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82 Cards in this Set
- Front
- Back
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Medicaid
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title 19, both state and federally supported, low income (elderly excluded here); food stamps housing
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Medicare
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medical insurance; federally suppotred, has 4 parts to it
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Medicare Part A
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paid for by gov; hospital stays (includes a deduction)
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Medicare Part B
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what pays the doct, not necessary to carry, but saves $ in the long run
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Medicare Part D
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Two teers: 1. all genetics
2. brand names w/min copayments Prescirption drug coverage-pritoized to your private insurance company |
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What happens if you don't have part D?
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Insurance premium will go up 1% every month -confusing to elderly
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Fasting growing population?
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Elderly--5 mil americans over age of 85
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Medicaid
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1499.99 in bank, car at home worth under 30,000, based on income and assests (check this one)
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Aging
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a process that converts a healthy adult into a frail one; break down of immune system
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What is the single area that has produced long-gevity?
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Cardiovascular Area-but to really know we need longitudinal studies @ least 50 years long
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Hemostatis
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ability of body to fix itself--older people hemostates is not as good
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Aspiration ammonia
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coughing to get stuff outta lungs (losing cilia)
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**what does decreased body water do to meds?
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H20 soluble meds concentration should be decreased, and fat soluble meds concentration should be increased --note ppl should do weight baring activities here
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What is senile purpura
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bluish color on skin; blood spots on hands
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Epidermis changes to skin?
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epidermis is thinner
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***What is the pupils blood supply?
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No blood supply
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Changes in aqueous kinetics
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Glaucoma-causes increased pressure in the eye
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Increased density of lens
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cataracts
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Why do elderly eat spicy & sweet foods?
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Taste buds are desensitized
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What does atrophy of cochlear hair cells cause?
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Presbycusis-lose both increase or decrease to high-pitched sounds
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**Aorta becomes more rigid and lose of elasticity?
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Left ventriulcar hypertrophy
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Orthostatic hypotension defined as
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decreased barorecptor reflex less than 20mmHg
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*What's CAD
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enlarged heart, (NOT JUST BECAUSE OF NORMAL AGING)
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What's normal BP levels for an elderly
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135/80
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altered CO, decrease in number of adrengic receptors, and decreased HR all lead to
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decreased response to stress
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**creatinine clearne
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140-age x body weight (kg)
__________________________ 72x serum creatinine Mulitply by .85 for female |
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what can help with memory loss?
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brain excersises imparative
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What two problems do all falls have?
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environmental and genetic
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If anemia is seen in elderly thne
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it must have an underlying cause
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3 endocrine disorders seen in elderly?
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hypothroidism; DM, CAM, decreased T cell function
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what can you do* to help with decreased gastic HCL production?
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give H2 blockers; affects abrsoption in stocah by increase in gastric pH in elderly
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***What three things increase?
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sytemic hypertension, hypotension, incontinence
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*what's presbyoyia versus prescusbus?
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Presbyopia si loss of lens elasticity in eyes; prescycusis is loss of auditory neuros and atropy of choclear hair cells leading to decrease ability to hear high and low pitched sounds
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Pharm
*what are the top 4 drugs elderly consume? |
1. cV agents
2. diuretics 3. analgesics 4. GI agents |
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**Be able to twist C clearance around
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don't give drugs in cyc p450 pathway; cc decreased in elderly so half life of a drug is increased (ex coudamin--2 days higher in older peeps)
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**what are the principles for prescribing to eldery?
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Start low and go slow and *avoid adverse drug events--most serious complication for elderly prescribing
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What two drugs have adverse side effects to elderly
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antipshytoic, and antibotoics
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**Prinicipels for G. perscriing?
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1. evaulaute need
2. take history 3. know pharm 4. make it easy 5. remember drugs can cause illness |
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*What B.E.E.R.S?
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list of 33 drugs you should never prescribe to elderly;
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DO's for presciring?
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treat a diagnosis not a symptom; ask about herbals (selnenum); write out instructions;aconsult a pharm, drug holidays
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What four catgegoirs of drugs can elderly receive full adult dose?
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lAX, antibotics, diuretics, and pain meds
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**What is the protein requirement?
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.8gm/kg (body lb)/day; albumin levels below 3.0g/dl is poor prognostic sign/
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**what is the caloric requirment?
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30kcal/kg (ideal body weight)/day
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**What is the fluid requirment of the elderly?
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30ml/kg (IBW)/day
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What are signs of protein calorie malnutrition?
