Exam 1 - pathological aging

what are the five I's of pathological aging

1. intellectual impairment

2. incontinence

3. immobility

4. instability

5. Iatrogenic drug reactions

True or False:

incontinence in older adults is common and normal

this is false because it is NOT normal

what is the most prevalent incontinence

urge incontinence

what is urge incontinence

involuntary detrusor contractions accompanied by strong urge to void

what areas of the spine can be looked at to possibly help fix urge incontinence

lumbar, sacroiliac

what population most commonly experiences stress incontinence

women

what is stress incontinenece

intra-abdominal pressure (laughing, coughing, sneezing, lifting) that puts pressure on bladder causing leakage

what is mixed incontinence

urge and stress combined

related to BPH

what is overflow incontinence

neurological problems or bladder outlet obstruction

what conditions fall under the immobility category

Fibromyalgia (FM)

Polymyalgia Rheumatica (PMR)

Temporal Arteritis

what is the condition characterized by diffuse MSK pain lasting longer than 3 months, stiffness worse in morning

fibromyalgia (FM)

what is Polymyalgia Rheumatica (PMR)

pain in proximal joints of shoulders and pelvic girdle

s/s appear SUDDENLY and insidiously

muscle strength is UNAFFECTED but pain makes it difficult to exert themself

those with PMR usually have an elevated __ level as well as increased ___ protein, ___, and ____

ESR, C-reactive protein, fibrinogen, alpha-2-globulins

what is the AKA of temporal arteritis

giant cell arteritis

temporal arteritis often presents in patients with ___

PMR

describe temporal arteritis

- affects CAROTID ARTERY

- TEMPORAL HEADACHE

- low grade fever, night sweats, anorexia, weight loss

MEDICAL EMERGENCY

Instability in older adults is pathological because it often leads to what

falls and fractures

what is the leading cause of morbidity and mortality in the elderly

instability (falls)

elderly who fall have a ___% greater risk for hospitalization and an ___X greater risk of dying

10, 8

where are common fractures in the elderly

wrist, forearm, pelvis, hip

where do most falls occur

in patient's home

what are Iatrogenic Drug reactions

adverse drug reactions

what is the average number of medications the average older adults is taking

4-5

what % of older patients receive inappropriate medications

25

Intellectual Impairment is comprised of the 3 D's what are these?

depression

dementia

delerium

what is the term for:

a mood disorder that causes persistent feeling of sadness and loss of interest in things. It affects how one thinks, feels, and behaves.

depression

what is the term for:

a state of mental confusion with disorientation to time and place and is a cardinal sign of serious physical illness or drug intoxication

delerium

what is the term for:

a group of symptoms affecting memory, thinking, and social abilities. It is IRRECOVERABLE deterioration of brain cells and connections.

dementia

unlike dementia, delirium is an ___ condition that is a _____ ____

a. chronic, medical emergency

b. acute, medical emergency

B

for it to be classified as depression, there must be unexplained changes in mood that persist for at least __ weeks

2

describe the mental status and alertness seen in patients with depression

impaired short-term memory, concentration, and thinking, along with low self-esteem

alertness fluctuates between normal and lethargic to hypersensitive

is depression acute, chronic, or both

both

can depression be reversed

yes

what is a major cause of depression outlined in the notes

loss

many screening tools are utilized to assess depression in patients, what are the major ones we talked about in class

Geriatric Depression Scale (GDS)

PHQ-9

when your patient takes a GDS screen for depression, they will be scored out of 15. A normal score is ___, mild depression is __, and very depressed is ___. If the patient answers NO on questions ___, ___, ___, ___, or ___ it is automatically depression

3, 7, 12

1,5,7,11,13

describe the onset of dementia, the mental status, and the alertness

slow onset (months-years)

poor short and long-term memory

normal alertness

is dementia reversible

no

what is the most common cause of dementia

Alzheimer's disease

what are some assessment tools for dementia

mini-mental status exam (MMSE)

mini-cog test

assessments for dementia are used to rule out what conditions

delirium, depression, B12 deficiency

in patients with dementia, what MUST be reviewed at every clinic visit

safety of current living situation

what is the typical presentation of a patient with Alzheimer's

memory impairment

aphasia

impaired social or occupational function

age 40-90

what is a type of therapy for Alzheimer's which stimulates senses of touch, hearing, taste, smell and sight through the use of music, photos, aromatherapy, and textured objects

Snoezelen Multisensory Environments

what type of diabetes is common with Alzheimer's? What is it?

Type 3

manifests as insulin resistance within the brain leading to decreased neurocognition

describe the onset, mental status, and alertness of delirium

rapid onset (hours to days)

poor short and long term memory, hallucinations, exaggeration of personality

highly agitated or lethargic

can delirium be reversed

it can if the underlying cause is treated

what are some causes of delirium

infection

adverse reaction to medication

recent hospitalization or acute medical condition

what are some ways to assist in the s/s of delirium

maintain hydration, support sleep and rest, avoid sensory overload, assess for changes in condition

what are the 3 types of delirium

hyperactive, hypoactive, mixed

what is the most easily recognized type of delirium? what is it?

Hyperactive

restlessness, agitation, rapid mood changes or hallucinations, and refusal to cooperate with care

what is mixed delirium

both hyper and hypoactive signs and symptoms

person may quickly switch back and forth between the two

what is hypoactive delirium

inactivity or reduced motor activity, sluggishness, abnormal drowsiness, seeming to be in a daze

what does the 4At or 4 A's Test screen for

alertness, attention, acute change, AMT4

delirium

what does the Short/Long CAM (Confusion Assessment Method Scoring Instructions) screen for

delirium

true or false:

when a patient presents to your office with delirium, it is okay to provide treatment before you give them an emergency referral to the ER

false