Imaging for Older Adults

True or false: since 1900, the number of adults over the age of 65 has tripled

True

What percent of the population is 65 or older?

13%

The percent of older adults is expected to rise to ____ by 2025

18%

What percent of the population is 80 or older?

2%

What is the average life expectancy for males?

76

What is the average life expectancy for females?

81

What is the average median age of the country and what is it expected to rise to by 2025?

35.5, 39

By 2050, about 1/5th of the population in the US will be over what age?

65

What is the primary source of income for older adults?

Social security benefits

____% if the elderly attend some form of religious activity weekly

50

Categories for persons 65 or older: young-old:

65 to 75 years

Categories for person 65 or older: old:

75 to 85

Categories for persons 65 or older: old-old:

85-100 years

Categories for persons 65 or older: elite old:

Over 100 years

The older Americans are primarily ______, but this is expected to change

Caucasian

What race is projected to triple the population?

African-Americans

Hispanic populations will increase from below 4% now to about ___%

16

True or false: minorities have a high incidence of obesity and late onset of diabetes

True

Why do the majority of minorities not report health problems?

• poverty

• poor education

• stereotyping/discrimination

Dementia

Deterioration of intellectual ability accompanied by emotional disturbances

What percent of adults over the age of 65 suffer from anxiety, depression, and paranoia?

5-7%

What percent of adults over the age of 80 suffer from anxiety, depression, and paranoia?

30%

Is depression more prevalent in older adults or younger adults?

Younger adults

What percent of older adults suffer from anxiety disorders?

6%

Who has the highest suicide rate?

Older adults, primarily caucasian men who live alone

What percent of older adults believed there is something chronically wrong with them?

10-15%

Alcohol abuse for 65 and older is what percent for men?

2-5%

Alcohol abuse for 65 and older is what percent for women?

1%

What is most of the drug abuse in older adults from?

Prescription medicine

Older adults make up about ____% of the medication intake in the US

25

Most drug abuse is due to aging adults having what?

Too many medications prescribed for them

Behavior disorders can take the form of:

• physical aggression

• wandering

• disruptive verbal outburst

Common causes of behavior disorders include:

• depression

• dementia

• psychosis

• Alzheimers’s disease

What are the forms of elderly abuse?

• physical

• sexual

• emotional

• neglect (including by own self)

About _____ persons age 60 and older were a victim of abuse or neglect

500,000

What should you look for when looking for abuse?

• caregiver gives responses, prevents patient from responding

• caregiver is inappropriate with patient

• caregiver lacks affection toward patient

How many licensed drivers are age 65 or older?

26 million (increased to 40 million in 2020)

In 1999 the number of nonfatal injuries in the US was ____%

19

True or false: drivers 65 and older have a higher crash death rate than all adults over the age of 18

True

In 2002, what percent of older driver fatalities occurred during the daytime hours?

81%

In 2002, what percent of older driver fatalities occurred during the weekend?

72%

What percent of MVA’s occur with another vehicle?

75%

Are men or women 2x’s more likely to be in an accident?

Men

True or false: drivers over 65 are more likely to die from their injuries from an MVA than any other age group

True

What are some changes associated with aging?

• skin wrinkles

• vascularity decreases

• skin on hands and forearms becomes thin and fragile (can easily be torn)

• purple macules appear due to blood leaking through weakened capillaries

• brown macules appear on back of hands, forearms, and face

• nails becomes yellow and thick

• loss of vision, hearing, and taste

What visual changes occur in older adults?

• decrease in reading speed

• difficulty seeing in dark

• difficulty reading small print

What percent of older men experience hearing impairment?

48%

What percent of older women experience hearing impairment?

37%

Why is understanding the changes older adults experience important to know?

• rapid changes in light may disrupt patients ability to move

• loss of hearing make it difficult for patient to follow directions

True or false: its okay to assume that a patient cannot hear

False

What are the pulmonary changes older adults experience?

• chest wall stiffens

• cough reflex less

• pulmonary function changes

Why is it important to understand that older adults have less of a cough reflex?

• may take longer to drink contrast media

• patient Amy aspirate on fluids when drinking

• become fatigued easily

• patient with chronic pulmonary disease may find it difficult to lie for a long period of time

What are the cardiovascular changes older adults experience?

• coronary arteira calcify and lose elasticity

• heart valve thickens

• decline in blood flow

  • pt may need additional blankets

  • rapid position changes causes dizziness

  • pt becomes tired easily

What are the gastrointestinal changes older adults experience?

• gastric secretions decrease

• abdominal muscles (and urinary) weaken

• ability to swallow becomes less effective

• mouth tends to be dry

• absorption of iron, vitamin B12, and folate decrease causing potential for anemia

• many elderly pts are without teeth

• tone of sphincter muscle decreases

Why is knowing that the tone of sphincter muscles decrease in older adults important for imaging?

