Geriatrics

Question 1

number of older adults in US

Answer 1

Older adults currently number over 27 million in the U.S.; this number is expected to reach 86 million by 2050

Question 2

life expectancy for men and women

Answer 2

Life expectancy is now age 81 for women and age 79 for men on average

Question 3

percent of americans over 85 projected within 40 years

Answer 3

5%

Question 4

percent of americans over 65 that live in the community

Answer 4

95% - Frailty is a common myth about the older population

Question 5

percent of americans over 65 that live in long-term care facilities

Answer 5

5%

Question 6

Assessing the older adult

Answer 6

• Different from disease-oriented approach of history taking and physical exam of younger patient
• Focus is on healthy or “successful” aging
• -Understand and mobilize family, social, and community supports
• -Importance of skill directed to functional assessment
• -Opportunities for promoting older adult’s long-term health and safety

Question 7

primary aging

Answer 7

• reflects changes in physiologic reserve that occur over time
• Independent of changes induced by disease
• Usually appear during periods of stress such as dehydration, shock, or other acute illnesses

Question 8

heterogeneity among aging population

Answer 8

• Usual aging vs. successful aging

- Individuals who escape onset of debilitating disease entirely live healthy lives into their 80’s and 90’s

Question 9

Blood pressure with age

Answer 9

systolic hypertension with widened pulse pressure often occurs

Question 10

heart rate and rhythm with age

Answer 10

pacemaker cells decline and affect response to physiologic stress
-can lead to dizziness and falls

Question 11

respiratory rate with age

Answer 11

unchanged

Question 12

temperature regulation with age

Answer 12

changes lead to susceptibility to hypothermia

set point of temperature changes - get colder easier

Question 13

skin, nails and hair with age

Answer 13

• Skin becomes fragile, loose, and transparent (hands/forearms); purple patches/macules called actinic purpura are frequently seen
• Nails lose luster, yellow, and thicken, especially toes
• Hair loses pigment and hairline recedes; also loss of hair occurs elsewhere such as trunk, pubic area, axillae and limbs, which is normal

Question 14

head and neck with age

Answer 14

-eyeballs recede into orbit, corneas lose luster, pupils become smaller, dry eyes are a common complaint, and presbyopia occurs to nearly everyone

Question 15

presbyopia

Answer 15

lens loses ability to focus, difficult to see objects up close (begins around age 40)

Question 16

presbycusis

Answer 16

afflicted person fails to catch upper tones of words while hearing lower ones, causing words to sound distorted

Question 17

taste with age

Answer 17

Diminished salivary secretions and decreased sense of taste occurs; medications and disease often account for this

Question 18

thorax and lungs with age

Answer 18

capacity for exercise decreases; chest wall stiffens; skeletal changes accentuate dorsal curve producing kyphosis, but resulting “barrel chest” has little effect on function

Question 19

vessels in the neck

Answer 19

systolic bruits heard in middle or upper portions of carotid arteries suggest partial arterial obstruction from atherosclerosis

Question 20

extra heart sounds

Answer 20

after age 40, an S3 strongly suggests congestive heart failure; an S4 can be heard in healthy older people, but often suggests decreased ventricular compliance and impaired ventricular filling

Question 21

cardiac murmurs

Answer 21

systolic aortic murmurs are common

Question 22

aortic sclerosis

Answer 22

-results from fibrosis and calcification and does not impede blood flow

Question 23

aortic stenosis

Answer 23

leaflets become calcified and immobile, which can cause outflow obstruction

Question 24

Aortic sclerosis and stenosis implications

Answer 24

increase risk of CV morbidity and mortality

Question 25

mitral regurgitation

Answer 25

usually occurs a decade later than aortic sclerosis and may become pathologic as volume overload increases in the left ventricle

Question 26

breasts and axillae with age

Answer 26

in the aging female, breasts diminish in size as glandular tissue atrophies and is replaced by fat; ducts surrounding nipples become more palpable as firm, stringy strands

Question 27

abdomen with age

Answer 27

fat tends to accumulate in the lower abdomen and near the hips, although total body weight remains stable; manifestations of acute abdominal disease are often blunted – pain is less severe and fever less pronounced

Question 28

male genitalia with age

Answer 28

sexual interest remains intact with aging but frequency declines; erection is more dependent on tactile stimulation; erectile dysfunction affects half of older men

Question 29

female genitalia with age

Answer 29

menstrual periods cease between ages 48 and 55; women often experience hot flashes for up to five years and may have vaginal dryness, urge incontinence, or dyspareunia; within 10 years, the ovaries are usually no longer palpable

