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Patient Care2 > Older Adult > Flashcards

Older Adult Flashcards

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

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

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
Q

where is most of the height loss occurring from

A

the trunk due to thinning of the intervertebral discs

26
Q

what is benign forgetfulness

A

can occur at any age
difficulty in recalling names, objects and certain details

27
Q

what are geriatric syndromes

A

cognitive impairment
delirium
incontinence
malnutrition
falls
gait d/o
frailty
sleep d/o
sensory deficits
fatigue
dizziness
Depression

28
Q

what are multidimensional problems

A

hearing
vision
polypharmacy
mobility

29
Q

what is dyspareunia

A

painful sex

30
Q

what are special areas to assess with the older populations

A

function status
polypharmacy
fall risk
cognitive problems
moods/depression
nutrition
incontinence
vision/hearing
social supports
financial concerns
goals of care
advance directives

31
Q

what is absolutely vital to assess in the older populations

A

functional status
-ADLs
-Instrumental activities of daily living (IADLs)

32
Q

What are IADLs

A

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
Q

what is the Katz Index used for

A

assesses independence in activities of daily living
6= independent 0= very dependent

34
Q

what is Lawton-brody used for

A

assessing instrumental activities of daily living scale

35
Q

what is the risk of adverse reactions in older adults increases with the number of meds

A

13% with 2 meds
58% with 5 meds
82% with 7 or more

36
Q

what is the prescribing cascade

A

adverse drug reaction is misinterpreted as a new medical condition, and so a new medication is prescribed

37
Q

what is an independent risk factor for hip fractures

A

polypharmacy - use of drugs affecting CNS

38
Q

what is Beers Criteria

A

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
Q

what are the 5 categories of the Beers Criteria

A

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
Q

what is the most modifiable risk factor for falls

A

medication use

41
Q

what are falls associated with

A

decline in functional status
increased chance of nursing home placement
increased risk of death-immediate or subsequent
greater use of medical services

42
Q

what are factors that play into falls

A

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
Q

What is the TUG screen

A

Timed Up and Go
evaluates gait, strength and balance
greater than or equal to 12 seconds to complete is at risk of falling

44
Q

What are the tools used for cognitive issues/assessment

A

MOCA - early decline
MMS (mini-mental status) - monitoring
Mini-cog - yes/no for further screening

45
Q

what are the nutritional concerns with the older populations

A

malnutrition is associated with increased mortality - weight loss can predict mortality
>70% of hospitalized older adults are at nutritional risk or are malnourished

46
Q

how do we assess nutrition with older populations

A

serial measurement of body weight
‘have you lost 10lbs over the past 6 months without trying?’
multiple tools

47
Q

what is the affect on urinary incontinence

A

major cause of social and emotional distress - can play a role in nursing home placement
increased risk in diabetics
multifactorial

48
Q

what are the factors that can play a role in fecal incontinence

A

decreased strength of external sphincter
increased rectal compliance
medications
lactose intolerance
poor mobility

49
Q

how often should the older populations obtain Tetanus immunizations

A

every 10 years (one dose of Tdap if never recieved)

50
Q

What are the cancer screenings done for the older populations

A

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
Q

when is osteoporosis screened fo

A

postmenopausal women < 65 yo at higher risk
all women age 65 and older

52
Q

when does colorectal cancer screening begin

A

average risk adults: begin screening at age 45
multiple test can be used to screen patients

53
Q

what are the different colorectal screening tests

A

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
Q

when should advanced care planning be done

A

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
Q

what are the benefits of advance care planning

A

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
Q

what are Advanced directives?

A

done while pt still can make decisions
ONLY acted upon if pt loses ability to make decisions for themselves

Patient Care2 (10 decks)

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