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32 Cards in this Set
- Front
- Back
periorbital changes
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atrophy of the orbital fat
- wrinkling and loosening of skin around eyelids, weakening of eyelid muscles - drooping eyelids - (ptosis) |
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older eye
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- 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 |
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presbyopia
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- 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 - |
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changes in visual function cont.
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- 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. |
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cataracts
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- 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 |
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age related macular degeneration
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- 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 |
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glaucoma
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- 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) |
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diabetic retinopathy
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- 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. |
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special aspects of the history for patients
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- functional status
- support system - medications - dietary habits - vision/ hearing - memory - depression |
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functional status
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- 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 |
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pattern of BP elevation with age
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- 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. |
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isolated systolic hypertension
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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 |
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pulse pressure
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- 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 |
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special conditions ass. with elderly hypertensive subjects
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- orthostatic hypotension
- BP variability - Postprandial hypotension - white coat syndrome |
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orthostatic hypotension
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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 |
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blood pressure variability
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- 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. |
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postprandial hypotension
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- 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 |
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aging and pulse rate
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- 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 |
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pulse abnormalities
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- 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 |
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dysrhythmias in the elederly
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- 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. |
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goal or oral health assessment lecture
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Identify signs of common soft and hard oral tissue abnormalities seen in older adults
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thrush
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caused by candida albicans
- fordyce granules - |
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vestibules
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- snuff keratosis
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tongue
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- hairy tongue
- bald tongue - scca of the tongue - hairy leukoplakia |
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floor of the mouth
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- SCCA of the floor of the mouth
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alveolar ridge
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- exostoses
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hard palate
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- palatal torus
- pleomorphic adenoma - denture stomatitis |
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soft palate
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- erythroplakia
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hard tissue examination
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- attrition
- enamel erosion - multiple restorations |
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root caries
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- 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 |
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risk factors for root caries
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- gum recession
- dry mouth (xerostomia) - change in diet - frequent snackes between meals and beverages high in sugars - poor oral hygiene - faulty restorations |
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risk factors for gum disease
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- inadequate plaque removal
- diabetes - smoking - genetics - compromised immune system |