• elderly pts need to be scheduled early so breakfast can be close to normal routine for taking meds

• elderly have a hard time holding barium for exam

What hepatic system changes do older adults experience?

• liver decreases in size

• enzyme activity and the synthesis of cholesterol decreases

• bile storage decreasea

True or false: since most drugs are metabolized in the liver, elderly are at an increase potential for drug toxicity

True

What are some changes that older women go through?

• muscle tone and bladder capacity decreases

• vaginal atrophy occurs

• involuntary bladder contractions increase

What are some changes that older men go though?

• prostate gland enlarges, tone of bladder neck increases

• the capacity of the bladder decreases

What are some musculoskeletal system changes that older adults experience?

• bone mass decreases/ weaker

• muscle mass decreases causing strength to decrease

• intervertebral discs shrink, vertebrae collapses resulting in shortened spinal column (kyphosis)

• lordotic curve of lower back flattens

• placement of neck + shaft of femur change

Why should you know that the lordotic curve of older adults flattens?

• adds to pt discomfort

• aid your pt in positions

• pts at greater risk of falling

What percent of older adults over 50 need assistance with everyday activities?

9%

What percent of older adults over 85 need assistance with everyday activities?

50%

What are the neurologic system changes that older adults experience?

• brain weight changes

• some short-term memory loss occurs

• sensorimotor function decreases

• reaction time decreases

• time needed to perform activities increases

• loss of sensitivity to pain

• decrease in posture (greater in women)

What are the top five causes of death in older adults?

• cardiovascular disease

• cancer

• cerebrovascular disease (strokes)

• pneumonia/flu

• chronic obstructive pulmonary disease

What is the leading cause of death for people 65 and older?

Cardiovascular disease

True or false: cancer is directly proportional to age

True

By 2010, 65 and older, ___% of all neoplasms were cancer

60

___% of deaths in people over the age of 65 are from heart disease, cancer, and stroke

80

What is the most common injury to older adults?

Hip

Why is the most common injury to older patients the hip?

Due to falls and increase in osteoporosis

What do you do for an older adult that fell and has an injury to the hip?

• treat as a trauma

• do not move foot or leg

• take AP comparison first without moving limb to check for fractures

  • may need to do dan-miller

For imaging of the pelvis and hip, if the pt is non-trauma what may you have to do to the limb?

Immobilize it

If your pt has a pelvis/hip injury and has had hip surgery, what should you avoid doing?

Placing in “frog leg” position

What is the most common procedure done in hospitals in the US on the elderly?

Arthroplastic surgery

What is a arthroplastic surgery also known as?

Total joint replacement

Total joint replacement

• seen on 50+

• done to replace joint due to degenerative joint disease

• operative procedure

• knee and hip most common

  • also seen on shoulder and elbow

What is the most common injury that is seen with total joint replacements?

Dislocation

For a total joint replacement, what should you never do?

Hyperflex joints

Kyphosis

• abnormal curvature of the t-spine

• stooped posture

• reduction in height

• commonly seen in postmenopausal women

What projection will best demonstrate kyphosis?

Lateral

What is common pathology of the spine in older adults?

• osteoarthritis

• osteoporosis

Osteoarthritis

Degeneration of joints

Osteoporosis

Loss of bone mass

Osteoporosis increases with what?

Age and menopause

If a patient has osteoporosis what does it predispose them to?

Vertebral and hip fractures

What should you do to your technique when imaging patients with pathologies?

Decrease and may need to use short exposure time die to pt tremors or difficultly holding still

True or false: older adults tend to have less inhalation capacity

True

Why might you have to center higher for chest imaging on older adults?

To accommodate for more shallow lung fields

What are some common chest pathologies in older adults?

• pneumonia

• emphysema

• pulmonary d

Emphysema

• chronic lung disease

• seen as increased lung dimension on radiograph, barrel chest with depressed and flattened diaphragm obscuring costophrenic angles with an elongated heart shadow

If your pt has emphysema should you increase or decrease your technique?

Decrease

Pneumonia

• inflammation of lungs resulting in accumulation of fluid. creates an increase in radiodensities in regions

• most common radiographs are PA and lateral erect chest

Should you increase or decrease your technique if you pt has pneumonia?

Slightly increase

Pulmonary edema

• condition of excess fluid within the lung

• commonly see in congestive heart failure

Congestive heart failure

• causes weakness in heart resulting in backup of blood into lungs

• seen on radiographs as an increase in radiodensity in the hilar regions

• PA and lateral upright radiographs of chest

• increase exposure

What should you do when working with the elderly?

• take time to educate pt

• speak slow and close

• treat with dignity and respect

• give pt time to rest

• avoid tape- paper tape is ok

• give extra blankets

• repeat instructions

• assist pt to bathroom or dressing room

• do not leave alone on x-ray table

• place on pad on the x-ray table (if applicable/allowed)