Geriatrics Study Notes

General Treatment:
- The treatment protocol for older patients with diabetes mirrors that of other age groups. However, special attention must be given to the patient's ability to understand and follow the treatment plan.
Complicated Treatment Plans:
- Aging patients newly diagnosed with diabetes often encounter complex treatment plans due to various existing health issues and the medications they are prescribed.
- Continuous follow-up in an ambulatory care setting is essential.

Lifestyle Modification Difficulties:
- Poor nutrition, inability to exercise, and ingrained habits (e.g., smoking, high saturated fat diet) complicate lifestyle changes.
Pre-existing Health Conditions:
- Conditions such as hypertension and heart disease, alongside age-related kidney and liver function decline, complicate diabetes management.
Polypharmacy:
- Older adults often take multiple medications, increasing the risk of adverse drug interactions.
Hypoglycemia Risks:
- Older adults are more likely to experience hypoglycemia and may not quickly recognize signs of low blood glucose.
Development of Complications:
- Complications from diabetes can occur rapidly due to long histories of prediabetes.
Understanding and Adherence Issues:
- Older adults often have diminished physical or mental abilities which can hinder their understanding and adherence to treatment regimens.
Financial Constraints:
- Many older patients may struggle to afford necessary medications and supplies.

When conducting patient education for an older adult with diabetes at WMFM Clinic, consider factors such as:
- Sensory impairments (e.g., vision, hearing)
- Physical limitations affecting dexterity or mobility
- Cognitive changes that may impede understanding
- Community resources available for support.

Dental Issues:
- Decreased number of taste buds, saliva production, and sense of smell affects eating.
Dysphagia:
- Difficulty swallowing is common in older adults.
Digestive Changes:
- Decreased hydrochloric acid production influences calcium and iron digestion.
- Reduced intrinsic factor secretion affects Vitamin B absorption, leading to excessive fatigue.
Altered Transit Times:
- Food passes more quickly through the small intestine, leading to malabsorption.
- Reduced peristalsis susceptible to constipation and diverticular disease.

Medications:
- Medications such as antidepressants and diuretics can lead to constipation.
Liver Size Reduction:
- The liver decreases in size and weight post age 70, resulting in slowed drug and alcohol metabolism.

Conditions:
- Gastroesophageal reflux disease (GERD)
- Peptic ulcers
- Diverticulosis
- Cholelithiasis
- Colorectal cancer
Preventative Measures:
- Dietary counseling and routine screenings should be integral part of care.

Skin Changes:
- Decreased cellular reproduction in the epidermis leads to thinner skin, prone to tearing and bruising.
- Dermis mass diminishes, reducing collagen and blood supply.
Functional Implications:
- Decreased vitamin D synthesis, increased sensitivity, and slower healing processes.
Conditions:
- Seborrheic keratoses (age spots), shingles (also related to varicella-zoster virus).

Moisturizing:
- Use room humidifiers, bathe less frequently, use warm water, and employ mild soaps.
Protective Clothing:
- Wear protective clothing in cold weather to mitigate environmental effects.

Muscle and Bone Changes:
- Deterioration of muscle mass and bone density, leading to conditions like osteoporosis and osteoarthritis.
- Increased likelihood of falls resulting in fractures, especially in skeletal structures under increased body weight.
Fracture Risks:
- Hip fractures are common and can significantly reduce independence and lead to complications.

Risk Factors:
- Female gender, family history, estrogen deficiencies, racial background, sedentary lifestyle, and poor nutritional intake can all contribute to osteoporosis.
Prevention:
- Weight-bearing exercises and calcium/vitamin D supplementation are crucial.
Treatment Medications:
- Alendronate, risedronate, raloxifene, ibandronate, denosumab, and teriparatide are common treatments.

Injury Statistics:
- Falls are the leading cause of injury in people over 70, linked to sensorimotor decline and osteoporosis.
Preventative Measures:
- Regular vision checks, understanding medication side effects, using assistive devices, avoiding icy conditions, engaging in weight-bearing exercise, and modifying home hazards.

Cognitive Changes:
- The brain shrinks as one ages, leading to slower processing of information.
- Normal aging does not equal inevitable dementia; many maintain cognitive ability throughout aging.
Dementia:
- Sudden cognitive decline should be investigated as it may indicate serious underlying issues (e.g., systemic diseases, depression).

Definition:
- A degenerative brain disorder leading to memory loss and cognitive decline.
Diagnostic Challenges:
- No definitive test; diagnosis is based on clinical evaluations and imaging studies.
- AD is not a normal part of aging and is a leading cause of death.
Prevalence:
- Approximately 6 million Americans suffer from AD, with increased risks correlating with age.
Medications:
- Various medications are available to treat symptoms, including Donepezil and Memantine.