Geriatrics

81.1

what is the avg life expectancy for females?

77.28

what is the avg life expectancy for males?

9-12

healthy persons who make it to the expected age can expect to live ______yrs longer

20

___% of the probability of living long is genetic 

“young old” or “seniors”

what is the term for those aged 65-75?

elderly

what is the term for those aged 75-95?

oldest old

what is the term for those aged 85-95?

centenarians 

what is the term for those 95+?

frail elderly

• usually people >75yo who are afflicted w/ physical or mental disabilities that interfere w/ ability to independently perform ADL

• significant risk of post-surgical complications

50

__% of all adverse drug rxns are in pts >65yo

immobility, instability, incontinence, impaired intellect/memory, impaired senses

what aer the most common medical problems in geriatric pts?

falls

what is the leading cause of accidental death & non-fatal injury in the elderly? 

white males > white females > black males > black females

what is the highest risk group for falls in the elderly?

UTIs, acute anemia, pneumonia

what acute illnesses often have a sx of falls in the elderly?

COPD, arrhythmias, CHF

what chronic diseases often have sx of falls in the elderly?

UTI

• s/sx: 

  • falls

  • increased confusion

  • mood changes

  • bowel constipation

  • polyuria/urinary incontinence

  • low fever in later stages

• labs:

  • WBC: normal until later stages

worse than 20/40 - 20/60

studies have found an increased risk of falls in the elderly when their VA is ___

doubles

studies have found that changing an elderly pt’s MF from a BF to a PAL _____ the risk of falls

increased

studies have found that fall risk in the elderly ______ after vision improvement

yes

is renal impairment a normal part of aging?

yes

is dry eye a normal part of aging? 

no

is renal failure a normal part of aging?

no

is urinary incontinence a normal part of aging?

no

is sicca syndrome a normal part of aging?

no 

is exposure keratitis a normal part of aging? 

persistent pain

what is the most common medical complaint in the elderly?

persistent pain

• pain lasting >3mo

• prevalence: 25-50%

• etiologies: arthritis, cancers, claudication, leg cramps, neuropathy

loss of reading & sharpness

what is the most common visual complaint in the elderly? 

cataracts, dry eye

what can cause the complaint of loss of reading & sharpness in the elderly?

Charles Bonnet syndrome

• visually impaired pts often seeing images (of lilliputian people most often)

• duration: few days - many years

• pathophysiology: visual parts of brain are deprived of actual input so it makes up its own images from the normal neuronal background noise

T

T/F: elderly pts will tend to measure their lives as years left rather than years lived

140/90mmHg

what is the normal BP in the elderly pt? 

triples

an SBP of >140 _____ the risk of CVD

orthostatic hypotension

• seen in 30% of elderly pts

• may report blurring of vision & gray outs

• must measure BP sitting & standing

no (increase in arrhythmias) 

does the HR change w/ aging?

90%

what is the average pulse ox in the elderly? 

1 degree lower

what is the avg body temperature in the elderly?

<85

there is an increase in confusion & falls associated w/ pulse ox ____%

increased

the elderly have an ______ susceptibility to hypothermia

spastic hemiplegia 

abnormal gait: stroke pt drags on one side

spastic diplegia

abnormal gait: scissor gait

steppage gait/foot drop

abnormal gait: muscle weakness

cerebellar ataxia

abnormal gait: wide stance, waddle walk

sensory ataxia 

abnormal gait: lost sensation, smacks foot down 

age associated cognitive impairments

mild mental impairment, not associated w/ other dz

amnestic mild cognitive impairments

impairment in memory associated w/ Alzheimer’s dz

non-amnestic mild cognitive impairments

language or visuospatial function problems

1. age associated cognitive impairments

2. mild cognitive impairments

3. dementia 

what are the types of mental impairments in the elderly? 

dementia

• early or late onset

• commonly Alzheimer’s

• s/sx:

  • gradually progressive decline in multiple functions: memory, orientation, judgement, insight, language

  • depression frequent early on

  • psychosis, agitation, behavioral dis-inhibition later on

vascular dementia

• 10% of dementias

• etiology: strokes, CVD

• s/sx:

  • stepwise pattern onset: stable for months, then sudden level drop then again stable

  • early incontinence

  • gait disturbances

  • flatted affected

  • memory of people is good

Parkinson’s

• pathophysiology Lewy bodies in brainstem

• 2nd most common dementias

• s/sx:

  • flatted affect & speech

  • slow movement

  • balance issues

  • gait disturbances

  • tremors

  • rigidity

Parkinson’s plus

• Parkinson’s findings w/ dementia & diffuse Lewy bodies

• s/sx:

  • flatted affect & speech

  • slow movement

  • balance issues

  • gait disturbances

  • tremors

  • rigidity

  • visual hallucinations

  • cognitive fluctuations

• death in ~1y after dx

flatted affected

• often seen in Parkinson’s pts

• will speak w/ a hypophonic, hushed quality

• masklike appearance w/ decreased blinking

• chin down head posture

  • fixation peering upwards

  • restricted down gaze

hydrocephalic dementia

• late onset condition 

• s/sx:

  • evolves slowly over weeks - months 

  • impaired affect & mood

  • motor slowing 

  • urinary incontinence

  • gait instability 

  • gait: wide w/ shuffling walk 

delirium 

• acute confusional state most often due to toxic encephalopathy 

• acute onset (hrs - days) 

• secondary to medical condition (drugs, anesthesia, stress, infections, endocrine disorders) 

• s/sx: 

  • disorientation

  • excitement

  • defective perceptions w/ illusions & hallucinations

loss of pigment & hair overall 

what are the hair changes seen in the elderly? 

frontal & vertex

where do males experience hair loss w/ age?

vertex

where do females experience hair loss w/ age?

