Lecture 4 (Geriatric Medicine)-Exam 2 Flashcards
(77 cards)
1
Q
Normal age-related changes in anatomy:
* What can happen to the heart?
* What can accumulate?
* What can happen to the aorta and left atirum?
* What about the valve leaflets?
* What can happen to the coronary artery?
A
- Increased heart weight, left ventricular mass and wall thickness, mild hypertrophy
- Fibrosis and collagen accumulation
- Rightward shift and dilatation of aorta and left atrium (aortic stenosis or regurg
- Calcific and fatty degeneration of valve leaflets
- Coronary artery dilatation and calcification
2
Q
Normal age-related changed in physiology: Heart and vessels
* What declines? (3)
* What can stiffen?
A
- Peak cardiac output declines
- Peak heart rate declines
- Peak ejection fraction declines
- Arteries stiffen
3
Q
Normal age-related changed in physiology:
* What can occur with the valves?
* Prolongation of what?
* What happens to BP?
A
- Valvular regurgitation occurs
- Prolongation of PR, QRS, and QT; left axis deviation
- Systolic blood pressure increases (and diastolic can go down therefore increases pulse pressure)
4
Q
Altered physiologic response to infection
* What may they not experience?
* May not report what?
A
- May not experience an increase in temperature
- May not report typical pain syndromes
5
Q
Altered physiologic response to infection
* May not demonstatrate what?
* What is not reliable?
A
- May not demonstrate typical presentation – no cough, but pneumonia, no dysuria but UTI
- WBC count is not a reliable indicator of infection in the elderly.-> if a cough with elderly, get the CXR because WBC is not realible
increase mortality with abdominal pain among elderly
6
Q
MSK:
* What do the elderly lose?
A
Loss of strength, stature and bone health with age
7
Q
Muscles:
* What happens over time? (5)
A
- Shrink and lose mass – a sedentary life accelerates
- # and size of muscle fibers decrease
- Water content of tendons decreases
- Handgrip strength decreases
- Heart muscle declines in efficiency
8
Q
Bones:
* What happens over time? (4)
A
- Mineral content decreases
- Crush fractures of spine occur
- Less water content in cartilage
- Connective tissues lose elasticity
9
Q
Counteracting the process:
* may of these changes result from what?
* The most what?
* What is key?
* What type of counseling?
A
- Many of these changes result from disease
- The most sedentary group in US is >50
- Exercise and stretching is key
- Nutrition counseling
10
Q
Calcium
* When do men and women need calcium supplements? How much?
A
- Women 51-70 need 1200mg/day
- Men 51-70 need 1000mg/day
- Men and Women >70 need 1,200/day
11
Q
Vitamin D:
* Humans convert from what?
* What is not enough for aging humans?
* What does it contribute to?(5)
A
- Humans convert from direct sun exposure
- Sun exposure not enough for aging humans – need to supplement
- Contributes to cognitive decline (check if your patient’s mental status changes), depression, bone health, cardiovascular disease, Type 2 DM and other disease.
12
Q
Vitamin D:
* What is the recommended supplement dose?
* What lab to check?
A
- Recommended supplement between 600 and 1000 IU daily
- Lab to check – 25-hydroxyvitamin D concentration.
13
Q
Other key nutrients in bone health
* What helps bone crystal?
* What helps improve bone strength?
* What helps bone formation and mineralization?
A
- Phosphorus – bone crystal
- Magnesium – improves bone strength
- Vitamin K – bone formation and mineralization
14
Q
Other key nutrients in bone health
* What helps collagen synthesis?
* What helps cell differentation and eye health? What can too much lead to?
A
- Vitamin C – collagen synthesis
- Vitamin A – cell differentiation, eye health (macular degeneration). Too much can cause bone loss. (10,000IU)
15
Q
Most common MSK changes:
* When does osteoporosis occur?
* How do you women lose their bone density?
* How many women and men are affected?
* What are the MC sites?
