Geriatrics final

Theories of aging

Fibroblasts

Neuroendocrine markeres (hypothalmic axis)

Free radical theroy

Errors in protein synthesis

Werners Syndrome

Advanced aging

What is the free radical theory

Damage of DNA/RNA antioxidants

UV light damages

Aging is a _____ and not a ____

Developmental process

Accumulation of disease

Are glaucoma and macular degeneration considered normal processes of aging?

No

Ignoring hearing loss can

reduce quality of life

The MCC of sensorineural hearing loss

Loss of hairs of corti

The MCC of conductive hearing loss

Auditory canal atrophy

The MCC of Retro-cochlear hearing loss

CNS 8th Nerve tumor (Schwannoma)

Age-related increased vulnerability to adverse outcomes when exposed to stressors

Frailty

Involuntary loss of small amounts of urine due to increased inta-abdominal pressure, cough, laugh, sneezing

Stress incontinence

Cause of Stress incontinence

Laxity of pelvic floor

Managment of Stress incontinence

Kegels

Inability to delay voiding after sensation of bladder fullness

Urge incontinence

Causes of Urge incontinence

Detrusor muscle hyperactivity

Cystits

Stones

Stroke/dementia/parkisons

Management of Urge incontinence

Treat infection

Bladder relaxants

Bladder training

Leakage of urine from mechanical forces on an overdistened bladder

Overflow incontinence

Cause of Overflow incontinence

Anatomical obstruction from prostate

Detrosr underacvtivity

Managment of Overflow incontinence

Sx removal of obstruction

Cath

Leakage of urine due to cognitive and/or physical impairmenet, unwillingless, or environmental barriers

Functional incontience

Major cause of funcitonal incontinence

Dementia

Features of both urge and stress incontince

Mixed

Drugs associated with Urge UI

Sedatives, loops, alc caffiene, cholinergics

Drugs associated with obstructive UI

Sedatives & Loops

Drugs associated with funtional UI

Alcohol

AE of Anticholinergics

Dry mouth, inc IOP, delirum, visual changes, cosntipation

Alpha agonist AE

HA, tachy, inc BP

Conjugated estrogens AE

Endometrial CA, inc BP

Cholinergic agonists AE

Bradycardia, hypotension, bronchospasm, inc gastric acid secretion

Alpha blockers AE

Orthostatic hypotension

Creatinine clearance decreases by ____ per decade after 50

7.5 -10%

Is Anemia normal in the elderly?

No, but Hb can be slightly reduced

As a part of NPA, the CV system is less able to react to

Catecholamine and sympathetic responses energy metabolism

CV system at a cellular level

Impaired mitochondrial capacity to increase ATP

The eldelry have ____ excersize tolerance and are more prone to ___

Less

Hypotension when changing positons

CAD, Arteriosclerosis, HTN HD --> NPA?

NO (just common disroders found in the elderly)

Is elevated BP in the elderly normal?

No

How should eldelry be treated for BP

Start low and go slow - rapid reduction leads to serious AE

Most common CVA

Non-hemmorhagic (thrombotic or atherosclerotic)

MC hospital discharge diagnosis in the US

Heart Failure

In the lungs, ___ and ___ stiffen

elastin and collagen

Most apparent age related changes in endocrine

Glucose homeostasis, Reproductive function, Calcium metabolism

What is important to know when looking at thyroid tests in eldelry?

Drug interactins distory thyroid function tests

TSH is an acute phase reactant so is not reliable in an inflamm state

TSH can be as high as ___ in the elderly and be safe

6-8

First line treatment in Type 2 DM

Lifestyle changes

then Metformin

A1c goals for healthier adult patient

7-7.5%

A1c goals for elderly with extensive comorbidities

8-9%

___ in the eldelry is associated with hypoglycemia

tight glycemic control!

