Geriatric Patient (Detailed Version)

Aging: Biological and Chronological Age

What is the chronological entry point for “old age”?

65 years.

What age ranges define young-old, old-old, oldest-old, centenarians, and supercentenarians?

Young-old: 65–74,

Old-old: 75–84,

Oldest-old: 85+,

Centenarians: 100+, Supercentenarians: 110+.

How does biological age differ from chronological age?

Biological age refers to the physical condition and functional capacity, which may not match chronological age.

Can a person be biologically old at 65 and physically fit at 75?

Yes, aging varies among individuals.

Classification by Function

What is functional age?

A classification based on general health and ability to perform activities, not chronological age.

What categories define functional age?

Functionally independent, frail, functionally dependent.

How is functional age measured?

Through activities of daily living (ADLs) and instrumental activities of daily living (IADLs).

Primary, Secondary, and Optimal Aging

What is primary aging?

Normal age-related changes, universal and progressive, e.g., skin wrinkling.

What is secondary aging?

Age-related changes due to disease or trauma, e.g., heart disease.

What is optimal aging?

Slowed or altered aging through prevention, e.g., healthy diet and exercise.

Normal Physiological Aging

What general physiologic changes occur with aging?

Reduced cell metabolism, tissue changes, gradual decline in organ function.

How does skin change with aging?

Thin, wrinkled, dry, pigmented spots, reduced elasticity, lower temperature tolerance.

Musculoskeletal System

How does bone mass change with age?

Bone volume decreases after age 40.

What happens to muscles and joints?

Muscular strength and speed decline

What causes curvature in cervical vertebrae?

Decreased bone density and atrophic changes in cartilage and muscle.

Cardiovascular System

How does cardiac output change?

It declines slightly

What happens to blood vessels?

Less elastic, reduced lumen size, increased peripheral resistance.

How is atherosclerosis influenced?

Aging, diet, smoking, and lack of exercise contribute to fatty deposits.

Respiratory System

What changes occur in vital capacity?

It decreases, reducing oxygen-carbon dioxide exchange efficiency.

How is the cough reflex affected?

It becomes less effective, increasing infection risk.

Gastrointestinal System

How do digestive secretions change with age?

Hydrochloric acid and other secretions decrease.

How does peristalsis change?

It slows, affecting nutrient and medication absorption.

Central Nervous System

How does cognition change with aging?

Slower intellectual function

Does long-term memory decline?

No, it remains relatively constant.

Peripheral Nervous System

How is tactile sensitivity affected?

It decreases with age.

What is proprioception and how is it affected?

Awareness of body position declines, increasing fall risk.

Sensory Systems

What changes occur in vision?

Presbyopia, decreased acuity, reduced peripheral vision, glare sensitivity, color perception issues.

What changes occur in hearing?

Presbycusis, thick/dry cerumen, decreased ability to hear high frequencies, tinnitus.

How does taste change?

Salt perception declines

Endocrine System

What changes occur in the thyroid and metabolism?

Thyroid efficiency and basal metabolic rate decrease.

How is thermoregulation affected?

Older adults are sensitive to cold and may not show fever with infection.

Immune System

How does immunity change with age?

Declines overall

How are skin and mucous membranes affected?

Reduced defense against pathogens.

Cognitive Change

How can cognitive changes affect daily activities?

They reduce concentration and attention.

What environmental factors can distract older adults?

Excess light and noise.

How does oral health affect cognition?

Tooth loss and gingival inflammation are linked to lower cognitive performance.

Pathology and Disease

What factors influence longevity?

Genetics, environment, lifestyle, diet, exercise.

What lifestyle factors increase disease risk?

Tobacco, alcohol, obesity.

Which systemic diseases are linked to periodontitis?

Atherosclerosis, diabetes, respiratory infections, rheumatoid arthritis.

Chronic Conditions

What chronic diseases commonly affect older adults?

Alzheimer’s, osteoarthritis, alcoholism, osteoporosis, STDs, respiratory, cardiovascular diseases.

Alzheimer Disease

What is Alzheimer Disease?

Nonreversible dementia affecting memory, thinking, and judgment.

What are early and late onset types?

Early: 30s–40s, rare

What are treatment goals?

Support patient and family, preserve function, prevent complications.

Which medications are used?

Antidepressants, antianxiety, antipsychotics, anticonvulsants.

How does oral health relate to Alzheimer Disease?

Periodontal disease may contribute to brain inflammation.

Osteoarthritis

What are common symptoms?

Joint pain, stiffness, crepitation.

What treatments exist?

Physical therapy, exercise, rest, drugs, dietary modifications.

How should dental care be adapted?

Short appointments, afternoon scheduling, jaw breaks.

Alcohol Abuse

Why are older adults more vulnerable?

Physiologic changes require less alcohol for adverse effects.

What risks exist?

Worsened health problems, medication interactions, depression.

Osteoporosis

What causes it?

Hormonal changes, low calcium/vitamin D, aging, sedentary lifestyle.

How is it prevented?

Adequate calcium and vitamin D, load-bearing exercise, lifestyle modifications.

What medications treat it?

Bisphosphonates, selective estrogen receptor modulators, calcitonin, parathyroid hormone.

How does osteoporosis relate to oral health?

Reduced bone density affects periodontal and mandibular bone.

How should dental care adapt?

Extra time, prevent falls, avoid surgery if taking bisphosphonates.

STDs

Which STD is most common in older adults?

HIV/AIDS.

Why are older adults at higher risk?

Thinner epithelium, reduced immunity, longer lifespan, generational differences.

Dental hygiene considerations?

Physician referral, nonjudgmental communication, patient education.

Respiratory and Cardiovascular Disease

Which respiratory diseases are common?

Pneumonia, COPD, asthma.

Dental care adaptations?

Monitor vitals, adjust seating.

Which cardiovascular diseases are common?

Hypertension, angina, myocardial infarction, CHF, valve disease, stroke.

Dental care adaptations?

Monitor BP, relaxation techniques, lifestyle counseling.

Oral Changes

How do lips, oral mucosa, and tongue change?

Lips dry, less elastic

What is xerostomia?

Subjective dry mouth, caused by medications, autoimmune disease, diabetes, radiation.

What is oral candidiasis?

Fungal infection, common in dentures, xerostomia, immunocompromised.

How do teeth change?

Darkening, pulp narrowing, attrition, abrasion, increased root caries.

Periodontium

What changes occur in bone and gingiva?

Bone loss, decreased healing

What increases risk for periodontal disease?

Chronic diseases, medications, similar factors as younger adults.

Dental Hygiene Care

Why is oral health important?

Component of overall health and wellness.

How should care be adapted?

Consider cognitive, sensory, physical limitations

What barriers exist?

Perceived lack of need, financial, access, mobility, physical barriers.

What precautions should be taken?

Eliminate hazards, adjust seating, short appointments, raise chair slowly.