Geriatrics Flashcards
1
Q
How much longer is life expectancy for women compared to men?
A
approx. 5 years
2
Q
What is the average life expectancy in the USA?
A
78.8 y/o
3
Q
What is the leading cause of death in those > 65 y/o?
A
Heart disease
4
Q
When does muscle strength peak?
A
approx. 30 y/o
remains fairly constant until 50 y/o
5
Q
What happens to collagen as a person ages?
A
- increased density
- irregular cross-links
- loss of water content
- decreased elasticity
6
Q
(true/false) Weakness/fatigue in the elderly is often related to disease.
A
False
often related to inactivity
7
Q
What happens to connective tissue as a person ages?
A
Becomes stiffer and denser
8
Q
What training programs produce quicker and more predictable results in the older population regarding strength training?
A
High intensity and power training programs
9
Q
(true/false) mobility gains are slower in older adults
A
true
10
Q
When is bone mass at its peak?
A
late 20s
11
Q
What percent of water content is lost in the IV discs by 65 y/o?
A
30%
12
Q
What changes occur in the CNS as a person ages? What participation restrictions arise?
A
- decreased myelin, neurons, and neurotransmitter synthesis
- decreased blood flow
- decreased conduction velocity
- normal changes do not typically restrict participation
13
Q
What changes occur in the spinal cord and peripheral nerves?
A
- loss of anterior horn cells and posterior roots (sensory fibers)
- loss of motoneurons result in the increased size of remaining motor units
- essential tremor (age-related)
14
Q
What is presbyopia?
A
visual loss characterized by inability to focus properly and blurred images due to loss of accommodation; elasticity of the lens
15
Q
What visual colors are commonly affected as a person ages?
A
blue and green
16
Q
What happens to a person’s resting pupils as they age?
A
resting pupils increase in size
Decreased pupillary responses and sensitivity of corneal reflex
17
Q
Diagnosis
opacity clouding of the lens that results in the gradual loss of vision
- darkening of vision
- loss of acuity and distortion
A
cataracts
18
Q
What is glaucoma?
A
Increased intraocular pressure with degeneration of the optic disc and atrophy of the optic nerve
19
Q
What part of the visual field is affected by glaucoma?
A
peripheral
can progress to total blindness if not treated
20
Q
diagnosis
Loss of central vision associated with age-related degeneration of the macula, compromised by decreased blood supply or abnormal growth of blood vessels under the retina
A
senile macular degeneration
21
Q
What part of the visual field is affected by senile macular degeneration?
A
central
peripheral vision is commonly retained
22
Q
diagnosis
damage to retinal capillaries; growth of abnormal blood vessels and hemorrhage leading to retinal scarring and detachment
A
diabetic retinopathy
23
Q
What part of the visual field is affected by diabetic retinopathy?
A
central vision
total blindness is rare
24
Q
(true/false) The rate of hearing loss in women is 2x that of men age they age
A
False
men have higher occurrence of hearing loss with an earlier onset
25
What causes conductive hearing loss?
damage to external auditory canal, tympanic membrane, and/or ossicles
| mechanical hearing loss
26
What symptom may be present with conductive hearing loss?
tinnitus
27
What is sensorineural hearing loss?
central or neural hearing loss
28
What is presbycusis?
sensorineural hearing loss associated with middle and older ages
29
What are the s/s of presbycusis?
- bilateral hearing loss (starts with high frequency then progresses)
- poor auditory discrimination and comprehension
- tinnitus
30
What is otosclerosis?
Immobility of the stapes resulting in profound conductive hearing loss
31
What changes occur within the vestibular system?
- degenerative changes of utricle and saccule
- loss of hair-cell receptors
- decreased number of vestibular neurons
- decreased VOR functioning
- decreased acuity/delayed reaction times
- disorganized postural response patterns
32
What medications can be prescribed for treatment of BPPV?