A
- Osteoporosis – bone loss outstrips replacement beginning around age 35
- Women can lose up to 20% of bone density in the first 5-7 years after menopause
- Half of all women and 1 in 4 men over the age of 50 will break a bone due to osteoporosis
- Most common sites – hip, spine, wrist
16
Q
Osteoporosis:
* What population is affected? (2)
* How many fractures a year? What are they called?
A
- ~18% of people >65 y/o have osteoporosis
- 10 million Americans >50 y/o
- 1.5 - 2 million fractures per year in US are attributed to osteoporosis, these are often called “fragility fractures”
17
Q
Diagnosing osteoporosis:
* What testing is done?
* What is the MC way?
* Where is density usually measured?
A
- Bone Mineral Density (BMD) testing
- Most common – dual x-ray absorptiometry (DXA) – a low level x-ray scanner
- Density is generally measured at he hip and spine
18
Q
Diagnosing Osteoporosis
* What does the imaging result in?
* What are the scores?
A
The result is a “T score” – the extent to which bone density differs from the average bone density of young, healthy people
A T-score from a bone density scan, also known as a DXA scan,indicates bone density and the risk of fracture:
* T-score of -1 or higher:Bone is healthy
* T-score of -1 to -2.5:Osteopenia, a less severe form of low bone mineral density than osteoporosis
* T-score of -2.5 or lower:Osteoporosis
* A T-score is a comparison of a patient’s bone density to the average bone density of healthy young adults.A lower T-score indicates a greater risk of fracture.
19
Q
Screening Recommendations
* When do people need to be screened for osteoporosis?
A
- U.S. Preventive Services Task Force recommends all women aged 65 and over be screened
- Women at high risk for fractures under the age of 65 should also be screened
20
Q
X-ray findings for osteoporosis
* What can you see on an x-ray?
A
Bone Density Deficiency May Be Detected on X-ray, But Not Diagnosed
21
Q
What are the signs on x-ray for osteoporosis?
A
When examining the X-ray image for signs of bone density deficiency, look for the following:
Overall Appearance of Bones: Bones that appear more translucent or less dense than usual.
* Cortical Bone Thickness: The outer edges of the bones should be examined to see if they appear thinner than normal.
* Trabecular Patterns: Look at the spongy, inner part of the bone for changes in the density and pattern of the trabeculae.
* Vertebral Bodies: If the X-ray includes the spine, check for any signs of vertebral compression or fractures.
* Fracture Lines: Any unusual lines or breaks in the bone structure.
* For a definitive interpretation, it is essential to consult a radiologist or a medical professional specializing in bone health. They can provide a detailed analysis of the X-ray and identify any indications of bone density deficiency.
22
Q
What is important to monitor in aging patient?
A
Monitoring for Height Changes is an Important Assessment in the Aging Patient
23
Q
Kyphosis/Hyperkyphosis
* What is hyperkyphosis?
* What is the angle in hyperkyphosis?
A
- Hyperkyphosis isexcessive curvature of the thoracic spine, commonly known as the “dowager’s hump.
- Angle > 40% in hyperkyphosis
24
Q
Kyphosis/Hyperkyphosis
* Impairs what? (2)
* Increased what?
A
- Impairs mobility
- Impairs vision indirectly
- Increased risk of falls
25
What does systems does kyphosis affect? (5)
* Height loss
* Inability to stand upright
* Pulmonary volume reduced
* Distension of abdomen
* Constipation, early saity
26
Which of the following changes is a normal physiologic change associated with aging?
A) Significant loss of memory affecting daily functioning
B) Increased skin elasticity and thicker skin
C) Decreased muscle mass and bone density leading to difficulty with physical activities
D) Increased frequency of severe dizziness resulting in falls
C) Decreased muscle mass and bone density leading to difficulty with physical activities
27
Which of the following is a typical age-related change in the integumentary system?
A) Increased number of sweat glands and oil production
B) Thinning of the skin and increased susceptibility to bruising
C) Improved skin hydration and elasticity
D) Enhanced skin repair and regeneration
B) Thinning of the skin and increased susceptibility to bruising
28
What are 5 common conditions in geriatrics?