Question 30

prostate with age

Answer 30

proliferation of prostate epithelial and stromal tissue, known as benign prostatic hyperplasia, begins in the third decade, continues until the seventh and then plateaus; only half of men with BPH have symptoms

Question 31

peripheral vascular with age

Answer 31

aging itself conveys relatively few clinically important changes for the peripheral vascular system

Question 32

musculoskeletal with age

Answer 32

significant shortening becomes obvious in old age with most loss of height occurring in the trunk as intervertebral discs become thinner and vertebral bodies shorten/collapse from osteoporosis; skeletal muscles decrease in bulk and power; range of motion diminishes due to osteoarthritis

Question 33

nervous system with age

Answer 33

- aging may affect all aspects of the nervous system, from mental status to motor and sensory function and reflexes; most elders do well on mental status exam but selected impairments become evident; “benign forgetfulness” causes difficulty in recalling names, objects, and certain details - Difficult to distinguish changes of normal aging from age-related or other diseases

Question 34

communicating with older adults

Answer 34

- Provide well-lit, moderately warm setting w/ minimal background noise and safe chairs and access to the examining table - Face patient and speak in low tones; make sure the patient is using glasses, hearing devices, and dentures if needed - Adjust the pace and content of the interview to the stamina of the patient; consider two visits for initial evaluations if needed - Allow time for open-ended questions and reminiscing; include family, caretakers when needed, especially if the patient has cognitive impairment - Carefully assess symptoms, especially fatigue, loss of appetite, dizziness, and pain, for clues to underlying disorders - Ensure written instructions are in large print and easy to read

Question 35

cultural dimensions of aging

Answer 35

- Clinicians must acquire new knowledge and awareness about the health beliefs and culture that shape the older adult’s response to illness and the health care system - Federal reporting categories no longer capture the wide array of cultural differences that affect how older adults understand suffering, illness, and decisions about care, ranging from the use of alternative therapies to when to seek health care - Cultural values particularly affect decisions about the end of life

Question 36

10 minute geriatric screener

Answer 36

- Assesses vision, hearing, mobility, urinary incontinence, nutrition/weight loss, memory, depression, and physical disability - Assesses physical, cognitive, and psychosocial factors

Question 37

cognitive impairment tests for geriatric

Answer 37

MoCa, MMSE

Question 38

Dpression for geriatrics

Answer 38

GERIATRIC DEPRESSION SCALE

Question 39

Activities of Daily Living tests

Answer 39

Lawton IADL Scale

Question 40

"sixth vital sign"

Answer 40

- assessing functional status - Assessment of older adults places special emphasis on maintaining independence and optimal level of function - Primary focus is maintaining functional status - A number of performance-based assessment instruments are available such as: - -10-Minute Geriatric Screener - Patients should also undergo risk factor assessment for falls

Question 41

General survey of geriatrics

Answer 41

Undernutrition, slowed motor performance, loss of muscle mass, and weakness suggest frailty

Question 42

Isolated systolic hypertension after age 50 triples risk of what?

Answer 42

coronary heart disease

Question 43

skin of geriatrics

Answer 43

- Physiologic changes of aging: thinning, loss of elastic tissue, turgor, and wrinkling - Actinic purpura - well-demarcated, vividly purple macules

Question 44

HEENT of geriatrics

Answer 44

Conduct a careful and thorough evaluation of the head and neck

Question 45

thorax and lungs of geriatrics

Answer 45

perform usual examination, noting subtle signs of changes in pulmonary function

Question 46

cardiovascular system of geriatrics

Answer 46

S3 suggests dilatation of the left ventricle from CHF; systolic crescendo-decrescendo murmur in the 2nd intercostal space suggests aortic sclerosis or aortic stenosis

Question 47

peripheral vascular of geriatrics

Answer 47

Diminished or absent pulse may indicate arterial occlusion

Question 48

Abdomen of geriatrics

Answer 48

Widened aorta and pulsatile mass in abdominal aortic aneurysm

Question 49

Breasts and axillae of geriatrics

Answer 49

Lumps or masses mandate further investigation

Question 50

female genitalia and pelvic exam of geriatrics

Answer 50

Allow careful time for positioning; rectovaginal exam

Question 51

male genitalia/prostate of geriatrics

Answer 51

Pay special attention to any masses in the rectum and nodularity or masses of the prostate

Question 52

musculoskeletal system of geriatrics

Answer 52

Joint deformity, deficits in mobility, or pain with movement requires more thorough examination

Question 53

nervous system of geriatrics

Answer 53

- Pursue further examination if any deficits are noted - Focus especially on memory and affect - Abnormalities of gait and balance correlate with risk of falls