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Flashcards in Geriatrics Deck (54)
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Primary aging

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)


Optimal aging

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


Usual Aging

Occurs in people who have aged and experienced illness


Factors that influence living to 100

genes- 20%
healthy lifestyle- 20-30%


Blood Pressure

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


Heart rate and rhythm

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


Respiratory rate and temp

RR is unchanged
Inc susceptibility to hypothermia


Skin, Hair and Nails

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


Head and Neck

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



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



Young adulthood = loss of high pitched sounds
Presbycusis = hearing loss assc with aging


Lungs and Thorax

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



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


Peripheral Vascular

Peripheral arteries tend to lengthen and become torturous


Breast and axilla

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


Male and Female Genitalia, Anus, Rectum, Prostate

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



intervertebral discs become thinner and the vertebral bodies shorten or collapse


Nervous System

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


Adjusting the Office Environment

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


Shaping the Content and Pace of the Visit

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


Eliciting Symptoms in the Older Adult

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


Addressing Cultural Dimensions of Aging

Group decision making as opposed to patient autonomy


Common Concerning Symptoms: ADLs

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


Common Concerning Symptoms: Instrumental Activities of Daily Living

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


Common Concerning Symptoms: Medications

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



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


Acute and persistent Pain

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
• 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


Smoking and Alcohol

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)


Advanced Directives and Palliative Care

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.


When to screen

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