* HF
* CVA
* Fractures
* UTIs
* Pneumonia
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HF risk increases with what?
increases with age
30
Heart failure in older adults
* What age group is commonly affected?
* What are the causes? (5)
12% of people over age of 80yo experience HF
* CAD: longer you are alive, the more your arteries will be atheroscleric
* HTN heart disease: Have more difficulties pumping and need more pressure to pump out
* Valvuar heart disease: fibrosis or aging
* Cardiomyopathy: struggling to work
* High output failure: anemia, theamine def, hyperthyroid
31
Dx CHD in older population
* What are things you need to look into/ do?
* High degree of suspicion: ask questions about their life (excerise, getting up stairs, sleeping etc)
* Must evaluate the risk: look at smoking, hypertension, DM and lipid status
* Red flags: new and progressing symptoms
* Exam: consider performing ankle brachial index to asssess for peripheral vascular disease (if having in the heart, prob happening in other areas)
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CVA in the geriatric population
* What are the stoke symptoms? (5)
* Sudden numbness or weakness
* Confusion or trouble speaking, altered mental status
* Vision problems in one or both eyes
* Difficulty walking, dizziness, loss of balance or coordination
* Severe headache with no known cause
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CVA in the Geriatric Population
* how do you dx it?
* What is the treatment?
Diagnosis- Neuro exam (NIH score), CT/MRI (look for bleeding)
Treatment
* Ischemic-TPA if in window (less than 4.5 hours), thrombectomy
* Hemorrhagic-BP management, surgical intervention, supportive care
34
CVA in the geriatric population
* What type of sxs in the elderly?
* Delayed what?
* Increased risk of what?
* Risk of what?
* What type of impact?
* What type of considerations
* Prevention tailored to what?
* Atypical stroke symptoms in the elderly
* Delayed dx and recognition (educate family on signs)
* increased risk of complications
* Risk of hemorrhagic transformation
* Cognitive and psych impact (when in SNH or hosp: can be depressed)
* Social and support considerations
* Prevention is tailored to the elderly (control lipids, BP, etc)
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36
In what communities is asymptomatic bacteriuria common?
37
When do you need to send urine investigation?
38
39
What are the all the considerations for geriatric UTI? (8)
40
Geriatric pneumonia
* What are the sxs?
* How do you dx it?
* What is the txt?
* Symptoms: Cough, Fever or chills, SOB, chest pain, fatigue, AMS, pleural effusions
* Diagnosis: Physical exam, CXR (can be difficult because cannot stand), blood tests
* Treatment: Antibiotics (increase resistance), Antivirals, O2 (difficult to keep on), rest, fluids, spiratomy
41
Geriatric pneumonia
* What are the sxs?
* Higher risk of what?
* Compromised what?
* Increased prevalence of what?
* Delayed what?
* Atypical presentation of sxs
* higher risk of aspiration pneumonia
* compromised immune function
* increased prevalence of comorbidities
* delayed dx and treatment
42
Geriatric pneumonia
* increased risk of what?
* Functional what?
* increased what?
* What type of strategies?
* increased risk of complications
* functional decline and frailty
* increased hospitalization and prolonged recovery
* prevention strategies (vaccination and hygiene)
43
hip fractures:
* How many in a year?
* What do 90% result from?
* Who is more likely to fx a hip?
* 300,000 per year in United States (AAOS)
* 90% result from falls in older patients
* Women are 2-3 X more likely to fracture hip
44
Hip Fractures
* What are the increased risk factors?
* What are the increased complications?
* Increased Risk Factors-Osteoporosis, falls, chronic conditions
* Increased Complications- High mortality, immobilization, infections
45
Hip fractures:
* What is the txt and recovery?
* What are the prevention strategies?
* Treatment and Recovery- Push for early surgical intervention, often require placement
* Prevention Strategies- Fall prevention and bone health
46
Vertebral Compression Fractures
* how many in the US?
* What population does this occur more in?
* What gender?
