Geriatrics exam 1

What percent of people over 65 will have chronic disease?

80%

Medicare will only pay for the first ____ days of admission

100

Medicaid pays ~ ___% of SNF costs

80%

What is the definition of elderly?

older american act of 1965 states 60** years and older

maximum survival of a species

life span

The length a particular group can be expected to live (average)

life expectancy

what is likely the most influential influence on life expectancy?

genetic

fibroblasts divide about ___ times before removed from the population

All cells have the ability to remember how many times they divide through ______

30 times

Telomeres

What is Werner syndrome?

features of premature aging

What are the 3 theories on aging?

1. neuroendocrine pacemakers

2. Free Radical Theory products of metabolism

3. Errors in protein synthesis

What are the 2 neuroendocrine pacemakers?

- Hypothalamic-Pituitary Gonadal axis

- Hypothalamic-Pituitary Adrenocortical axis

What type of neuroendocrine pacemaker is this?

Menopause, Dopamine , Human Growth Hormone

- Hypothalamic-Pituitary Gonadal axis

What type of neuroendocrine pacemaker is this?

Truncal obesity, glucose intolerance, osteopenia, cataracts

- Hypothalamic-Pituitary Adrenocortical axis

In the Free Radical Theory products of metabolism, there is damage of _______ antioxidants (Vit C and E)

______: may also induce DNA mutations

DNA/RNA antioxidants (Vit C and E)

UV light

Errors in protein synthesis are usually caused by

amino acid sequence errors

Aging is a _____ process, NOT accumulation of disease

developmental

_____ are conceived more and ______ live longer

males

females

Individuals born in America between 1946 and 1964 are referred to as _______ as a result of the significant increase of births that occurred during that 22-year period

'baby boomers'

Occurs independently of disease, yet is associated with increased disease prevalence and susceptibility. As we age, we lose this ability - what is this known as?

loss of homeostasis

Why do elderly people tend to weigh less?

they lose muscle and gain of fat

Why does GI motility decrease?

lower fiber

reduced fluid

reduced exercise

What occurs witht he GU/ as we age? (males and females)

impotence

What are the effects on the skin as we age?

1. lower subQ fat

2. lower vascular supply

3. dryness due to atrophy of sweat glands

4. Loss of elasticity and skin thickness

What are the visual diseases that occur as we age?

Glaucoma

macular degen

Cataracts

presbyopia

What are 2 visual disturbances that are not normal processes of aging?

glaucoma

macular degeneration

How is the lens affected as we age?

Increased ______ of lens and ciliary muscle lead to _______

rigidity; presbyopia

How is the iris affected as we age?

Decreased adaptability to changes in light, secondary to _______ of the iris ​

stiffness

What are the sxs of macular degen?

no pain

drusen

blurred central vision

how to tx macular degeneration?

Healthy diet

Smoking

Maintain BP and healthy weight

Excercise

What are the sxs of glaucoma

loss of side vision

- no early signs

How to tx glaucoma

Medications, usually eye drops

Laser or conventional surgery

What are the sxs of cataracts?

cloudy lens

Colors that may not appear as bright as they once did.​

glare

poor night vision

What are the RF for cataracts?

smoking

DM

sunlight

What is the tx option for diabetic retinopathy?

laser tx

sx

What is presbycusis? mc in who?

age related hearing loss

males

at what age does presbycussis occur?

~30y/o

how does presbycussis develop (3 steps)

What are some RF for hearing loss? what do they have in common?

HTN

Heart disease

Alcohol

Noise

DM

Smoking

all have to do with arteries

________ can cause dementia

Hearing loss

What is the cause for sensorineural hearing loss?

loss of hairs of corti

loss of cochlear neuron

inner ear problems

What is the mc cause of Conductive Hearing Loss

Auditory Canal Atrophy

5 types of conductive hearing loss

Infections in the skin lining the ear canal ​

Fluid in the middle ear, ​

Arthritis that affects the bones of the ear​

A Hole in the ear drum, not very common in older people. ​

Paget’s disease of bone​

What is a Schwannoma?

CN VIII tumor, retrocochlear hearing loss

What happens to the GI system as we age?

Tension in the upper esophageal sphincter _______ (presbyesophagus)

Stomach lining's capacity to resist damage _______

decreases

decreases

How is the nervous system affected as we age?

Brain Size _______ along with ________

Diminished Amounts Of ________ in localized areas

How to help the elderly with their sleep?

Decreases; blood flow as we age

Neurotransmitters

avoid sedatives and give afternoon sunlight

Why do we get PUD as we age?

Stomach lining's capacity to resist damage decreases

defined as age-related increased vulnerability to adverse outcomes when exposed to stressors (either intrinsic or extrinsic)

frailty

involuntary loss of urine

urinary incontinence

Who is urinary incontinence most common in?

women

what is the MC cause of urinary incontinance in women?** (TQ)

childbirth

URINARY INCONTINENCE IS NOT CAUSED BY _____ ALONE

AGE

Urination is under what control?

