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37 Cards in this Set

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Syncope
sudden, transient loss of consciousness followed by spontaneous and typically complete recovery.
33% of elderly injured
Syncope
is a symptom--not a disease differentiated from a fall with head trauma: brief unconsciousness.
results from several interacting abnormalities or disorders
Syncope ?Primary cardiac disorders:
about 10% but subsequent sudden cardiac death is 25%.
Carotid sinus hypersensitivity
Orthostatic hypotension:
asymptomatic, but it can cause syncope
6% of syncope, many causes (diabetes hurts PNS)
rule out w/multiple BP measurements, lifestyle modifications
Postprandial hypotension
syncope after eating a meal Large decreases (> 20 mm Hg)
affects ppl w HTN
Reflex-mediated syncope:
due to straining while defecating or urinating, strenuous coughing : Sx: increasing intrathoracic pressure, increasing vagal tone, reducing venous return to the heart, and decreasing cardiac output, thereby reducing BP
Vasovagal (neurocardiogenic) syncope
stimulation of the vagus nerve (young ppl)
stress or other
Other syncope
Cerebrovascular insufficiency (vertebrobasilar)
many prescription drugs
Hypoglycemia
seizure
Chronic Dizziness and Postural Instability
broad term
class acute <1 month, acute >1 month
13 to 30%.of elderly
Dizziness
(1) vertigo (2) dysequilibrium
(3) presyncope (4) mixed dizziness (5) nonspecific dizziness
Falls
caused by acute disorders
Falls most commonly occur when several different problems
(environmental cuses or events are not considered falls) ??
Geriatric Essentials
ask about falls (pt don’t volunteer info)
½ of elderly people who fall cannot get back up
Falls Intrinsic factors
Age-related changes can impair systems involved in maintaining balance and stability
Proprioception
Falls Extrinsic factors:
Environmental factors (slippery surface, environment unfaliliar)
situational (rushing to bathroom)
Falls complications
50% of falls among elderly people result in an injury.
Dx: kind of obvious
Performance tests: Get-Up-and-Go Test
Gait Disorders
slowing of gait speed or a deviation in smoothness, symmetry, or synchrony of body movement. Symmetry of motion and timing between left and right sides is often lost
Difficulties in initiation of gait,Pseudoclaudication symptoms-
Gait initiation failure, Footdrop, Short step length
More Gait disorders explanations
Irregular and unpredictable trunk instability (CNS)
Deviations from path (cerebellar)
Gait Dx:
• Discuss the patient's complaints, fears, and goals related to mobility
• Observe gait with and without an assistive device (if safe)
• Assess all components of gait
• Observe gait again with a knowledge of the patient's gait components
Pathologic fractures
from underlying disorders that weaken bone
swelling, deformity, and pain when movement is attempted
Compartment syndrome
limb-threatening complication may results in ischemia
Pulmonary embolism
fatal complication due to major hip and pelvic trauma.
Osteoporosis
low bone mass and microarchitectural deterioration of bone
• dual-energy x-ray absorptiometry.
• Prevention and treatment involve Ca and vitamin D supplements
Primary osteoporosis:
Primary osteoporosis can be classified as type I or II. Type I
is thought to result mainly from the hormonal changes that occur with aging
Secondary osteoporosis
small proportion of osteoporosis
due to many causes, including hyperparathyroidism, hyperthyroidism, cancer, immobilization, GI disease, renal abnormality
Risk Factors
older age, female sex, white or Asian race, family history
decreased lifelong exposure to estrogen or testosterone, low Ca or vitamin D intake
alcohol, caffeine, etc NO Ca and vitamin D:
Symptoms and Signs
Osteoporosis has been termed a silent disease because, until a fracture occurs, symptoms are absent, can cause vertebral compression
Osteo Tx
Raloxifene Salmon calcitonin Bisphosphonates
Antiresorptive therapy:
Parathyroid hormone (PTH):
Urinary Incontinence
• The involuntary leakage of urine.
Eight to 34% of community-dwelling elderly persons suffer from urinary incontinence
transient common in the elderly
intrinsic: urinary tract dysfunction
Urinary Incontinence
delirium urinary, tract infection, Atrophic urethritis and vaginitis
Alcohol and drug use, psychiatric disorders ,
Excessive urine output, Restricted mobility, Impacted stool Established incontinence, Detrusor overactivity Outlet obstruction
Outlet incompetence
Dx Incontinence
Keep a diary, Stress testing Observation of voiding
Postvoiding residual volume
Urinalysis, cystoscopy, urodynamic evaluation
Changes in Peripheral Blood
hematocrit decrease. Mean corpuscular volume increases slightly
RBC morphologic characteristics do not change
Changes in the Lymphoid System
Age-related changes in the lymphoid system (immune senescence) affect cellular and humoral immunity. decreased marrow reserve
Delusions and Hallucinations
Delusions are false, fixed, idiosyncratic ideas
Hallucinations are false visual, auditory, olfactory, or tactile perceptions
Behavioral and Psychologic
Symptoms of Dementia
intolerable, disruptive actions
Treatment is best accomplished with nondrug therapiespsychosis and aggression are treated with drugs.
Sudden onset of behavioral and psychologic symptoms of dementia (BPSD)
indicates another disorder such as a UTI, heart failure, or pain
antipsychotics have adverse effects
increasing BPSD at sundown
• Risk Factors BPSD.
Patients with dementia lose adult inhibition
misunderstand visual and auditory cues
impaired short-term memory
may have problems expressing their needs clearly or at all.