Geriatrics

Question 1

Primary aging

Answer 1

changes in physiologic reserves over time that are independent of and not induced by any disease

More likely in periods of stress (temp, dehydration, shock)

Question 2

Optimal aging

Answer 2

Occurs in people who escape debilitating disease entirely and maintain healthy lives late into their 80s and 90s.

Question 3

Usual Aging

Answer 3

Occurs in people who have aged and experienced illness

Question 4

Factors that influence living to 100

Answer 4

genes- 20%

healthy lifestyle- 20-30%

Question 5

Blood Pressure

Answer 5

Systolic Raises over time
Aorta and large arteries become atherosclerotic
Diastolic stops rising at the 6th decade
Orthostatic Hypotension in elderly

Question 6

Heart rate and rhythm

Answer 6

Resting heart rate remains unchanged
Pacemaker cells decline in the SA node
As does maximal heart rate
Response to physiologic stress decreases

Question 7

Respiratory rate and temp

Answer 7

RR is unchanged

Inc susceptibility to hypothermia

Question 8

Skin, Hair and Nails

Answer 8

Paler, wrinkly, opaque skin with decreased tugor and vascularization
Actinic Purpura – purple patches that fade over time, comes from poor capillaries with blood diffusion
Actinic Keratoses (face and hands and feet)
Seborrheic Keratoses
Nails yellow and thicken, especially on toes
Hair things, grays and decreases in quantity
Hairloss is genetically determined
55 yo+ women = facial hairs appear on the chin and upper lip

Question 9

Head and Neck

Answer 9

Decreased salivary secretion and sense of taste with aging
Meds contribute a lot to changes
Decreased olfaction and increased sensitivity to bitterness and saltiness can contribute to decreased taste
Angular Chelitis – overclosure of the mouth may lead to maceration of the skin at the corners

Question 10

Eyes

Answer 10

Eye fat cushions atrophy
Pupils are smaller and sometimes irregular
Visual acuity diminishes gradually until approx. 70 tears and then more rapidly
Near vision begins to blur
Elasticity loosens
Presbyopia = by 5th decade
Inc risk for cataracts, glaucoma, macular degeneration
Thickening and yellowing of lense = less light to retina = more light needed for reading
Lens grows and pushes iris forward and inc risk for narrow angle glaucoma

Question 11

Ears

Answer 11

Young adulthood = loss of high pitched sounds

Presbycusis = hearing loss assc with aging

Question 12

Lungs and Thorax

Answer 12

Capacity for exercise decreases
Chest wall becomes stiffer and harder to move
Resp muscles may weaken
Lungs lose some elastic recoil
Lung mass declines
Residual volume increases
Speed to breathe out diminishes
Cough is less effective
Kyphosis common
Osteoporotic vertebral collapse and increasing the anteroposterior diameter of the chest

Question 13

CV

Answer 13

Aging affects neck sounds and adds to significance of extra heart sounds like S3 and S4
Torturous aorta can increase jugular venous pressure due to inefficient draining
Systolic bruits heard in the middle or upper portions of the carotid arteries suggest, but do not prove, partial arterial obstruction from atherosclerosis.
After age 40, S3 strongly suggests CHF from volume overload of the left.
4th heart sound= decreased ventricular compliance and impaired ventricular filling. Common in young athletes
Middle-aged and odler adults commonly have a systolic aortic murmur.
Aortic sclerosis - tube
Aortic Stenosis – valve
Mitral regurg happens about 10 years after aortic

Question 14

Peripheral Vascular

Answer 14

Peripheral arteries tend to lengthen and become torturous

Question 15

Breast and axilla

Answer 15

Soft granular nodular lumpy
Glandular tissue diminishes and becomes fat
Proportion of fat increases, amount decreases.
Axillary hair diminishes

Question 16

Male and Female Genitalia, Anus, Rectum, Prostate

Answer 16

Sex interest intact, but frequency diminishes
Erections become more dependent on tactile than erotic cues
Testicles drop lower
Penis decrease sin size
50% older population have erectile dysfunction
BPH in third decade to 7th. Due to androgens

Question 17

MSK

Answer 17

intervertebral discs become thinner and the vertebral bodies shorten or collapse

Question 18

Nervous System

Answer 18

Brain volume, number of cortical brain cells decrease, microanatomical and biochemical changes
Older patients are more susceptible to delirium, a temporary state of confusion that may be the first clue to infection or problems with medications
Atrophy of interosseous muscles – first in thumb/first finger
Benign essential tremors = slightly faster and diminish at rest
Reflexes diminish over time, less likely – knee
If assc with other neuro deficits, investigate more

Question 19

Adjusting the Office Environment

Answer 19

temp regulation
brighter light
face patient directly
quiet room
no distrations
pocket talker for amplified voice

Question 20

Shaping the Content and Pace of the Visit

Answer 20

listen to reflections of the past, can be helpful and help them too
assess fatigueuse brief screening tools

Question 21

Eliciting Symptoms in the Older Adult

Answer 21

Geriatric Conditions – collection of sx/symptoms common in older adults but not specific to dz
Cognitive impairment, delirium, falls, dizziness, depression, urinary incontinence, and functional impairment

Question 22

Addressing Cultural Dimensions of Aging

Answer 22

Group decision making as opposed to patient autonomy

Question 23

Common Concerning Symptoms: ADLs

Answer 23

Basic self-care abilities
Do they need help
Bathing Dressing Tolieting, Transferring, Continence, Feeding, Managing Money

Question 24

Common Concerning Symptoms: Instrumental Activities of Daily Living

Answer 24

Higher function
Do they need help
Using the telephone, shopping, preparing food, housekeeping, laundry, transportation, taking medicine

