease
84
postural changes of UE
head forward shoulder extended scapula protracted elbow flexed wrist ulnar deviated finger flexed
85
postural changes of spine
thorax increased kyphosis lumbar spine straightening
86
postural changes of LE
hip and knee flexion ankle decreased dorsiflexion
87
minimum rom
should have at least 90 deg shoulder abd with sufficient ER/IR 45 pron/sup 45 wrist flex 30 wrist ext finger flexion within 1 inch of palm N hip ext 90 deg hip flex N knee ext 110 deg knee flex
88
most common cervical disc degeneration
c5-6 followed by c6-c7 then c4-c5
89
most common reason for sc dysfunction
cervical spondylotic myelopathy
90
peripheral nervous system impairments
loss of vibratory sense decreased ankle stretch reflex

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