EMRG 251 Geriatrics (V2-2024)

Special Considerations in Geriatrics

Cardiovascular Changes

• Net Effect: Decreased efficiency of the cardiovascular system.

  • Heart Hypertrophy: Thickening of heart muscle.

  • Decline in Cardiac Output: Reduced blood flow from the heart.

  • Arteriosclerosis: Stiffening of blood vessels affecting circulation.

  • Atherosclerosis: Build-up of plaque in arteries, narrowing them.

  • Aortic Stenosis: Aortic valve fails to open fully, impeding blood flow.

Electric Conduction System

• Electric conduction system deteriorates

  • pacemaker cells in the SA node decrease

  • leading to bradycardia, dysrhythmias, and heart blocks

• Muscle and Valve Degeneration: Decreased contractility and cardiac output, with valve stiffening affecting blood flow.

• Valve degeneration

Causes of Decline

• Aging is not the only factor; lifestyle plays a crucial role:

  • Sedentary Lifestyle: Contributes to deconditioning.

  • Psychological Factors: Disabilities may limit physical activity.

Respiratory Changes

• Lung Elasticity: Decrease with age, impacting breathing efficiency. causing the stiffening lungs due to calcification of costochondral cartilage.

• Muscle Strength: Respiratory muscles weaken, leading to:

  • Vital Capacity Decrease: Less air expelled from lungs.

  • Increased Residual Volume: More air remains in lungs after exhaling.

• decreased respiratory drive = decreased sensitivity to arterial blood gases = slower reaction to hypercarbia and hypoxemia

• Cough and Gag Reflexes: Weakened reflexes raise aspiration risk.

• Ciliary Mechanisms: Slowed clearance of bronchial secretions increases respiratory infections.

Renal Changes

• Kidney Function: Blood flow decreases by 50% leading to:

  • Decreased kidney size, affecting filtration capacity.

  • Imbalance in fluid and electrolytes.

  • Sodium Sensitivity: Sluggish responses to sodium deficiencies.

  • Thirst Mechanism: Decreases, raising dehydration risk.

Incontinence Concerns

• Urinary Incontinence: Not a normal part of aging, with significant social impacts:

  • Stress Incontinence: Leakage during pressure events.

  • Urge Incontinence: Strong sudden urge to urinate leads to leakage.

Digestive Changes

• Taste and Smell: Decrease in taste buds and olfactory receptors reduces food enjoyment.

• Production Decreases: Reduced saliva and gastric secretions slow digestion.

• Esophageal Sphincter: Weakens, causing reflux.

• Gastric Motility: Slower movement through the digestive tract affects nutrient absorption.

• Drug Detoxification: Declines with age, increasing medication sensitivity.

Musculoskeletal Changes

• Bone Mass: Decrease leads to brittle bones and fractures.

• Height Loss: Common due to spinal compression.

• Joint Flexibility: Loss contributes to arthritis and mobility issues.

• Muscle Mass: Significant reduction with age affects strength and mobility.

Nervous System Changes

• Cognitive Abilities: do not assume that an elderly person possesses less cognitive skill

• Neurological Examination: Includes memory and speed of processing changes.

• Brain Weight: Reduces by 5-10% with unclear functional impacts still maintaining reserve capacity. smaller and lighter brains does not equal to diminished mental capabilities for productive elderly people.

• Sensory Organ Changes:

  • Visual and Auditory: Declines in sight and hearing.

  • Decreased Tear Production: Corneal drying

  • Decreased night vision/color differentiating

  • Proprioception: impairs with age, making a person unstable

Sensory Changes Table

• Clouding of Lens: Leads to cataracts and impaired vision.

• Inner Ear Changes: Cause decreased hearing and balance issues.

• Dental Issues: May cause underestimation of health due to untreated dental problems.

Psychiatric Conditions

• Depression: Common but often underdiagnosed in the elderly; treatable but may present like other conditions.

• Suicide Risks: Higher among diagnosed depression patients; typically discretely serious about intentions.

Geriatric Assessment Insights

• Illness Presentation: Common but not normal aging; clarifies distinction.

• Multiple Health Issues: More common with increasing age, often overlapping symptoms.

• Scene Assessment: Look for clues in living conditions, mental well-being, and medication adherence.

Toxicology and Medication Management

• Drug Interactions: Risk increases with polypharmacy; monitor for noncompliance issues and prepare for difficulties in administration.

• Common Errors: "Double dosing" is a frequent therapeutic error; careful documentation needed.

Elder Maltreatment

• Understanding Mistreatment: Includes various forms from known caregivers, requiring careful observation for signs and history documentation.

End-of-Life Care Considerations

• DNR Orders: Essential to respect patient choices while providing compassionate care.