Geriatrics Flashcards
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
Eyes
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
Ears
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
CV
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
MSK
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