- antihypertensives
- anticonvulsants
- tranquilizers
- aspirin
- NSAIDs
33
What changes occur to the somatosensory system with age?
decreased muscle spindles, joint receptors, cutaneous receptors, and corresponding myelinated axons
## Footnote
Decreased distal to proximal extremity vibration, discriminative touch, and proprioception (may contribute to impaired balance, ataxic gait, difficulty walking on uneven surfaces, and increased fall risk)
34
(true/false) there is no uniform decline in intellectual abilities throughout adulthood
true
## Footnote
- changes do not show up until mid-60s
35
What cardiac changes occur with aging?
- decreased coronary blood flow
- cardiac valves thicken and become stiff
- loss of pacemaker cells in SA node
- arteries thicken
- decreased exchange through capillary walls
- increased peripheral resistance
- decreased blood volume
- increased blood coagulation
36
What are the cardiovascular responses with rest regarding the following in terms of aging?
- RHR
- cardiac output
- resting BP
- Resting HR and cardiac output are relatively unchanged
- increased resting BP
37
What are the cardiovascular responses during exercise regarding the following while aging?
- HR acceleration
- Maximal O2 uptake
- HR
- exercise capacity
Decreased
38
What causes decreased stroke volume as a person ages?
decreased myocardial contractility
39
What is the decreasing rate of cardiac output? When does it start?
Decreases 1% per year starting at 20 y/o
| due to decreased HR and SV
40
What changes are made to the lung parenchyma as a person ages?
- alveoli enlarge and become thinner
- fewer capillaries for delivery of blood
41
What changes in lung capacity occurs with age?
- decreased vital capacity
- increased residual volume
42
(true/false) Clinical signs of hypoxia are heightened in older adults.
False - they are blunted
43
(true/false) the couging mechanism is impaired in older adults
true
44
What is the result of a decreased gag reflex?
Increased risk of aspiration
45
What changes occur to the esophagus with age?
- reduced motility and control of lower esophageal sphincter
- acid reflux and heartburn
- hiatal hernia is more common
## Footnote
- decreased stomach and intestinal motility
46
Osteoporosis is defined by bone mineral density at the ___ and/or ____ that is _____ standard deviations below a young, normal mean reference population
Bone mineral density at the **hip and/or spine **that is** > 2.5 standard deviations below** the mean reference population
47
Osteopenia is defined by a bone mineral density between ____ and ____ standard deviations below the reference population
BMD between 1-2.5 standard deviations below reference population
48
Urinary stress incontinence is related to weakness of what muscles?
pelvic floor
49
What medications affect bone loss?
- corticosteroids
- thyroid hormone
- anticonvulsants
- catabolic drugs
- estrogen antagonists
- chemotherapy
50
Bone loss is about __% per year starting at age 30-35 for women and age 50-55 for men
1% per year
51
What is the percentage of bone loss per year after menopause?
5% per year
| lasts 3-5 years
52
What areas are commonly affected by bone loss?
1. vertebral column
2. femoral neck
3. distal radius/wrist
4. humerus
53
what medications may be prescribed to slow bone breakdown?
- biphosphanates
- raloxifene (evista)
- denosumab (prolia, zgeva)
- terparatide (forteo)
- abaloparatide (thymlos)
54
What is the recommended calcium intake for women?
< 50 y/o: 1000 mg/day
>50 y/o: 1200 mg/day
55
What is the recommended calcium intake for men?
<70 y/o: 1000 mg/day
>70 y/o: 1200 mg/day
56
What is the recommended vitamin D intake?
< 50: 400-800
> 50 y/o: 800-1000
57
Do women or men experience 3/4 of hip fractures?
women
58
About __% of those with hip Fx will not return to their PLoF.