In GI system there is a decrease in

Intrinsic factor*

Gastric acid and prostaglandins*

Esophogeal motility, thirst, hunger, peristalsis

MC Esophogeal disorder in eldelry*

Dyphagia

Ways we can treat dysphagia

Positioning*

Make liquids thicker

Classic sxs of GERD

Heartburn (everything else is atypical)

2nd MC malignancy in the US

Malignant GI tumors

MC presentation of malignant GI tumor

Anemia

How to prevent c.diff?

Avoid ABX

Sxs of C.diff

Non-bloody diarrhea

Leukocytosis

Odor

C.diff complication

Colonic perforation*

Tx C.diff

Vanco, Questran

Metro, Fidamoxicin

Causes of constipation

Lack of fiber

Slower motility

Decrease in body water

Treatment of constipation

Osmotic laxatves (Lactulose)

What NOT to use in ESRD for constipation

Mg based laxatives

Ph Enema

Geriatric Giants

FTT, Gait disorder/falls, pressure ulcers, UI, Constipation/diarrhea

Tx for osteoporosis

Bisphosphonates (take on empty stomach)

Bisphosphonates are CI in

Esoph disorders

Known malabsoprtion

Largest single cause of preventable restricted activtiy in elderly

Injuries from falls

When do falls at home have a much higher incidence?

Within 1 month of hospital discharge

MC spot to fall

bedroom/bathroom

Get Hx of fall via

SPLAT

Symptoms

Previous falls

Location

Activity

Time

Test for falls

Get up and go tests (< 10sec)

Easy treatment to prevent falls

Lower the bed

Pressure on capillary beds greater than ____ will cause necrosis in as little as ____(plus add shearing forces and mositure from incontinence = pressure ulcers!

32mmHg

2 hours

Bony prominences*

Greater trochanter, Heels, Sacrum, Scapula, Occiput

Non-blanchable erythema that is typically painful

Stage 1 ulcer

Partial skin loss usually epidermis & dermis (blister, abrasion, superficial crater)

Stage 2 ulcer

Full thickness loss with damage TO not through underlying fascia

Stage 3 ulcer

Full thickness loss through fascia to supporting structures

Stage 4 ulcer

Any wound that you can not see

Unstabgeable

If dry ulcer (like eschar)

Local care

Cover

Iodine

Screening test for arterial ulcers/PAD

ABI

ABI of ____ = PAD

> 1.4

MC type of ulcer

Venous stasis ulcers

punched out appearance, brown sclay

venous stasis ulcers

Cornerstone tx of venous stasis ulcers

Compression bandages (not sx)

Small ulcers on the plantar or lateral side are usu

Diabetic foot ulcers

Malnutrition can present as

confusion or hypotension

Working memory is reliant on this area, it undergoes cell shrinkage and cell loss with age

Prefrontal cortex

Elderly seen to make more ___ decisions

Gut

Aging enhaces the ability to remeber information that is

emotionally positive and personally relevant

These memories tend to be more resilient, are less affected by brain da,age, aging or Alz

Remote memory & semantic memory

Overtime memory is no longer dependent on hippocampus, but instead

the surrounding cortical regions (lots of repetition spread out over many years)

Semantic memory is reliant on

temporal lobe

Older adults tend to have much better ____ than young adults, so they perform better on tasks of vocab and world knowledge

Semantic memory

Multiple acquired cognitive defects that occur in the absence of acute confusions

Dementia

Is there a specific dx test for dementia

No

Demential with Lewy Bodies

Lewy bodies in cortex and brainstem --> confusion with delirum and ALWAYS PROGRESSES*

Vascular dementia

Mild recovery, but NOT to baseline (multi-infact, lacunar state)

MC Dementia

Alzheimer's

Distubance in consciousness & change in cognition that develops over a short period of time

Delirium

Major RF for delirium

New RX (Anticholinerfics*)

Confusion assessment method

Needs 1&2 AND 3 or 4

1) acute onset and fluctuating course

2) inattention

3) disorganized thinking

4) altered level of consciousness