* 1.5 million annually in elderly in United States
* Nearly 50% males/females over age 80 have VCFs (common to be asymptomic)
* Estimates indicate 1 in 5 women >50 have a VCF
47
Vertebral Compression Fractures
* usually caused by what?
* What does treatment entail?
* May refer to who?
* What are red flags?
* Usually caused by osteoporosis
* Treatment ranges from conservative to surgical (why perpherial nerves are compressed, can have back pain)
* May refer to Ortho or Neuro
* Urine and bowel incont, weightloss, weakness are red flags
48
Compression fractures
* What are the two types?
* May be what? (2)
* Non-traumatic with osteoporosis
* Mild trauma – “sitting down”
* May be asymptomatic
* May be very painful
49
Treatment Of Vertebral Compression Fractures
* What is key?
* What is the txt when patient has no neuro involvement?
* What is the txt with neuro involvement?
* Key is level of neurologic deficit
* No neuro involvement: conservative treatment for pain with bracing
* + neuro involvement and/or severe pain- refer consideration of surgical intervention
50
What can you give to a patient with no neuro involvement with compression fraction?
51
Sarcopenia:
* Age related what?
* Who is affected?
* Corresponding loss in what?
* Age related decrease in bulk of muscles
* Estimates of 22% for women and 23% for men between the ages of 30-70, with strength loss of 30%
* Corresponding loss in balance and coordination
52
Sarcopenia
* What tightens and loses?
* WHat is replaced?
* Joint capsules tighten and lose flexibility
* Lean muscle mass replaced by adipose tissue
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Lean muscle is placed by what?
Adipose
54
Feeding tubes:
* What are the two types of feeding tubes?
* What are the feeding routes through the nose? What are the two types of GI ones?
55
Feeding tube placement: Key considerations
* What are the medical implications?
* What are the risk of complications?
* What is the impact on quality of life?
* Medical Implications: Nutrition Support, Provides essential nutrients when oral intake is insufficient.
* Risk of Complications: Includes infection, tube displacement, and aspiration pneumonia.
* Impact on Quality of Life: May improve physical health but could affect comfort and quality of life. Consider patient autonomy.
56
Feeding Tube Placement: Key Considerations
* What are the psychosocial efficts?
* What are the ethical and descision making considerations?
* Psychosocial Effects: Can affect the patient’s and family's emotional well-being as well as social interactions and activities.
* Ethical and Decision-Making Considerations: Informed Consent: Ensure patients or their surrogates are fully informed and involved in decision-making.
57
Patient Education for Driving When Vision and Hearing Are Diminished
* What are the vision considerations?
* What are the hearing considerations?
* Vision Considerations: Regular Eye Exams, Adaptive Devices, Safe Driving Practices
* Hearing Considerations: Hearing Aids, Minimize Distractions, Regular Hearing Tests
58
Patient Education for Driving When Vision and Hearing Are Diminished
* What are the general safety tips?
* Frequent Rest Breaks, Plan Routes
* Self-Assessment: Regularly assess driving abilities and consider alternative transportation options
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Patient Education for Driving When Vision and Hearing Are Diminished
* What are the legal and health considerations?
Review Local Regulations: Understand and comply with local driving regulations (ex: rountine driving tests)
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Prolonging independence in aging
* What are the assistive devices?
* What are the technology?
* What are the support services?
* Assistive Devices: Use mobility aids like walkers and canes, and implement daily living aids such as reachers and adaptive utensils.
* Technology: Utilize smart home systems for voice control and emergency alerts, and access telehealth for remote medical consultations.
* Support Services: Arrange for in-home care services and engage with community programs such as senior centers and meal delivery services.
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Prolonging independence in aging:
* What is the health and wellness
* what is the social engagement?
* Health and Wellness: Encourage regular exercise to maintain strength and balance, and promote a healthy diet to support overall health and energy.
* Social Engagement: Maintain social connections through activities and support groups, and offer volunteer opportunities for meaningful engagement.
62
Suicide and depression in the geriatric patient:
* how can we assess for this?
* Have you thought about hurting yourself?
* Have you lost interests in hobbies?
