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Older Adult Flashcards

(56 cards)

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1
Q

by 2030 how much of the US population will be 65 years or older

A

20% (70 million)

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2
Q

in 2020 what was the life expectancy

A

78.93 Years

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3
Q

what percentage of 65 year olds or older live within the community

A

95%

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4
Q

what percentage of 85 years or older live in institutions

A

10%

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5
Q

what is important to focus on for the older adults assessment

A

healthy or “successful” aging
- understand and mobilize family, social and community supports
-importance of functional assessment
-promote older adult’s long-term health and safety

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6
Q

what are the goals of care for the older adults

A

Not just maximize life span, but maximize HEALTH span (maintain function, fulfilling, active lives, promote healthy aging)
what are the patients goals?

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7
Q

what are changes in physiologic reserve that occur over time called?

A

primary aging

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8
Q

what are the changes in vital signs with aging

A

Blood pressure: HTN or auscultatory gap
HR and rhythm: decline in function of pacemaker cells, affects response to physiologic stress
temp: changes in temperature regulations leads to susceptibility

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9
Q

what occurs due to loss of subcutaneous tissue (esp fat) with aging

A

actinic (solar or senile) purpura

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10
Q

what is “onion skin”

A

fragile, loose or transparent (hands/forearms) skin

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11
Q

what is presbyopia

A

age related vision loss; need for reading glasses

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12
Q

what are age related eye changes

A

eyeballs recede into orbit
corneas lose luster
pupils become smaller
dry eyes are common (less secretions from lacrimal glands)
presbyopia
increase risk of glaucoma, macular degeneration, cataracts

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13
Q

what is presbycusis

A

decreased hearing - lose higher tones

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14
Q

what are the thorax and lung changes with age?

A

decrease in exercise capacity - can be cardiac, pulmonary or both
chest wall stiffens - increased work to breath
kyphosis due to osteoporosis

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15
Q

what is S3 after age 40 suggestive of?

A

strongly suggests heart failure

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16
Q

what is S4 suggestive of

A

can be heard in healthy older people, but usually suggests decreased ventricular compliance and impaired ventricular filling

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17
Q

what increases risk of CV morbidity and mortality

A

aortic sclerosis and aortic stenosis

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18
Q

what is aortic sclerosis

A

fibrosis and calcification
dose not impede blood flow

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19
Q

what is aortic stenosis

A

leaflets become calcified and immobile
outflow obstruction

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20
Q

what are breast changes with age

A

diminish in size - glandular tissue atrophies and is replaced by fat
ducts surrounding nipples become more palpable and firm, stringy stands (calcification deposits)

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21
Q

what are the abdomen changes with age

A

fat accumulates in lower abdomen and near the hips
signs of acute abdominal disease is blunted

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22
Q

what are the Male GU changes

A

Intercourse: sexual interest remains intact, frequency declines, erection is more dependent on tactile stimulation and ED in 1.2 of older men
prostate: Bengin prostatic hyperplasia (BPH)

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23
Q

what is BPH changes in men with age

Study These Flashcards
A

benign prostatic hyperplasia
proliferation of prostate epithelial and stromal tissue
typically begins in the third decade
continues until the 7th and then plateaus
only half of men with BPH have symptoms

24
Q

what are the female GU changes with age

Study These Flashcards
A

Menopause: loss of estrogen tone
periods cease between age 48-55
hot flashes for up to 3 years
vaginal dryness
urge incontinence
dyspareunia
within 10 years, ovaries are usually no longer palpable

