Geriatrics Midterm

Normal Aging – Muscle Loss Begins

Muscle mass loss begins around age 30 and continues through life.

Normal Aging – Muscle Loss by 8th Decade

About 30% of skeletal muscle mass is lost by the 8th decade.

Normal Aging – Cause of Muscle Loss

Due to decreased fiber size and number; largely from disuse.

Sarcopenia Definition

Gradual loss of muscle mass, strength, and function in adults 60+.

Sarcopenia – Type of Fibers Affected

Type II fast‑twitch fibers (strength, power, functional movements).

Sarcopenia Risk Factors

Inactivity, obesity, insulin resistance, low hormones, malnutrition.

Sarcopenia Management

Resistance training, protein 20–30g/meal, Vit D, Omega‑3s, magnesium.

Bone Aging – Cortical Bone Loss

Women lose 2–3% per year post‑menopause.

Bone Aging – Trabecular Bone Loss

Men and women lose 1–2% per year.

Bone Aging – Disc Changes

Intervertebral discs dry out; vertebral degeneration increases.

Bone Health Management

Vit D, calcium, weight‑bearing exercise, avoid smoking.

Eye Aging – Presbyopia

Lens stiffens → difficulty focusing on near objects.

Eye Aging – Light Needs

60‑year‑olds need 3× more light to read than 20‑year‑olds.

Eye Aging – Floaters

Normal unless sudden increase → retinal detachment concern.

ENT Aging – Hearing Loss Type

Sensorineural hearing loss from hair cell degeneration.

ENT Aging – Taste/Smell Decline

Begins around age 50.

Skin Aging – Key Changes

Thinner, drier, less elastic, reduced sweat glands.

Skin Aging – Collagen Benefit

Supplementation improves moisture, elasticity, and reduces wrinkles.

Nervous System Aging – Sensory Decline

Fewer spinal cord cells → decreased sensation.

Nervous System Aging – Slower Conduction

Nerves transmit signals more slowly.

Cardiovascular Aging – Arterial Stiffness

Arteries thicken and stiffen → increased systolic BP.

Cardiovascular Aging – LV Hypertrophy

Heart walls thicken; slower filling.

Digestive Aging – Lactase Decline

Leads to lactose intolerance.

Digestive Aging – Constipation Cause

Slower GI transit.

Digestive Aging – Nutrient Absorption

Decreased absorption of Vit D, calcium, B12.

Gut Microbiome – Healthy Aging Pattern

More Bacteroidetes → better metabolism.

Gut Microbiome – Dysbiosis Effects

Poor digestion, inflammation, cognitive decline.

Pulmonary Aging – Diaphragm Weakness

Leads to less forceful cough and higher infection risk.

Pulmonary Aging – Elasticity Loss

Lungs and chest wall become less compliant.

Genitourinary Aging – Kidney Changes

Smaller kidneys → increased urination frequency.

Genitourinary Aging – Bladder Changes

Weaker muscles → incontinence.

Endocrine Aging – Hormone Decline

↓ GH, ↓ testosterone → muscle loss.

Immune Aging – Autoimmunity Risk

Immune system less able to distinguish self vs foreign.

Five I’s of Pathological Aging

Incontinence, Immobility, Instability, Iatrogenic reactions, Intellectual impairment.

Urge Incontinence

Most common; detrusor overactivity; strong urge to void.

Stress Incontinence

Leakage with coughing, laughing, lifting; MC in women.

Mixed Incontinence

Combination of urge + stress.

Overflow Incontinence

Bladder overdistention; obstruction or neurogenic atony.

Fibromyalgia Features

Diffuse pain >3 months, morning stiffness, tender points, sleep disturbance.

Polymyalgia Rheumatica Features

Shoulder/pelvic girdle pain; strength preserved; ↑ ESR/CRP.

Temporal Arteritis Red Flags

Temporal headache, jaw claudication, visual changes; medical emergency.

Instability – Fall Risk Factors

Neuropathy, proprioception loss, meds, dehydration, OH, dementia.

Iatrogenic Drug Reactions

Older adults average 4–5 meds; 25% receive inappropriate meds.

Depression in Elderly

Persistent sadness, apathy, hopelessness; reversible with treatment.

Dementia Definition

Progressive, irreversible cognitive decline affecting ADLs.

Delirium Definition

Acute, fluctuating confusion; medical emergency.

Top 5 Causes of Death in Older Adults

CVD, Cancer, Stroke, Chronic Lung Disease, Alzheimer’s.

Stroke – % Ischemic

87% of strokes are ischemic.

Stroke – Age Risk

Risk doubles every 10 years after age 55.

Stroke Clinical Signs

Facial droop (forehead spared), severe headache, AMS, 6 D’s, 3 N’s, A.

COPD Prevalence

20–25% of adults over 70.

Asthma in Elderly

Often underdiagnosed; mimics COPD/HF.

Pneumonia Risk

150,000 adults 65+ hospitalized yearly.

ILD Features

Breathlessness, fatigue, cough; overlaps with aging.

Osteoporosis MC Sites

Hip, wrist, spine.

Postmenopausal Fracture Risk

50% will have osteoporotic fracture.

DEXA Scan Gold Standard

Hip DEXA.

Osteoporosis Management

Ca, Vit D, resistance training, stop smoking/alcohol.

OA Prevalence

Affects 1 in 3 adults over 65.

OA Treatment

Physical activity, adjustments, TENS, acupuncture, glucosamine.

HTN Prevalence

50% of adults 65+.

HTN Complications

Atherosclerosis, HF, MI, stroke, kidney failure, aortic dissection.

CVD Aging Mechanisms

Arterial stiffening, endothelial dysfunction, myocardial fibrosis.

CVD Management

Mediterranean diet, exercise, SGLT2 inhibitors, statins, stop smoking.

Cancer – Age Distribution

81% of cancers occur in adults 55+.

Cancer Mechanisms

Senescence, telomere shortening, epigenetic changes.

Prostate Cancer Stats

1 in 8 men; MC in African American men.

Breast Cancer Stats

1 in 8 women; screening begins age 40–44.

Lung Cancer Screening

Annual low‑dose CT age 50–80 with 20 pack‑year history.

Colorectal Cancer Screening

Start at age 45.

Cancer Red Flags

Weight loss, lymphadenopathy, fever, night pain, blood in stool/urine.

SES as Health Determinant

Stronger predictor of outcomes than race.

Native American Health Risks

Higher mortality, diabetes, depression, suicide, infant mortality.

Disability Health Risks

4× more likely to report poor health; ↑ obesity, smoking, inactivity.

Veteran Health Risks

High suicide, homelessness, PTSD, MST.

Rural Health Risks

↑ obesity, diabetes, cancer, injury; ↓ access.

Cultural Competence Definition

Respectful, responsive care aligned with patient values.

Predictors of Cultural Communication Problems

Explanatory models, values, relationship preferences, racism, language barriers.

Ageism Definition

Prejudice against older adults based on age.

Digital Ageism Barriers

Cost, privacy, interface complexity, account setup, text size.

Older Adult Tech Adoption

Smartphone ownership and telehealth use increasing.

Clinician Role in Digital Inclusion

Education, support, biopsychosocial assessment, accessible tech.