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35 Cards in this Set

  • Front
  • Back
What are the most prevalent chronic diseases in the geriatric population?
40% of M and 50% of F have HTN or OP

20% have CAD or cancer

10% have DM

4% of people over age 65 and 20% of people over age 85 have Alzheimer's disease
What race has more chronic disease and is also the most likely to have functional decline?
African American
What is the primary Goal of geriatric care?
Promote wellness and independence, maximizing function and not "curing"
What are the four main aspects of geriatric care?
Physical health

Mental health

Functional status

Social situation
What are four problems that the elderly have with medications which often times makes them appear to be "non compliant"?
Polypharmacy

Multiple prescribers

Child safety caps on pill bottles

Insurance issues
This is defined as access to a nutrionally adequate, culturally compatible diet at all times that is not obtained through emergency food programs.
Food security
What two races are at incrased risk of food insecurity?
African Americans

Hispanics
What is the appropriate screening question to ask a geriatric patient to see if they are receiving adequate nutrition?
Have you lost more than 10lbs over the past 6 months without trying to do so?
What is a good way to screen for malnutrition in the eldery?
Visual inspection

Measure height, weight, BMI
BMI = weight (kg) / height (m2)
< 18.5 kg/ m2 = underweight
What can be expected with the vital signs in geriatric patients?
Hypothermia is more common

Systolic HTN and widened pulse pressure 2/2 atherosclerosis

Orthostatic Hypotension

Unchanged resting HR, but limited max. HR (difficulty to respond to stress)

Abnormal rhythms, may cause syncope
What are two things that should be especially noted on the skin exam in geriatric patients?
Check for basal and squamous cell carcinoma and melanomas

Check for nonblanching redness (pressure sores)
Occurs in pts > age 50

Chronic, autoimmune, subepidermal, blistering skin disease that rarely involves mucous membranes

Caused by IgG in the basement membrane

Epi: aging immune system?, otherwise unknown

Sx: itching and burning skin
Bullous Pemphigoid
How do you TX bullous pemphigoid?
Tx: Steroids, TP better than PO; in severe cases immunosuppressants (azathioprine - Imuran)
Most common types of noncancerous (benign) skin growths in older adults

Appears as a brown, black or pale growth on the face, chest, shoulders or back

Appears ‘stuck on’, has warty or smooth surface
Seborrheic Keratosis
What is the TX for seborrheic keratosis?
May be itchy and bleed when pt picks at lesion
Tx:
No intervention
Freeze off with liquid nitrogen
Shave off
Must be distinguished from skin cancers such as melanoma
This can be seen in the eye exam of the geriatric.

It results from cholesterol deposits in or hyalinosis of the corneal stroma and may be associated with ocular defects or with familial hyperlipidemia.

It can be a sign of disturbance in lipid metabolism, an indicator of conditions such as hypercholesterolemia, hyperlipoproteinemia or hyperlipidemia.
Arcus Senilis (Cornealis)
This, associated with the eye, was found predictive of mortality in 10 years for geriatric patients.
Measured visual impairment
What is done when examining the mouth of the geriatric patient?
Inspect for denture sores, tooth and gum health

Oral cancer screen include inspection and palpation without dentures
This is red and painless
If persists > 2 weeks, Bx is mandatory

Most common in older persons with long-standing alcohol or tobacco use or poor hygiene
Early oral cancer lesion
If you hear rales in a geriatric patient, and there isn't an underlying pathology, what does this most likely mean?
Atelectasis
This is a collapse of lung tissue affecting part or all of one lung. This condition prevents normal oxygen absoption to healthy tissues
Atelectasis
What are four details about the heart examination in the geriatric patient?
1. Atrial and ventricular ectopy is common at baseline

2. S4 is common among older persons free of cardiac disease

3. S3 is associated w/ CHF

4. Systolic ejection murmur is less reliable as a sign of hemodynamically significant aortic stenosis
This problem, associated with the abdominal region of the geriatric patient, is common
Fecal impaction
What is the TX for fecal impaction?
Tx: bowel regimen including fiber and scheduled toileting
What is something associated with the abdominal/rectal exam in geriatrics that you should screen for?
Screen for colon CA with fecal occult blood testing
If ovaries or uterus palpable > 10 yr beyond menopause usually indicates?
Pathology
Any adnexal mass in a woman > 50 yr is considered?
malignant until proven otherwise !
This neurologic problem increases the risk of falls?
Peripheral Neuropathy
How do you assess for peripheral neuropathy?
absent Achilles tendon reflex

reduced vibratory sense

impaired position sense at the great toe

inability to maintain unipedal stance for 10 sec in three attempts
In what ways could an infection present in the geriatric patient?
Temp may be WNL or low

WBC may be WNL or low

Sx could be lethargy, confusion, agitation or CHF
What is used to test a patient for dementia?
Mini cognitive assessment:
3 item recall
Clock-drawing test
Draw a clock
Put in all the numbers
Set the handles to 3 o’clock

Also the mini mental exam is widely used.
What are the primary risk factors for the older driver?
Poor vision and contrast sensitivity

Dementia

Impaired neck and trunk rotation

Limitation of ROM in shoulders, hips & ankles

Foot abnormality

Poor coordination and ↓ speed of movement

Alertness affected by meds or ETOH
When is a geriatric patient at increased risk of suffering abuse?
when a care giver has problems, such as mental illness or substance abuse

when the recipient of the abuse is financially or otherwise dependent on the abuser

when they live in socially isolated environment and
in the presence of external stress
This is an interesting fact about Medicare part A?
does not provide coverage for glasses, dentures, long term care
This has strict income regulations and requires ‘spending down’ existing personal assets first
Medicaid