50%
59
What are vertebral compression fractures commonly caused by?
osteoporosis
60
What are the chief complaints of vertebral compression fx?
quick onset, severe, local spine pain that is increased with trunk FLX
61
What must a person with chronic vertebral compression fractures do after prolonged upright activities?
lay supine for 15-30 minutes to decrease loading
62
(true/false) stress fractures have soft tissue injury to accompany it
false
63
Where are stress fractures commonly found?
1. pelvis
2. proximal tibia
3. distal fiula
4. metatarsal shafts
5. foot
## Footnote
can be unsuspected source of pain
64
What must you look for if a stress fracture is suspected?
local tenderness and swelling
65
(true/false) UE fractures heal quicker than other fractures
false
| heal slower
## Footnote
Adults become prone to complications such as PNA, decubitus ulcers, and mental status complication
66
(true/false) Arthritis is greatly associated to depression
true
67
# diagnosis s/s
- acute onset (often at night and is worse at night)
- duration: hours to weeks
- hypoalert or hyperalert
- distracted
- hallucinations
- episodes of agitation
- memory deficits: immedient and recent
- disorganized thinking and incoherent speech
- disrupted sleep/wake cycles
delirium
68
What are the possible causes of reversible dementia (neurocognitive disorders)?
- drugs
- nutritional disorders
- metabolic disorders
- psychiatric disorders
- toxins
69
What type of dementia is the most prominent?
Alzheimer's type dementia
| 60-80% of cases
70
Are men or women more susceptible to alzheimer's type dementia?
women
71
What is the costliest disease in the USA?
dementia
72
What are risk factors for alzheimer's dementia?
- advanced age
- family hx
- apolipoprotwin E-4 gene
- CVD risk factors
- limited social and cognitive engagement
73
Describe minimal cognitive impairment of alzheimer's dementia.
- mild memory changes
- difficulty with planning or multitasking
- may not progress to dementia
- daily life is not usually affected
74
Decribe mild alzheimer's dementia.
- memory loss (short-term)
- difficulty finding words
- confusion about location of familiar faces
- longer to accomplish normal, daily tasks
- trouble handling money and bills
- compromised judgement
- loss of initiative
- mood and personality changes
75
Describe moderate alzheimer's dementia.
- increased memory loss and confusion
- shortened attention span
- problem recognizing faces
- difficulty with language (reading, writing, and numbers)
- difficulty with organizing thoughts and thinking logically
- difficulty with unexpected situations
- restlessness, anxiety, and agitation
- sundowning
- repetitive statements or movement
- hallucinations
- loss of impulse control
- perceptual motor problems
76
Describe severe alzheimer's dementia.
- unable to communicate
- unable to recognize faces
- complete dependence
- loss of sense of self
- weight loss
- difficulty swallowing
- lack of b/b control
77
What is preclinical alzheimer's dementia?
When individuals have measurable changes in brain CSF and blood biomarkers w/o noticeable symptoms
78
What are the characteristics of vascular dementia?
## Footnote
Caused by infarctions in the grey and white matter
- sudden onset w/ step progression
- spotty distribution of deficits
- focal neuro s/s
- possible pseudobulbar affects
- associated with stroke, CVD, and HTN
79
What are the s/s of normal pressure hydrocephalus?
- memory loss
- difficulty walking
- inability to control urination
80
What is the standardized screening test for dementia?
MMSE
81
What ulcers are typically larger and have a higher rate of mortality in older adults?
peptic and duodenal ulcers
82
What is the most common large intestine disease in older adults?
diverticulitis
83
What medication(s) can cause dyskinesia?
| involuntary, stereotypic and repetitive movements
long-term use of neuroleptic drugs and anticholinergic drugs, levodopa
84
What medication(s) can cause akathisia?
| motor restlessness
antipsychotic drugs
85
What medication(s) can cause essential tremor?
- tricyclic antidepressants
- adrenergic drugs
86
What medication(s) can cause parkinsonism?
- antipsychotics
- sympatholytics
87
What gait speed is needed for safe community ambulation?
0.8-1.2 m/s
