Geriatrics

Question 1

People over 65 will have how many other significant co-morbidities?

Answer 1

3

Question 2

People under 65 will have how many other significant co-morbidities?

Answer 2

2

Question 3

What are some consequences of falls?

Answer 3

• loss of self image
• social embarrassment and loss of confidence
• stigma of ‘old age’
• frailty

Question 4

What are the core elements of dignity (Kinnear et al., 2015)

Answer 4

• Respect for personhood and the individual
• Communication and forms of address
• Privacy
• Toileting
• Nutrition and feeding
• Cleanliness and the environment
• Staff attitudes

Question 5

What is the importance of dignified care?

Answer 5

can have a positive effect on treatment and social outcomes

Question 6

What are barriers and facilitators of dignity on an organisational level?

Answer 6

• Time
• Staffing levels
• Staff training and experience
• Organisational support/values
• Resources
• Specific dignity measures

Question 7

What are barriers and facilitators of dignity on a ward level?

Answer 7

• Ward environment
• Colleagues/team
• Staff attitudes
• Workload
• Support
• Communication

Question 8

What are barriers and facilitators of dignity on an individual level?

Answer 8

• Addressing patient needs
• Involving family/carers
• Reflection
• Dealing with an emergency
• Religion
• Neglect

Question 9

Why does depersonalisation occur in healthcare?

Answer 9

• when workers have negative cynical attitudes towards their clients
• clinicians try to distance themselves from the patient to protect themselves emotionally (may be a result of heavy responsibilities and workload pressure)

Question 10

Primary aging

Answer 10

processes that occur independent of disease processes

Question 11

Secondary aging

Answer 11

physical and physiologic deteriorations caused by pathologic processes

Question 12

Chronological aging

Answer 12

changes associated with passage of time

Question 13

Biologic aging

Answer 13

success for adaptation with the passage of time (tied up with functional abilities and capacities)

Question 14

What are characteristic changes in the integumentary system for geriatrics?

Answer 14

• Epidermis thins, collagen is lost and connections between cells weakens
• Greater risk of injury, tears and infections and the skin repairs less quickly
• Skin can become ‘paperthin’ and translucent
• Vitamin D3 production decreased by 75% and melanocyte activity decreased
• Sweat glands are less effective so cannot lose heat as well and sebaceous gland activity decreased so becomes dry
• Dermal blood supply decreased and blood vessels can become more fragile causing redness (rosacea).
• Dermis thins and elastic fibres decrease – sagging and wrinkling skin
• Nerve endings decline so feel less pressure, touch and injurious stimuli
• Pigment production in hair decreases with age, it lightens and becomes grey

Question 15

What are bone and joint characteristic changes for geriatrics?

Answer 15

• Decreased bone mass and calcium content
• Osteoporosis can weaken bones to a point that fractures occur in normal stresses
• Joints are subjected to wear and tear
• Arthritic problems – Arthritis means damage to the articular surface
• Intervertebral discs reduce in size and desiccate

Question 16

What are muscle characteristic changes for geriatrics?

Answer 16

• Skeletal muscle fibres get smaller, fewer myofibrils, smaller ATP and glycogen reserves
• Cardiovascular performance decreases (by 65 there is a decrease of 30-50 % anaerobic and aerobic performance)
• Skeletal muscles are less elastic so are less flexible - restrict movement and circulation
• Tolerance to exercise decreases and ability to recover from injury decreases

Question 17

What are nervous system characteristic changes for geriatrics?

Answer 17

• Reduced brain size, fewer cortical neurones and nearly 40% reduction in number of spinal cord axons
• Myelin sheaths degenerate ad 10% decline in nerve conduction velocity contributes to a decrease in neuromuscular performance
• Number of branches and synaptic interconnections decreases (synaptic transmission is less efficient)
• Decrease blood flow to brain
• Reaction rates are slowed and motor control precision and coordination decreases

Question 18

What are blood characteristic changes for geriatrics?

Answer 18

Decreased packed cell volume (less cells) - resulting in anaemia from nutritional deficiencies, inadequate exercise, and disease

Question 19

What are circulation characteristic changes for geriatrics?

Answer 19

• Thombi causing constriction or blockage of peripheral veins
• Valves less efficient causing blood pooling in periphery
• Arteries less elastic
• Calcium salts and lipids can be deposited

Question 20

What are heart characteristic changes for geriatrics?

Answer 20

• Decreased maximum cardiac output
• Changes in activity of pacemaker and conducting system
• Reduced elasticity of cardiac skeleton
• Damaged cardiac cells replaced by scar tissue (diminished mechanical efficiency)
• Reduced cardiac reserve capacity (amount of cardiac output remaining above that required for ADL decreases)

Question 21

What are immune system characteristic changes for geriatrics?

Answer 21

becomes less effective

Question 22

What are endocrine system characteristic changes for geriatrics?

Answer 22

• Pituitary, pancreas, adrenal glands and thyroid change with age, there is also decline in reproductive hormones.
• Changes in peripheral tissues may make them less responsive to some hormones (glucocorticoids and ADH)

Question 23

What are digestive system characteristic changes for geriatrics?

Answer 23

• Taste ability changes with age – food tastes bland and unappetising and there is a decrease in olfactory receptors. - - Reduced olfactory and gustatory activity often causes changes in diet
• Epithelium more susceptible to damage and peptic ulcers become more likely
• Smooth muscle tone decreases
• Loss of teeth due to dental caries (cavities)

Question 24

What are respiratory characteristic changes for geriatrics?

Answer 24

• Elastic tissue decreases (less elastic support structure)
• Chest movements are restricted by arthritic changes (vital capacity and forced expiratory volume fall)
• Reduction in exercise capabilities and performance
• Respiratory muscle weakness
• Some degree of emphysema in normal in age >50 so there is and increase in alveolar size
• Static and dynamic lung function decreases

Question 25

What are urinary characteristic changes for geriatrics?

Answer 25

- Decrease in functional nephrons by about 30-40 % - Reduced glomerular filtration rate - Problems with urinary reflexes - Voiding can become problematic

Question 26

What are reproductive characteristic changes for geriatrics?

Answer 26

- Male climacteric (perimenopause and andropause) - Ovulation and menstruation cease (menopause) between ages 45-55 (interval preceding is perimenopause)

Question 27

What are fluid, electrolyte and acid-base balance characteristic changes for geriatrics?

Answer 27

- Total body water decreases slightly from 40-60 so reduces dilution of wastes, toxins and drugs - Reduced sensitivity to ADH - maintaining fluid balance means taking in more fluid (but elderly people have less sense of thirst and may not drink enough to maintain blood osmolality so dehydration is common) - Net loss of body mineral content as muscle mass and bone mass decreases

Question 28

What are the adverse effects of ageing on the musculoskeletal system?

Answer 28

- Loss of muscle mass (sarcopenia) - Reduced motor units’ activation - Poorer muscle quality including fat infiltration - Decline in maximal strength and power - Loss of bone density (osteoporosis)