What is the Atypical Presentation of Disease in geriatric patients?
- Altered mental status
- Change in alertness
- Change in functional status
- Depression without sadness
- Infections without fever, leukocytosis, tachycardia
What are some causes of poor nutrition in the geriatric population?
- Protein-calorie deficiencies
- Dehydration
- Obesity
- Excesses, i.e., alcohol
Social and functional factors may play a significant role in under nutrition. Micro nutrients may be missing from the usual diet. Prepared foods are often high in sodium, fat, and simple carbohydrates. There is a decline in the ability to recognize thirst, therefore dehydration may become a problem especially under stress, such as hot weather or illness. Weight gain is common in older age, with an average of about 1 pound a year after age 20. We know from the Nurses Study that this weight gain is associated with heart disease. While alcohol is not necessarily a nutritional substance, older adults may have more free time, more time for drinking and socializing. Depression plays a part in alcohol intake also.
What are some respiratory changes seen with aging?
- Reduced pulmonary capacity
- By age 75, VC may be ê up to 50%
- Pao2 decreases with age
- (30yo-90 vs.70yo-70)
- Loss of cilia, reduced cough reflex
What are some cardiovascular system changes seen with aging?
- Reduced:
- Ability to raise the heart rate
- Compliance of ventricles
- Response to catecholamines
- Conduction pathways, SA, AV node functional cells
- Vasoconstictive ability
- Between ages 30-80 CO ê by 30%. When this is added to increased PVR= appreciable drop in end organ perfusion
What are some vascular system changes seen with aging?
- Decrease in vasomotor tone
- Decrease in baroreceptor response
- Less elastin in tunica media
- Smooth muscles thickens
- Plaques develop
What are some renal system changes seen with aging?
- Renal perfusion falls 50%, Kidney mass 20% from age 30-80
- GFR is reduced 8ml/min/decade
- Hepatic blood flow reduced
- Heightened risk of trauma, infection, etc.
What are some nervous system changes seen with aging?
- By age 70 brain weigh reduced by 10%
- Decreased
- Cerebral flow,
- Neurotransmitters
- Impulse velocity
- Blood brain barrier is more permeable:
- RX cross into brain easier
What are some Musculoskeletal Changes seen with aging?
- Muscle shrinkage, calcification
- Osteoporosis, thinning of the disks
- Kyphosis
- Decrease in height 2-3 inches
- Balance changes, falls are common
What are some fluid volume changes seen with aging?
- Impaired water and conservation of sodium
- Delayed and less thirst response
- Increased ADH concentration and secretion
- Total body water decreases
- Ability to concentrate urine decreases
What are signs of dehydration in the geriatric population?
- Dry oral mucosa
- Longitudinal tongue furrows
- Upper body muscle weakness
- Fatigue, confusion
What are reasons why elderly are at higher risk of injury hospitalization?
- Longer lives may bring more frailty or cognitive impairment
- Illness or medications can cause dizziness
- or unsteadiness
- Slower response times, including while driving, can increase accident risk
- Safety hazards often exist in homes
- When elderly are in an accident there is a greater likelihood of being seriously hurt
What are common causes of injury in older adults?
- Falls
- Motor vehicle accidents
- Battery
- Suicide
- Six times more likely to die
- < 30% return to baseline functional status
- Injuries more subtle
Describe Falls in Older Adults
- Leading cause of injury
- Leading cause injury-related mortality
- Account for > 60% of the total causes of injury in the US
What are causes of falls in older adults?
- Accidents related to:
- common changes of age
- Environmental hazards
- Cardiac Dysrhythmias
- Orthostatic Hypotension
- Dizziness/Vertigo
- Syncope
- Vertebral-basilar insufficiency
- Drugs
Things that make falls worse:
- Anticoagulant use
- History of falls
- Osteoporosis
- Thin
- Severe mobility problems
What does the SAFE acrony stand for?
- *S –** Do you feel Safe at home? What Stress do you feel in your relationship?
- *A –** Do you feel Afraid or have you been Abused by any of your caregivers?
- *F –** Are there any Family or Friends that you could ask for help or support?
- *E –** Do you have a safe place to go in case of an Emergency? Is it an Emergency now?
What are some causes of Delirium in Old Age?
- Pharmacologic agents that interfere with cholinergic function or sedation
- Alcohol withdrawal
- Sensory deprivation
- The environment
- “Talking across” increases confusion
- Depression may masquerade as confusion
What are some characteristics of delirium?
- Acute
- Attention deficit
- Rambling speech
- Altered level of consciousness
- Fluctuating symptoms
- Delusional
- Illusions
- Often hyperactive
- Medical emergency
What are some characteristics of dementia?
- Chronic
- Memory loss
- Cognitive dysfunction
- Restricted speech content
