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Flashcards in Geriatrics Deck (42):
1

What is Aging?

Gradual and spontaneous change:

Maturation: childhood/puberty/young adulthood

Then decline through middle/late age

2

What is senescence?

Capacity for cell division, growth, and function is lost over time and ends with death

3

What senses change?

What change occurs in the mouth?

Senses: Smell and Taste

Mouth: decrease saliva production

4

What changes occur in the esophagus?

Generally little change:

Decrease UES pressure/relaxation

Decrease amplitude of peristalsis

Longer duration of reflux episodes

5

*** Know the GI tract in the geriatric patient:

Change in the bowel?

Decline in absorption of Vit D, Zinc, and Ca++

Decrease in anal sphincter pressure (incomplete evac or incontinence)

6

What changes occur in the pancreas?

  • Decrease insulin secretion and sensitivity
  • Increase incidence of Diabetes II

7

What changes occur in the liver with age?

  • Delayed regeneration after injury
  • Decreased BF and metabolism of drugs
  • Decrease in serum albumin binding capacity
  • Decrease in LDL extraction from blood

8

What changes occur in the Gallbladder?

  • Decrease bile acid secretion
  • Increase phospholipid/cholesterol composition of bile

9

What types of medications cause constipation?

  • Anticholinergics
  • Opiates
  • Iron
  • Ca++ channel blockers
  • Ca++ supplements
  • NSAIDs

10

What types of medications cause diarrhea?

  • Antibiotics
  • Donepezil
  • Supplements
  • Metformin (she mentioned in class)

11

What changes in the Kidney of the elderly?

Decrease in:

  • weight, mass, and number/size of nephrons
  • Glomeruli and GFR
  • BF
  • Renin/Aldosterone levels

12

What changes in the urinary bladder?

  • Decrease in capacity and contractility
  • Increase of uninhibited contractions
  • Women: decrease urethral length and sphincter strength
  • Men: prostatic hypertrophy

13

Falls - standard?

IT IS NOT NORMAL TO FALL***

14

Intrinsic factors contributing to falls?

  • Cerebellum
  • Cognitive health
  • Musculoskeletal system
  • Nervous system

15

Extrinsic factors involved with falls?

16

What medications can cause falls?

  • Antidepressants
  • Antipsychotics
  • Benzos
  • Beta-blockers

17

*** important

General important causes of weight loss?

Ability to:

  • obtain food
  • prepare food
  • ingest/digest/absorb food

18

*****

Treatable causes of undesired wt. loss

  • Meds
  • Emotional probs (depression)
  • Anorexia/alcoholism
  • Late paranoia
  • Swallowing probs
  • Oral factors (dentures)
  • No money
  • Wandering (DIMENTIA)
  • Hyper/othyroidism
  • Enteric probs
  • Eating probs (cant feed oneself)
  • Low salt/cholesterol
  • Social probs

19

Meds that cause wt loss

  • CV: digoxin
  • GI: cimetidine
  • Psychiatric
  • Anti-ineffectives
  • Supplements
  • Antineoplastics
  • Anti-rheumatics
  • Theophylline (pulm)
  • Thyroid replacement

20

Memory loss?

IT IS NOT NORMAL TO HAVE MEMORY LOSS**

21

What is dementia?

Cognitive and behavior disorder from a chronic disease

****Symptom only***

22

What is benign senescent memory loss?

Normal decline in cognition with age

Does NOT impact functional status or behavior

23

What is delirium

Acute (abrupt) confusional state:

Inability to sustain attention and a change in perception with evidence that the disturbance is related to another condition

24

***** MUST KNOW DIFFERENCES BETWEEN DIMENTIA AND DELIRIUM

Dimentia

  • Gradual, chronic, irreversible, no change in attention

Delirium

  • Abrupt, acute, reversible, mental status varies drastically and quickly, short attention span

25

**** 

Primary dementias?

Alzheimers

Multi-infarct

Lewy Body disease

26

******

Most common treatable cause of dementia?

Depression*****

27

Large difference between alzheimers and lewy body disease?

Lewy body disease has a much faster progression and is thus harder to "treat"

28

Late onset of alzheimers has an increased risk when?

If allele 4 of APO-E on C19

29

Genetic testing and dementia?

Not recommended:

  • If you have the gene - may not get
  • If you dont have the gene - may get
  • No cure
  • Insurance

30

Dimentia symptoms?

Memory loss, aggression, hallucinations

Change in personality, behavior, and functionality

Sleeplessness

Sexually inappropriate

31

Physical exam Indicators of:

Focal neurologic deficits?

Parkinsonism?

Normal exam?

  • Focal
    • Multi-infarct
  • Parkinsonism
    • Lewy body
  • Normal
    • Alzheimers

32

First stage - mild dementia?

2-4 yrs prior and including diagnosis

Recent memory loss

33

Second stage - moderate dementia?

2-10 years after diagnosis

Memory loss, confusion, and short attention span

34

Third stage - Severe dementia?

1-3 years at the end

Unable to recognize family or self in mirror

35

** Know basics of Functional assessment of Alzheimers

Stage 1?

Stage 2?

Stage 3?

Stage 4?

  • S1
    • no difficulties
  • S2
    • word finding difficulties, forgetful
  • S3
    • decreased organization, difficulty in job
  • S4
    • Difficulty with complex tasks

36

** Know basics of Functional assessment of Alzheimers

Stage 5?

Stage 6?

Stage 7?

  • S5
    • Assistance with proper clothing
  • S6
    • very debilitating
  • S7
    • Less than 6 months left

37

Competency vs cognitive ability? (she discussed in class)

Competency: legal

ability and right to manage their own affairs

Cognitive ability: medical

38

***Greatest difficulty with medication and the elderly?

Compliance

  • Social circumstance
    • lives alone, transportation, finances
  • Regimen
    • ease of dosing
  • Health
    • cognition and vision

39

Metabolic changes in absorption and distribution?

  • Absorption
    • Decreased in GI tract and topical
  • Distribution
    • decrease in lean body mass, total body water, and serum plasma proteins
    • increase in body fat

40

Three main drug related problems (not including compliance)?

  • Adverse drug reactions
  • Adverse withdrawl events
  • Therapeutic failure

41

Risk factors for adverse drug reactions?

  • Mutiple meds and comorbidities
  • Certain drug classes

 

*Significant cause of hospitalization

42

When regimening the elderly - what extra precautions should be taken?

  • Determine necessity
  • Know potential ADRs
  • Start low
  • Go slow
  • Change only one medication at a time
  • Simplify regimen (and review at every visit)