* Living situations, loss of family and friends
* Are you eating?
* Are you lonely?
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Suicide and depression in geriatric patients
* What are the risks?
* What are the signs?
* Risks: Isolation, chronic illness, bereavement, and a history of mental health issues.
* Signs: Persistent sadness, withdrawal from activities, and changes in sleep or appetite.
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Suicide and Depression in the Geriatric Patient
* What is the txt?
* What is the prevention?
* Treatments: Psychotherapy, medication, social support, and crisis intervention.
* Prevention: Regular mental health screenings and caregiver education.
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Falls in the Elderly
* How many people fall?
* What the leading cause of what?
* What is key?
* More than one in four adults 65 and older fall each year (per CDC)
* Leading cause of death in the elderly and increasing yearly
* Prevention is Key
## Footnote
This is one of first questions we ask as providers: are they safe to go home?
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Education for fall prevention
* What are some home safety measures?
* What should in encourage for physical acitivity?
* What are some vision and hearing measures?
* Home Safety: Remove tripping hazards and install grab bars, non-slip mats.
* Physical Activity: Encourage regular exercise
* Vision and Hearing: Schedule regular eye and hearing exams
67
Education for fall prevention
* What is the medical management?
* What are the assistive devices?
* What is emergency preparedness?
* Medication Management: Review medications with a healthcare provider to avoid side effects that could increase fall risk.
* Assistive Devices: Use mobility aids
* Emergency Preparedness: Phone in reach
68
Polypharmacy
* What is it?
* The use of what?
* Common in who?
* Defined as the use of multiple medications to treat a single condition (>5)
* The use of multiple medications to treat many conditions in a single patient.
* Common in older adults and younger at-risk populations
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Polypharmacy
* What are the predictors of polypharmacy?
* What are the signs?
* Predictors of Polypharmacy - having multiple, chronic conditions, demographics, SDOH, long term facility resident, poor record keeping
* Common signs of polypharmacy in geriatrics - loss of appetite, fatigue, change in mental status, confusion, dizziness, change in mood.
70
Reducing polypharmacy in the elderly:
* Consider what
* Conduct what?
* Simplify what?
* Consider what options?
71
Geriatric living placement
* Independent living facility?
* Assisted living facility?
* Independent Living Facility: Offer room, board, and other amenities for one monthly fee, but they do not provide personal care or medical services.
* Assisted Living Facility: Offers help with daily activities and some medical assistance.
72
Geriatric living placement
* Skilled nursing facility?
* Nursing home?
* Skilled Nursing Facility (SNF): Provides 24/7 medical care and rehabilitation services.
* Nursing Home: Provides long-term care with a focus on extensive medical care and support.
73
Steps to Place a Patient into a Facility (ALF, SNF, or NH)
* What are the assessment of patient;s needs?
* Evaluate medical, personal, and social needs.
* Consult with family and other providers (OT/PT) for recommendations
74
Steps to Place a Patient into a Facility (ALF, SNF, or NH)
* What do you need to discuss with social sevices
* Identify and visit potential facilities and availability
* Review financial options
* Complete applications
* Finalize admissions and ongoing care
* Compare services, amenities, and staff qualifications.
75
Steps to Place a Patient into a Facility (ALF, SNF, or NH)
* Why do you need to f/u?
Establish a care plan and monitor the patient’s adjustment to the new environment.
76
Approach to end of life discussion
* Initiate what?
* Discuss what? define it
* Address what? Explain what?
Initiate the Conversation: Start early and include the right people
Discuss Medical Power of Attorney (POA)
* Define a Medical POA (A person appointed to make healthcare decisions if the patient is unable)
Address Do Not Resuscitate (DNR) Orders
* Explain what a DNR/DNI order is and ensure patient’s wishes are documented
77
Approach to End-of-Life Discussions
* Encourage what?
* Explain what?
* Ensure what?
Encourage the patient to make and/or review a Living Will
Explain Hospice and Palliative Care Options
Ensure Documentation: Confirm that all documents (Medical POA, DNR, Living Will) are completed