Central and peripheral

Bladder comfortably holds _______cc of urine before the urge to void

150-300

What occurs when the intra vesicular pressure rises above urethral phicter spressure

Leakage

intravesicular pressure can rise from increased intra-abdominal pressure

valsalva

**What is the bladder capacity in the elderly (normal is 300-600)?

250-300

- urge at 150

Why do women have incont and males have retention?

-decline in outlet resistance, from childbirth and deconditioned muscled

- enlarged prostate, increased residual urine

What is stress incontinence?

Involuntary loss of small amounts of urine due to increased intra-abdominal pressure, cough, laugh, ect

These are causes of what kind of incontinence?

Laxity of pelvic floor, causing hypermobility of bladder base and urethra or outlet or urethral sphincter weakness due to surgery or trauma

stress

What is the tx for stress incontinence?

kegels

alpha agonists

sx

What is urge incontinence?

inability to delay voiding after sensation of bladder fullness

- feel it then go

what are the causes for urge incontience?

detrusor hyperactivity caused by UTI, dementia, parkisons...

What is the tx for urge incontience?

treat infection

bladder relaxants

vladder training

What is overflow incontinence?

Leakage due to overdistended bladder

sx of overflow incontinence

Dribbling, weak stream, hesitancy, nocturia

What is the cause for overflow incontinence

obstruction (prostate)

detrusor underactivity

What is the tx for overflow incontinence?

Remove obstruction

Catheterization

What is functional incontinence?

Leakage of urine due to cognitive, functional, or environmental factors.

What are the causes for functional incontinence

dementia

restraints

inaccessible toilets

depression

catheters

What is the tx for functional incontinence

behavioral therapy

external collection

What is mixed incontinence?

combination of stress and urge incontinence

What is the tx for mixed incontinence?

bladder retraining

pelvic exercise

pharmacologic drugs

What are the complications of incontenece?

Where do you do a post void residual?** (TQ)

at the urologist!!! *

What are some reversible causes of incontinence

delirium

UTI

impaction

atrophic vaginitis

metabolic disorders

What are some Meds that cause incontience?

Diuretics

Lithium

psychotropics

anticholinergic

Alpha adrenergic

What type of incontinence does each cause:

Sedatives

Loop

Alcohol

Caffeine

Cholinergics

urge/obstructive

urge/obstructive

urge/functional

Urge

Urge

How do anticholinergics work for incontinence? - they ______ bladder capacity and ______ involuntary contractions

inc bladder capacity and decrease involuntary contractions

What type of incontinence are anticholinergics/musc used for?

Urge

stress

What are the AE of anticholinergics?

dry mouth

>IOP

delirium

visual changes

constipation

what kind of drugs are these Darifenacin (Enablex), Oxybutynin, Mirabegron (Myrbetriq ) - New

anticholinergics

what do alpha adrenergic agonists do for incontinence

increases smooth muscle contraction

What type of incontinence are alpha adrenergic agonists used for?

Stress incontinence due to sphincter weakness

What are the AE of alpha adrenergic agonists?

HA

Tachycardia

>BP

what kind of drugs are these

phenylefedrine

pseudoephedrine

alpha adrenergic agonists

What type of incontinence are Estrogen used for?

stress/urge due to atrophic vaginitis

What are the AE of Estrogens?

> BP

Endometrial CA

What type of incontinence are cholinergic used for?

Overflow incontinence 2/2 atonic bladder

What are the AE of cholinergic agents?

Bradycardia

hypotension

bronchospasm

> gastric acid secretion

What type of incontinence are alpha adrenergic blcokers used for?

overflow and urge from > prostate size

What are the AE of alpha adrenergic blcokers?

Orthostaic hypotension

Who is this surgery common in?

Repair of pelvic prolapse, bladder neck procedures

women with stress incontinence

Who is this surgery common in?

Transurethral resection of the prostate (TURP)

men with Outlet obstruction secondary to BPH

Which catheter is this?

Males mostly, some available for females> risk of skin irritation and UTI'sMay promote dependenc

External Catheters condom with a drain

Which catheter is this?

Must be physically able

Usually seen in community setting

Less infection risk than indwelling

Intermittent Catheterization performed by caregiver or patient

Which catheter is this?

> infection risk, bladder stones, ? Ca

Only valid use chronic retention, non healing pressure

ulcers secondary incontinence

Crazy long term effects

indwelling Cath generally overused, generally seen in men

What is the only indication of an indwelling cath?

chronic retention

non healing pressure ulcer

How long does an indwelling cath remain?

30 days MAX (4 weeks)

Renal effect of old age:

EPO

Renal mass

Concentration power

Cr clearance

- increase

- decreased by 30%

- worse --> excess water

- decrease 7.5-10% per decade after 50*** (TQ)

Why do older people typically have edema?

Poor Na excretion