20, 50

hair loss generally starts at age ___ and is stable by age ___

loss of turgor, decrease in vascularity of dermis, wrinkles, loss of subdermal fat, sun damage

what are the skin changes associated w/ aging? 

seborrheic keratosis

• benign epithelial tumor

• appearance:

  • stuck on appearance

  • verrucous papules/plaques

  • few - hundreds

  • location: face, trunk, arms

actinic keratosis

• precancerous cutaneous epithelial lesion 

• risk of SCC

• M>F

• appearance: 

  • seen on sun exposed areas

  • 1-3mm

  • rough, scaly

  • locations: forehead, cheeks, nose, hands, arms

basal cell carcinoma

• most common cancerous skin lesion 

• M>F

• genetic link 

• lighter skin types >

• appearance: 

  • locations: sun exposed areas, head, face

  • slow growing (months - years)

  • hard nodule, pearly rolled edge

  • central ulceration, bleeds

sebaceous hyperplasia 

• fairly common

• can be confused w/ BCC

• M>F

• genetic link 

• appearance: 

  • location: sun exposed skin, forehead & cheeks

  • soft yellow papules

  • 1-3mm raised donut shaped

malignant melanoma

• F>M

• light skin >

• increased risk w/ sun exposure

• appearance: 

  • locations: upper back, legs

  • irregular color, shape, size

  • avg 8-12mm

squamous cell carcinoma

• M>F

• lighter skin types >

• increased risk w/ sun, X-ray, or arsenic exposure 

• frequent invasion, possible metastases

• s/sx: 

  • slow growing

  • hard nodule, adherent scale

  • asymptomatic

  • can ulcerate & bleed

lost luster, thickens, yellowing, longitudinal grooves

what are the nail changes seen w/ aging?

polyuria, polydipsia, polyphagia, rapid weight loss, ketonuria, UTIs

what are the classic sx of hyperglycemia? 

hyperosmolar coma

• acute complication of diabetes frequently seen in undiagnosed diabetics

• associated w/ hx of illness (prolonged osmotic diuresis → dehydration → reduced alertness → convulsions → coma

• 44% mortality rate

elevated TSH, florid myxedema

what thyroid changes are commonly seen in the elderly pt?

myxedema coma

• rare thyroid issue in elderly

• state of decompensated hypothyroidism

• pt may have normal lab values

• precipitated by stressful event

florid myxedema 

• seen w/ hypothyroidism 

• dull, puffy face

• dry & thickened skin 

• swelling around eyes

• dry, coarse, thinned hair & eyebrows 

apathetic hyperthyroidism 

• CHF & tachydysrhythmias 

• weight loss, anorexia

• muscle weakness

• tremor of hands 

HTN, COPD, LVH, CHF, aortic sclerosis/stenosis

what are the cardiopulmonary changes seen w/ aging?

osteoarthritis, osteoporosis, Paget’s bone dz, cartilage thinning, bone remodeling

what are the musculoskeletal changes seen w/ aging?

osteoarthritis

what is the most common musculoskeletal change in the elderly?

osteoporosis 

what is the most serious musculoskeletal change in the elderly? 

osteoporosis 

• serious musculoskeletal disorder w/ aging

• lower back pain (often after a backward fall) 

• signs: kyphosis, loss of height 

hearing loss, tremors, poor balance, polyneuropathy, slowed memory/speed of thinking, depression

what are the nervous system changes seen w/ aging?

essential tremor

• most common tremor

• commonly +FHx

• age: any, most by 40yo

• appearance:

  • tremors during voluntary activity

  • involves upper limbs & head

  • can affect voice control

  • faster than parkinson’s 

  • increased frequency w/ stress & caffeine

  • decreased frequency w/ alcohol

• tx:

  • beta blockers

no

do sedatives work on baseline tremor? 

senile tremor

an essential tremor that becomes symptomatic in the elderly (>60yo)

intentional tremor (cerebellar tremor)

• associated w/ cerebellar disorders & chronic alcoholism

• appearance:

  • abnormal gait, finger-to-nose touch, rapid alternating movements, speech, &/or deep reflexes

  • tremor only seen at the extent of reach during precise voluntary movements

  • faster than parkinson’s

volitional tremor

an intentional tremor that can be arrested by strong effort of will

pill rolling tremor

• type of Parkinson’s tremor

• resting tremor of the thumb & fingers in a slow pronation movement

• may be unilateral

resting tremor

• type of Parkinson’s tremor

• a coarse, rhythmic movement confined to the hand & forearms

• seen when limbs are relaxed & resting

• disappears w/ active movement

bathing, dressing, toileting, transferring, continence, feeding, money management

what are some ADL?

telephone, shopping, preparing food, housekeeping, laundry, transportation, taking medicine

what are some IADL?