25
where is most of the height loss occurring from
the trunk due to thinning of the intervertebral discs
26
what is benign forgetfulness
can occur at any age difficulty in recalling names, objects and certain details
27
what are geriatric syndromes
cognitive impairment delirium incontinence malnutrition falls gait d/o frailty sleep d/o sensory deficits fatigue dizziness Depression
28
what are multidimensional problems
hearing vision polypharmacy mobility
29
what is dyspareunia
painful sex
30
what are special areas to assess with the older populations
function status polypharmacy fall risk cognitive problems moods/depression nutrition incontinence vision/hearing social supports financial concerns goals of care advance directives
31
what is absolutely vital to assess in the older populations
functional status -ADLs -Instrumental activities of daily living (IADLs)
32
What are IADLs
instrumental activities of daily living food shopping, driving or using public transportation, using the phone, housework/home repair, making meals, laundry taking meds, handling fincances
33
what is the Katz Index used for
assesses independence in activities of daily living 6= independent 0= very dependent
34
what is Lawton-brody used for
assessing instrumental activities of daily living scale
35
what is the risk of adverse reactions in older adults increases with the number of meds
13% with 2 meds 58% with 5 meds 82% with 7 or more
36
what is the prescribing cascade
adverse drug reaction is misinterpreted as a new medical condition, and so a new medication is prescribed
37
what is an independent risk factor for hip fractures
polypharmacy - use of drugs affecting CNS
38
what is Beers Criteria
used to assess inappropriate drug prescribing in older adults *list of medications considered potentially inappropriate for use in older patients, mostly due to higher risk for adverse events
39
what are the 5 categories of the Beers Criteria
drugs that are potentially inappropriate in most older adults drugs that should typically be avoided in older adults with certain conditions drugs to use caution drug-drug interactions drug dose adjustment based on kidney function
40
what is the most modifiable risk factor for falls
medication use
41
what are falls associated with
decline in functional status increased chance of nursing home placement increased risk of death-immediate or subsequent greater use of medical services
42
what are factors that play into falls
biological: weakness, mobility issues, balance, vision Behavioral: psychoactive med, 4+ meds, risky behaviors, inactivity Environmental: clutter and tripping hazards, no stair railings or grab bars, poor lighting
43
What is the TUG screen
Timed Up and Go evaluates gait, strength and balance greater than or equal to 12 seconds to complete is at risk of falling
44
What are the tools used for cognitive issues/assessment
MOCA - early decline MMS (mini-mental status) - monitoring Mini-cog - yes/no for further screening
45
what are the nutritional concerns with the older populations
malnutrition is associated with increased mortality - weight loss can predict mortality >70% of hospitalized older adults are at nutritional risk or are malnourished
46
how do we assess nutrition with older populations
serial measurement of body weight 'have you lost 10lbs over the past 6 months without trying?' multiple tools
47
what is the affect on urinary incontinence
major cause of social and emotional distress - can play a role in nursing home placement increased risk in diabetics multifactorial
48
what are the factors that can play a role in fecal incontinence
decreased strength of external sphincter increased rectal compliance medications lactose intolerance poor mobility
49
how often should the older populations obtain Tetanus immunizations
every 10 years (one dose of Tdap if never recieved)
50
What are the cancer screenings done for the older populations
colorectal: age 45-75 Breast: Biennial mammo ages 50-74 Lung cancer: age 55-80, 30 pack years, current smoker or quit in last 15 years Prostate cancer: individual discussion with patient cervical: can stop at age 65 if previous screening was adequate and negative
51
when is osteoporosis screened fo
postmenopausal women < 65 yo at higher risk all women age 65 and older
52
when does colorectal cancer screening begin
average risk adults: begin screening at age 45 multiple test can be used to screen patients
53
what are the different colorectal screening tests
High sensitivity guaiac-based fecal occult blood (gFOBT)- 3 stool specimens, 2 samples Fecal immunochemical testing for hemoglobin (FIT) FIT-DNA testing (cologuard) Flexible sigmoidoscopy ("flex-sig") colonoscopy CT colonography
54
when should advanced care planning be done
should be done at all ages, not just older adults want to ensure that pt gets care that is consistent with their own goals, values and preferences.
55
what are the benefits of advance care planning
increase chance that the provider and families will comply with pts wishes decrease hospitalization at the end of the life receive and needs less intensive treatments at end of life increased use of hospice better chance that the pt will die in their preferred place higher satisfaction with Quality of care
56
what are Advanced directives?
done while pt still can make decisions ONLY acted upon if pt loses ability to make decisions for themselves

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