Geriatrics

Question 1

What age group constitutes the most rapidly growing segment of the population?

Answer 1

folks >85 yo

Question 2

True or false: An 80-year-old person needs more calories than a 30-year-old person.

Answer 2

False. An 80-year-old person has half the lean body mass of a 30-year-old person and thus needs fewer calories. The basal metabolic rate is based on lean body mass.

Older patients, however, need more sodium, vitamin B12, vitamin D (and/or calcium), folate, and nonheme iron than younger patients.

Question 3

True or false: Hearing and vision changes are a normal part of aging.

Answer 3

True.

Presbyopia (hardening of the lens that decreases the ability to accommodate) becomes almost universal after age 50, thus the common need for reading glasses after age 50.

Presbyacusis, the loss of ability to discriminate between sounds, also is part of the normal process of aging.

Question 4

True or false: Brain atrophy is a normal part of aging.

Answer 4

True. Decreased brain weight, enlarged ventricles and sulci, and a slightly decreased ability to learn new material are normal parts of aging.

Question 5

Describe the 3 normal changes in male sexual function that occur with aging.

Answer 5

• Increased refractory period (after ejaculation, it takes longer to achieve another erection)
• Increased time to achieve an erection
• Delayed ejaculation (e.g., an older man may ejaculate only once every three times that he has sex)

Question 6

Describe the 3 normal changes in female sexual function that occur with aging.

Answer 6

• Decreased vaginal lubrication (women not on HRT may use estrogen cream or water-soluble lubricants)
• Dyspareunia caused by atrophy of clitoral, labial, and vaginal tissues (treated with estrogen cream)
• Delayed orgasm

Question 7

True or false: Impotence and lack of sexual desire are normal in older people.

Answer 7

False!!

Impotence in men and lack of sexual desire in either sex are not normal and should be investigated. Look for psychiatric disorders (e.g., depression) as well as medications (SSRIs and antihypertensives), vascular disease (watch for atherosclerosis risk factors), and neurologic disease (especially in patients with diabetes).

Question 8

What is the best prophylaxis for pressure ulcers in an immobilized patient?

Answer 8

Frequent turning and the use of special air mattresses.

Question 9

Describe the normal changes in sleep habits in older people.

Answer 9

Older persons

• require less sleep
• sleep less deeply
• wake up more frequently during the night
• awaken earlier in the morning
• takes longer to fall asleep (longer sleep latency)
• have less stage 3 and 4 and REM sleep

Question 10

Define pseudodementia. How do you recognize it?

Answer 10

Depression in older adults can resemble dementia. Look for a history that would trigger depression (e.g., loss of a spouse, terminal or debilitating disease) and other symptoms of depression (e.g., frequent crying, suicidal thoughts).

Question 11

True or false: Roughly 2% of the population is older than age 65.

Answer 11

False. Approximately 15% of people are older than age 65, and this number is increasing.

Question 12

True or false: Almost 50% of patients older than age 65 suffer from some type of dementia.

Answer 12

False. Roughly 15% of folks > 65 suffer from dementia.

Question 13

Describe the characteristics of Alzheimer dementia.

Answer 13

characterized by

• memory impairment, particularly memory for facts and events, that develops insidiously and progresses slowly over time
• ∆s language function
• ∆s visuospatial skills
• ∆s executive function

Question 14

Describe the characteristics of dementia with Lewy bodies.

Answer 14

dementia plus 2/3 of the following distinctive clinical features:

• visual hallucinations (small people)
• parkinsonism (bradykinesia, limb rigidity, and gait disorders)
• and cognitive fluctuations

Memory loss presents later in the course of the disease

Sleep disorders such as acting out dreams are common

Question 15

Describe a scenario that would make you suspect vascular dementia.

Answer 15

Look for a patient with vascular risk factors (e.g., hypertension, diabetes, dyslipidemia, coronary artery disease) whose presenting symptoms include a dementia with abrupt onset and a stepwise deterioration.

Question 16

True or false: Dementia is common in patients with Parkinson disease.

Answer 16

True. Dementia is a common feature of Parkinson disease.

Factors that influence the incidence of dementia include older age, age 60 ears or older at onset of Parkinson disease, longer duration of Parkinson disease, and severity of parkinsonism.

Question 17

Describe the characteristics of frontotemporal dementia.

Answer 17

focal deterioration of the frontal and/or temporal lobes leading to changes in personality or social behavior, with an eventual progression to dementia.

Age of onset is typically in the 50s or 60s.

Question 18

True or false: Only 5% of people older than age 65 live in nursing homes.

Answer 18

True. On the Step 2 examination, beware of old-fashioned stereotypes. Not all older persons are demented and living in nursing homes.