CH 45 Geriatrics

What is geriatrics?

The assessment and treatment of disease in those 65 years and older.

What demographic trend is referred to as the 'graying of America'?

The increasing number of older Americans and the need for more physicians.

What does the old-age dependency ratio measure?

The number of older people for every 100 younger adults (ages 18 to 64).

What is a common misconception about prehospital geriatric patients?

Most do not reside in nursing homes.

What factors influence living arrangements for older adults?

Marital status, financial resources, religious beliefs, ethnicity, gender, general health, and grown children.

What services are available to support older adults?

Delivered meals, personal care, housekeeping, transportation, caregiver support, respite care, and emergency response systems.

How does financial situation affect older adults' health?

Older people living in poverty may make lifestyle choices that pose serious health risks.

What psychosocial factors can influence aging?

Feelings of uselessness, mourning over loss of ability, and a sense of accomplishment in retirement.

What is the crisis of integrity versus despair in aging?

Integrity involves pride in accomplishments, while despair reflects unfulfilled goals and bereavement over losses.

At what age does the aging process typically begin?

In the late 20s and early 30s.

What factors can accelerate the aging process?

Genetics, preexisting disease, diet and activity levels, toxin exposure, and psychosocial characteristics.

What happens to respiratory capacity as people age?

Respiratory capacity undergoes a large reduction, with decreased vital capacity and increased residual volume.

What changes occur in the cardiovascular system with aging?

Decreased efficiency, thickening vessel walls, and increased systolic hypertension due to arteriosclerosis.

What neurological changes occur in older adults?

The brain decreases in weight and volume, affecting regulation of vital functions.

What are common sensory changes in older adults?

Declines in vision and hearing, with specific conditions like cataracts and presbycusis.

What is presbycusis?

Gradual hearing loss that occurs with aging.

What is Ménière disease?

A hearing-related impairment characterized by vertigo, hearing loss, and pressure in the ear.

What digestive changes may occur in older adults?

Fewer taste buds, reduction of saliva, and dental loss.

What risks are associated with ill-fitting dentures in older adults?

Choking, heartburn, and abdominal pain.

What happens to gastric secretions as people age?

Gastric secretions are reduced.

How does aging affect the ability to modify respiratory rate?

The ability to modify respiratory rate and tidal volume in response to changes is limited.

What are common changes in the nervous system due to aging?

Declines in mental function affecting respiratory rate, pulse rate, blood pressure, hunger, thirst, reflexes, and temperature regulation.

What is the significance of the old-age dependency ratio?

It is used to compare age structures between different societies.

What is the impact of the increasing number of older Americans on healthcare?

There is a growing need for cost-effective and efficient healthcare services.

What role do grown children play in the living arrangements of older adults?

They may seek help from medical social workers, care managers, and discharge planners.

What are the implications of decreased chest expansion in older adults?

It limits lung volume and maximal inspiratory pressure.

What is the impact of vascular stiffening on older adults?

It contributes to decreased cardiovascular efficiency and increased risk of hypertension.

What is a common symptom of acid reflux?

Heartburn

What condition is characterized by difficulty digesting food?

Indigestion

What can cause esophageal scarring?

Acid reflux

How does aging affect bowel functions?

Slight changes occur, leading to incontinence and increased constipation.

What factors can worsen constipation in older adults?

Some medications, diet changes, and decreased physical activity.

What happens to hepatic enzyme activity with age?

Some activities decline while others increase, affecting drug detoxification.

How do aging kidneys respond to sodium deficiency?

They respond slowly, which can cause electrolyte imbalances.

What is a risk associated with large sodium loads in older adults?

Overhydration and potential hyperkalemia.

What endocrine change increases the risk of type 2 diabetes in older adults?

Decreased insulin production and glucose metabolism.

What happens to antidiuretic hormone levels as people age?

They increase, causing fluid and electrolyte imbalances.

What skin changes occur with aging?

Skin becomes thinner, drier, less elastic, and more fragile.

What is a common change in sebaceous gland activity in older adults?

They produce less oil, leading to drier skin.

What can increased capillary fragility in older adults lead to?

Purple patches on the skin (purpura).

How does aging affect bone mass?

There is a decrease in bone mass, leading to brittle bones.

What musculoskeletal changes are common with aging?

Decreased muscle mass and strength, joint problems, and increased susceptibility to fractures.

What is a misconception about older adults and illness?

That illness is inevitable with aging.

How may myocardial infarctions present differently in older adults?

They may not include chest pain.

What debilitating health problems are common in older adults?

Hypertension, heart disease, arthritis, cancer, diabetes, and stroke.

What is the GEMS diamond used for in geriatric assessment?

To form a general impression based on Geriatric, Environmental, Medical, and Social assessments.

What is a key task during the primary assessment of a geriatric patient?

Determine life-threatening conditions.

What communication skills are important in history taking for older adults?

Active listening and nonverbal communication.

What can affect the assessment of older adults?

Sensory alterations, verbal communication skills, and mental/physical capabilities.

What is a common change in the thirst mechanism with aging?

It decreases, which can lead to dehydration.

What happens to the temperature regulating mechanism as people age?

It becomes less effective.

What is a common change in the blood glucose regulatory system in older adults?

It becomes less effective, increasing the risk of diabetes.

What are the components of a comprehensive history?

Chief complaint, present illness or injury, pertinent medical history, current health care status and needs.

What does pertinent medical history include?

Current cardiovascular health, exercise tolerance, diet history, medications, smoking and drinking habits, sleep patterns, and other intrinsic and extrinsic factors.