Question 25

Common Concerning Symptoms: Medications

Answer 25

``` 80% on at least 1 med 30% 8+ 50% adverse drug rxn inc exercise might be best for insomnia meds most common for fall poly pharm? Keep amount of drugs small ```

Question 26

Nutrtion

Answer 26

Underweight = serum albumin for all cause | Chronic dz and poor dentition, oral or GI disorders, depression = undernutrition

Question 27

Acute and persistent Pain

Answer 27

Pain is subjective Persistent pain More than 3 months •Assc with physiologic or functional impairment •Can fluctuate in character and intensity over time •Common cause: arthritis, cnacer, claudication, leg cramps, neuropathy, radiculopathy Acute • Distinct onset • Obviousl pathology • Duration short • Common: post sx, trauma headache Always ask for pain each visit, even mild impairment Ask caregiver Assising pain includes comprehensive evaluation of its effects on quality of life, social interactions, and functional level Engage patient

Question 28

Smoking and Alcohol

Answer 28

``` QUIT smoking Detection of alcoholism is low, we need to detect Can exacerbate – cirrhosis, GI bleeding, reflux dz, gout, HTN, DM, nsomnia, Gait disorders, and depression How to detect Memory loos, cognitivie impairment Depression, axiety Neglect of hygiene, appearance Poor appetite, nutritional deficits Sleep disruption HTN refract to therapy Blood sugar control probs Sz refract to therapy Impaired balance and gait, falling Recurrent gastritis and esophagitis Difficulty managing warfarin dosin Use CAGE (2+ = alch) ```

Question 29

Advanced Directives and Palliative Care

Answer 29

``` Providing information Invoking the patients preferences Identifyinf proxy decision makers Conveying empathy and support Encourage EOL care, DNRs, Written health proxy or power of attorney. ```

Question 30

When to screen

Answer 30

Base off their circumstances rather than age Life expectancy, time interval until benefit from screening accrues, and patient preference should be taken into account If life expectancy is short, give immediate treatment to benefit pt in remaining time If suffering, avoid more screening, but test for things that can aid prognosis

Question 31

Vision and hearing

Answer 31

Assess acuity objectively | Ask about hearing loss then do whisper test

Question 32

Exercise

Answer 32

Regular aerobic exercise to improve strength Mild 30 mins 5 days per week Vigor 20 mins 3 days per week

Question 33

Immunizations

Answer 33

Flu: 50+ yo yearly Pneumococcal: 65+ yo every 5 years Zoster: 60+ yo

Question 34

Household safety

Answer 34

Handrails on both sides of any stairway Wll lit stairways, paths, walkways Rugs secured by non-slip backing or adhesive tape Grab bards and non-slip mat or safety strips in the bath or shower Smoke alarms and plan of escaping fire

Question 35

Cancer screening

Answer 35

Breast- Biennially til 75, every 2-3 years if life expectancy is 4 years or more Cervical- Pap smears every 5 years or 3 years Colon- Eevry 10 years beginning at 50 Lung cancer and ovarian cancer not recommended Skin and oral cancer in high risk is okay

Question 36

Depression

Answer 36

65 yo men = suicide 10 % = depressed 10% of men 20% of women

Question 37

Dementia and mild cognitive impairment

Answer 37

Slow onset Mild cognitive impairment (MCI) Cognitive loss with dementia (mild) Doesn’t interfere with social or vocational function Amnestic MCI – memory is affected Non-amnestic MCI – language or visuospatial function affected AACI – age assc cognitive impairment

Question 38

Elder mistreatment

Answer 38

Signs of abuse | Malnutrition

Question 39

Lymph nodes over time

Answer 39

Palpable cervical nodes gradually dimishes with age and falls below 50% between 50 and 60 years Submandibular glands are easier to feel

Question 40

What is the 6th vital sign?

Answer 40

Implement skills directed to function assessment

Question 41

What do you if your patient is a poor historian?

Answer 41

Ask the patient if it is ok to talk to their family about it

Question 42

What are geriatric syndromes?

Answer 42

characterized by the interaction and probable synergism among multiple risk factors (falls, dizziness, depression, urinary incontinence, and functional impairment)

Question 43

What do you ask about in end of life care?

Answer 43

``` DNR? Identify proxy decision makers Provide info Explore patients preferences Convey empathy and support ```

Question 44

What two items do you add to the general assessment for VS?

Answer 44

Pain and functional Assessment

Question 45

What is functional status?

Answer 45

ability to preform tasks and fulfill social roles associated with daily living across a wide range of complexity

Question 46

What are types of geriatric screening tools?

Answer 46

physical features cognitive functions psychosocial functions urinary incontinence

Question 47

How do you screen for dementia?

Answer 47

mini cog

Question 48

What do you have to make sure to look for in the mouth during a physical exam?

Answer 48

CANCER, under tongue and on the floor

Question 49

What is the first step for cardio PE on the elderly?

Answer 49

JVP

Question 50

Where does fat accumulate?

Answer 50

lower abdomen

Question 51

When looking at an elderly females genitalia, what do you need to look for?

Answer 51

Bluish swelling-possible varicosities Caruncles-prolapse of fleshy erythmatous mucosal tissue at the urethral meatus clitorial enlargement

Question 52

What can you not palpate during a rectal exam?

Answer 52

the anterior median lobes

Question 53

What is diapers?

Answer 53

Acronym for incontinence ``` Delirium Infection Atrophic vaginitis/urethritis Pharmaceuticals Excess urine out put Restricted mobility Stool retention ```

Question 54

What is ddrriipp?

Answer 54

A look for incontinence ``` Drug Side Effects Delirium Restricted Mobility Retaining stool Inflammation Infection Psychogenic Polyuria ```