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32 Cards in this Set

  • Front
  • Back
periorbital changes
atrophy of the orbital fat

- wrinkling and loosening of skin around eyelids, weakening of eyelid muscles

- drooping eyelids - (ptosis)
older eye
- arcus senilis
- a cloudy opaque circle in the periphery of the cornea where iris meets the white of the eye

- result of fat accumulation

- does not impair vision
presbyopia
- difficulty in seeing close objects clearly..

- point of accomodation increases
- etiology - lens loses elasticity and flexibility and ciliary muscles that surrounds the lens shorten; the lens is unable to reshape and focus light on the retina.

- decreased ability to shift focus from near to far
- changes can be different for each eye

-
changes in visual function cont.
- reduced tolerance to glare
- differential rates of heardening of diff. parts of the lens and loss of rods (in the retina)

- problems in environments with uneven distribution of light

- decreased visual acuity (sharpness)
- lens and cornea more thick and opaque
- older adults need more light to function effectively in their environment.

- inability to discriminate color in teh green blue to violet end of the spectrum

- decreased ability to see in low light and adapt to dark
- iris muscles weaken
and slower shifr from rods to cones in the retina.
cataracts
- clouding of the lens
- uni or bilateral
- p[rogressive and painless
- blurred or dim with hazy vision
- change in pupil color
- risk factors - UV light exposure, DM with family hx
- very bright light can be painful after cataract surgery
age related macular degeneration
- affects 10% of older adults (25% of 80 pluys y.o.)

- irreversible vision loss; main cause of legal blindness
- damage to neurons in macula (the center of the retina)

- result - loss of central vision
- painless and develops gradually
glaucoma
- diseas of optic nerve
- impaired drainage of the viscous fluid into the bloodstream leads to the increased intraocular presure and loss of optic nerve fibers

- peripheral field vision loss
- types
1. open wide angle

2. closed angle (acute), vision loss, within a day of the onset of symptoms (pain, nausea, blurred vision and red eyes)
diabetic retinopathy
- complication of diabetes
- blood vessels of the retina weekend, rupture and leak or new blood vessels grow and release blood into the center of the eye

- blind spots or blurred vision which may fluctuate
- risk factors; poor control of blood sugra, high BP, cholesterol, blacks or hispanics and smoking.
special aspects of the history for patients
- functional status
- support system
- medications
- dietary habits
- vision/ hearing
- memory
- depression
functional status
- activities of daily living
- mobility, eating, toileting dressing and grooming

- instrumental activities of daily living (AIDL's)
- preparing meals, shopping groceries, managing money etc.

- disease burden - more important than diagnosis
pattern of BP elevation with age
- BP may increase with age but DO NOT consider it normal
- diastolic BP - increases with age up to 60 - 65 y.o. then stabilizes

- systoloc BP increases with age but post menopausal women have higher systolic BP than men.
isolated systolic hypertension
systolic BP > 140 diastolic less than 90

- most common form of HTN in adults age 50+

- etiology - increased stiffness in large arteries due to less lastin, more calcium cross linking and in creased collagen deposits (arteriosclerosis)

- significance `1. risk factor for CV and renal disease
2. higher morbidity and mortality rates related to elevated systolic BP in older adults than in younger adults
pulse pressure
- the difference between the maximum and minimum blood pressuresw produced during one heartbeat.

- causes more artery damage compared to high blood pressure with normal pulse pressure

- indicates increased stress on the left ventricle
special conditions ass. with elderly hypertensive subjects
- orthostatic hypotension
- BP variability
- Postprandial hypotension
- white coat syndrome
orthostatic hypotension
a fall of > 20 mm HG or adiastolic fall at least 10 mm within 3-5 min. of standing

- more common in individuals with HTN than in those with normal BP

- clinic signs - dizziness, lightheadedness blurred vision and confusion
- risk for syncope, falls and all causes of mortality in the elderly.
etiology - decrease in baroflex sensitivity and a deficeient heart rate response to the change in posture
blood pressure variability
- positively correlated to increaseing age

- one of the characteristic featuresw of hypertension in the elderly

- increased blood pressure variability may be an independent risk factor for cardiovascular events in elderly hypertensive patients.
postprandial hypotension
- a significant fall in BP both systolic and diastolic after meals
- occurs primarily in the elderly and more common in in individuals with high BP and those with higher daytime systolic BP variability

- symptoms - dizziness, light headedness, faintness and falls
aging and pulse rate
- pulse should (ideally) be measured in both arms for 30 seconds
- if irregular; take pulse for a full 60 secons
- pulse rate under 60 or over a 100 should be looked into.

- factors affecting pulse rate
- increased - fever, heat, anxiety, pain, stimulant drugs
- decreased - sleep, depressant drugs and heart disease
pulse abnormalities
- irregular pulse are relatively common in otherwise asymptomatic older adults
- circulatory compromise may make it difficult to feel a radial pulse
- weaker pulse common in patients with atherosclerosis and diabetes
dysrhythmias in the elederly
- atrial fibrilation - most common
- irregular, chaotic atrial rhythms
- can lead to embolous formation
- increased risk for TIA's / stroke
- anticoagulant therapy

- premature ventricular contractions common in adults >80 yo

- dysrhythmias may be intensified by stress.
goal or oral health assessment lecture
Identify signs of common soft and hard oral tissue abnormalities seen in older adults
thrush
caused by candida albicans
- fordyce granules
-
vestibules
- snuff keratosis
tongue
- hairy tongue
- bald tongue
- scca of the tongue
- hairy leukoplakia
floor of the mouth
- SCCA of the floor of the mouth
alveolar ridge
- exostoses
hard palate
- palatal torus
- pleomorphic adenoma
- denture stomatitis
soft palate
- erythroplakia
hard tissue examination
- attrition
- enamel erosion
- multiple restorations
root caries
- active - yellowish/ brownish below or at CEJ or along teh marginal gingiva

- soft or leathery on probing
- often covered by plaque
- requires TX.

inactive
- dark brown or black
- hard on probing
smooth and shiny
risk factors for root caries
- gum recession
- dry mouth (xerostomia)
- change in diet
- frequent snackes between meals and beverages high in sugars
- poor oral hygiene
- faulty restorations
risk factors for gum disease
- inadequate plaque removal
- diabetes
- smoking
- genetics
- compromised immune system