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anemia, fatigue, dementia, increased infections
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one cause of anoxeria
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increased activity of CCK (satiey)
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how much percent a day do bed fast patients lose?
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5%
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cardinal featurse of protein-eg malnution?
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alopecia(balding), glossities, decreased cholesterol (think malignanacy)
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Vitamin B12 defieciency
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decreased intake and decreased absorption leads to def (macroscytic anemia)
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What's needed for heart problems?
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magnesium
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**List types of prevention:
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Primary prevention-proactive
secondary preventin-chaning habits |
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*What three areas are involved in primary prevention?
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immunization* (flue shot-pneumococall vaccine), injury prevention, diet and exercise
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**name examples in secondary prevention?
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alchol and drug abuse, smooking cessation, TB skin testing, screening (history and physical exam); note MCV on CBC
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should old peeps exercise?
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yes, 30 minutes 3x a week(2/3 of max heart rate)
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*When should ammonia shot be given?
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1x before 65, and 1x for 65 every 10 years
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Death and dying: define polymyaligia
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"shoulder aching syndrome"; hips hurt; elevated ESR!!; >100 (should be around 15); no weakness but tenderness; morining stifneess>1 hr for 4 weeks; STEROIDS IMMEDI
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Temporal arterieis symptoms*
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dipolpia; headache; loss of vision,
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What has slower onset-symptoms?
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poly R-slower onset; malaise, anorexia, weight loss, anemai
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What is the loss of vision caused by in temporal artieries?
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occulision of ciliary artery d/t giant cell arterieist; infaraction of opitc nerve (will lose sight in affected eye immediately)
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How do you diagnose TA and what do you look for?
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TA biopsy..ESR>30; negative Rh factor
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Both you treat with steroids, but which one is more common?
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PMR
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What percentage of hip fractures result from a fall?
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90%
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Why do medis cause ppl to fall?
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Diuretics lower K+ levels, and hurry to pee
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*What are the two reasons for a fall?
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1. environmental causes
2. oragnic causes (drugs in body) |
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when a pateint has repeatedly fallen, what is the order you can look for things?
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1. look at meds first
2. enviromental 3. underlying med condition (uti causes mental changes) |
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*Major signs of death
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"modeling"-dark pathcy areas, cool limbs, sleeping, death rattle, jack stocks breathing, *hearing last sense to go, urine decreases
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what's kubler ross stage of greving?
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DAB-DA
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if stiffness goes away in morning or less than an hour?
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osteoarthritis
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*intoduction II*
Most older pppl have at least one...........condition and many have more than one |
chronic condition; (*Note, here arthirist is #1 chrnoic condition, then hypertension, hearing, heart disease)
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What percentage of health care cost can be attriubed to elderly?
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more than 1/3 for only 15% of population
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What does abuse of the elderly entail?
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verbal/physical/psyhological, establish a rapport with patient and note any stress or dietary changes
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What percentage of the toal health costs of the gross national product can be contriubted to elderly?
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15% (wow!)
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what's the average life expectacny (in 1991?)
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75.5 years
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What are some risk factors for falls?
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sensory, vstibular, propoictive, (CNS anything)_; systemic diseases, depression, meds, environment
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Alzheimer's
*What are the risk factors? |
1. advancing age
2. family history of dementia 3. presence of Down syndrom 4. exposure to aluminum 5. females 6. mutation in chromsome 14 |
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*If given a score, know if mild, late, terminant, or dead?
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Mild-"confused state"/years 2-8/small tasks/lost in familial places -Stage II
Late score/0-9 MMSE/inconstince/remote memory gone; >yr 6 Terminant stage-fetal postion Stage IV=death |
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*What is the workup for AZD?
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1. verifty dementia is present
2. history 3. physical-CBC/meds review/CT-rules out mulit-infarct 4. mental status examination |
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*What is the treatment for AZD?
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Ach inhibitors-memantipine * Aricept (Donepezil HCL)-to enhance cognitive function/once daily
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General understanding of AZD?
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Pathological loss of memory and dementia when it interferes with daily living/#1 deficient seen=judgement impairment/life expentency 8.5 years from the onset of symptoms/AZD is a disease of exclusion-rule everything else out
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AZD is characterized by:
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Amyloid plagues, neurofibrillary tangles, MAYBE atrophy
Dementia Neruologic signs abrupt onset/progeesive decline |
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How many months are there b/n the onset and diagnosis of the diease?
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32 months...nursing home after 56 months or 4 years
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Genetic Research evidence:
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14, 21-(21 is amloyoid plague protein (APP))
APoE4-chromsome 19/late onset AZD |