Why might determining the chief complaint be difficult?

Patients may believe symptoms are part of aging, ignore symptoms to avoid being labeled a hypochondriac, or underreport symptoms.

What should be done if the chief complaint seems trivial?

Use a standard list of screening questions to evaluate major organ systems functions.

What is the purpose of conducting a history of present illness?

To understand how the current condition differs from previous states and what prompted the patient to seek help.

What details should be obtained about a patient's medications?

List by name, dosing, frequency, provider, including prescribed medications not taken and medications from other sources.

What adjustments should be made for secondary assessments in older patients?

Limit physical manipulation, be aware of body temperature, and only remove clothing as necessary for inspection.

What changes in blood pressure should be noted in older patients?

Postural BP changes may vary, and marked changes can indicate possible hypovolemia or overmedication.

What are the symptoms of pneumonia in older patients?

Acute confusion, normal temperature, minimal to absent cough, wheezing, abdominal pain, and rhonchi in affected lobes.

What is the primary treatment for pneumonia?

Supportive care including fluids, oxygen, and analgesics for fever.

What preventive measures can be taken against pneumonia?

Pneumococcus vaccine, booster doses after 3 to 5 years, cessation of smoking, and respiratory exercises.

What diseases are included in Chronic Obstructive Pulmonary Disease (COPD)?

Chronic bronchitis, emphysema, and asthma.

What are the preventive measures for COPD?

Cessation of smoking, avoidance of environmental pollutants, immunization for influenza and pneumococcal pneumonia, pulmonary rehabilitation, and use of inhaled medications.

What are common symptoms of asthma in older adults?

Shortness of breath, chronic or nocturnal cough, and wheezing.

What is a pulmonary embolism?

A clot that blocks the blood vessel supplying the lung.

What is the classic triad of symptoms for pulmonary embolism?

Dyspnea, chest pain, and hemoptysis.

What are the leading causes of death among older adults in the U.S.?

Heart diseases, with coronary artery disease (CAD) being the number one cause.

What atypical symptoms might older patients report during acute coronary syndrome?

Dyspnea, syncope, weakness, confusion, nausea, vomiting, and fatigue.

What are the risk factors for heart failure?

Sex, ethnicity, family history, long-term alcohol use, smoking, and multiple medical conditions.

What preventive measures can help reduce the risk of heart failure?

Smoking cessation, healthy diet, blood glucose control, exercise, weight control, and hypertension control.

What can acute exacerbation of heart failure lead to?

Pulmonary edema, dyspnea, orthopnea, and decreased oxygenation to organ systems.

What factors can mask the presentation of heart failure in older adults?

Symptoms of old age or shared symptoms with other chronic illnesses.

What is the prehospital treatment for heart failure?

The same as with other populations, focusing on managing symptoms and ensuring patient stability.

What can mask the presentation of heart failure?

Symptoms and signs of old age or other chronic illnesses.

What are common triggers for acute exacerbation of heart failure?

Poor diet, medication noncompliance, onset of dysrhythmias, acute myocardial ischemia.

What is the initial treatment approach for prehospital care of heart failure?

Same as with other populations; familiarize with medications and evaluate ECTO2.

What is a critical aspect of managing heart failure?

Fluid monitoring and avoidance of fluid overload.

What is atrial fibrillation (AF) and its risk?

Atrial fibrillation increases the risk of stroke and heart failure by allowing blood stasis.

What factors contribute to dysrhythmias in older populations?

Age-related heart changes, existing cardiac disease, adverse drug effects, and a combination of factors.

What is a common treatment for bradycardia in older individuals?

Often treated with an internal pacemaker.

What percentage of US adults aged 65 or older have hypertension?

Approximately 70%.

What is the primary risk factor for stroke?

Hypertension.

What are common risk factors for stroke?

Age, family history, smoking, diabetes, high cholesterol, and heart disease.

What should be done for patients with transient ischemic attacks?

They should be treated as though they are having a stroke.

What are the symptoms of delirium?

Disorganized thoughts, inattention, memory loss, disorientation, personality changes, hallucinations, and delusions.

What can mimic the symptoms of delirium?

Intoxication, drug abuse, and severe psychological disorders.

What does the acronym DELIRIUM stand for in assessing causes?

Drugs or toxins, Emotional, Low PaO2, Infection, Retention of stool or urine, Ictal (seizures), Undernutrition or underhydration, Metabolism, Subdural hematoma.

What are common symptoms of dementia?

Short-term memory loss, confusion, difficulty retaining new information, and personality changes.

What are the two most common degenerative dementias?

Alzheimer disease and multi-infarct or vascular dementia.

What is the treatment approach for dementia?

There is no treatment for dementia itself, but underlying medical problems can be treated.

What are some preventive measures for aneurysms?

Proper diet, exercise, smoking cessation, and cholesterol control.

What can indicate early cerebral bleeding in aneurysms?

A new headache or change in a chronic headache.

What is the first manifestation of an aneurysm rupture?

Sudden and devastating stroke.

What is traumatic aortic disruption also known as?

Aortic dissection.

What is a key characteristic of aortic dissection?

The interior wall tears and blood collects between arterial wall layers.

What are early symptoms of large or ruptured aneurysms?

Difficulty swallowing and hoarseness.

What is the importance of family members in stroke assessment?

They provide information about the patient's baseline cognitive status and personality.

What should be done in the case of rapid onset of systolic hypertension?

Use antihypertensive therapy.