Term
| gerontologist vs geriatrician |
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Definition
gerontologist: sociology
geriatrician: certified practitioner |
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Term
| increased life expectancy is mostly due to: |
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Definition
| improved infant mortality rate |
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Term
| philosophy of geriatric care revolves around: |
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Definition
| increasing/maintaining independance |
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Term
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Definition
| unfair judging of elderly adults |
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Term
| capacity for cell division, growth, and function is lost over time ultimately leading to death: |
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Definition
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Term
| microscopic changes in aging skin:5 |
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Definition
1. epidermal thining
2. elastic fiber degeneration
3. thickening of collagen
4. reduced sebaceous and sweat glands
5. diminished vascularity |
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Term
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Definition
1. diminished cardiac responsiveness to B-adrenergic stimulation
2. |
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Term
| creatinine clearance declines at a rate of: |
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Definition
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Term
| by what age do many adults have osteoarthritic changes? |
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Definition
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Term
| what osteoarthritic changes are visible on xray |
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Definition
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Term
| changes in the nervous system with aging: |
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Definition
1. decrease in peripheral vibratory sensation
2. decrease in sweat production
3. slower processing
4. small decrease in brain mass |
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Term
| most comon age related vision eye problem |
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Definition
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Term
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Definition
| age related, high frequency sensorineural hearing loss |
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Term
| acute change in mental status w attn deficit accompanied by disorganized thinking or a change in alertness |
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Definition
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Term
| hypoactive delirium must be differentiated from: |
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Definition
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Term
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Definition
| hyperactive hypoactive and mixed |
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Term
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Definition
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Term
| considered the cornerstone of delirium pathogenesis |
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Definition
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Term
| the main stress induced modification of brain neurotransmitters: |
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Definition
| cholinergic defficiency and dopaminergic excess |
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Term
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Definition
1. drugs
2. lytes abnormal
3. infection
4. urinary retention/fecal impaction
5. cardiac issues
6. reduced sensory input |
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Term
| meds play a very important role in the development of delirium as a predisposing and precipitating factor: |
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Definition
| anticholinergic meds: (diphenhydramine, oxybutynin) |
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Term
| assessment for delirium requires: |
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Definition
1. face to face interview w pts to identify the presence of emergent situations such as hypoxia, hypotension, or sepsis
2. extensive hx to investigagte causes |
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Term
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Definition
1. tx underlying cause
2. low dose anti-psychotic
3. benzodiazepines for etoh or sedative withdrawls |
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Term
| when is imaging indicated for delirium? |
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Definition
| only when positive findings present during hx, physical exam or chart review |
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Term
| 2 types of interactive therapies to prevent delirium from reoccuring: |
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Definition
1. tx underlying causes; dehydration, infection, anti-cholinergic meds
2. supportive pharmacologic & nonpharmacologic therapy |
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Term
| first choice of depression meds: |
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Definition
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Term
| anti-depression med: used less frequently due to anti-cholinergic effects: |
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Definition
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Term
| anti-depression med: best used under direction of the psychiatrist |
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Definition
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Term
| neurotransmitters implicated in the pathophysiolofy of delirium: |
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Definition
| cholinergic deficiency & dopamine excess |
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Term
| meds that are risk factors for delirium:5 |
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Definition
1. benzodiazepines
2. anti-depressants (amytriptyline, imipramine)
3. anti-cholinergics (diphenhydramine and oxybutynin)
4. anti-convulsants
5. H2 blockers |
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Term
| 2 meds to treat delirium: |
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Definition
1. low dose antipsychotic (haloperidol)
2. Delirium from ETOH withdrawl benzodiazepines |
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Term
| 3 somatic complaints of depression: |
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Definition
1. fatigue
2. abd pain
3. HA |
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Term
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Definition
| common presentation of depression in the elderly |
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Term
| medications that can cause depression in the elderly:3 |
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Definition
| digitalis, propanolol, and benzodiazepines |
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Term
| which labs should be checked when evaluating a patient for depression: |
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Definition
CBC
Chemistry
T4 & TSH
VB12
Folate |
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Term
| anti-depressant that should not be used in the elderly: |
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Definition
| AMITRYPTALINE due to sedation and anti-cholinergic effects |
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Term
| which med for first line tx of depression: |
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Definition
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Term
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Definition
| insomnia... dose in the mornings to avoivd insomnia & GI distress |
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Term
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Definition
| anticholinergic effects (drowsiness, constipation, blurred vision, dry mouth, orthostatic hypotension |
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Term
| which TCA is considered first line in the elderly? |
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Definition
| Nortrotyline at bedtime- has less anticholinergic effects |
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Term
| indications for nortryptyline: |
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Definition
| depression assoc w chronic pain, insomnia, psychomotor agitation |
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Term
| major consideration for prescribing MAOIs: |
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Definition
| dietary restriction - low tyramine foods due to risk of HTN crisis or orthostatic hypotension |
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Term
| antidepressant that is also used as an appetite stimulant: |
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Definition
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Term
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Definition
| falls that occur as a prodrome to an illness |
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Term
| apathetic thyrotoxicosis: |
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Definition
| tiredness and slowing down caused by HYPERthyroidism |
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Term
| hypothyroidism in the elderly presents as: |
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Definition
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Term
| screening tool used to asses ADLs: |
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Definition
| PSMS - physical self maintenance scale |
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Term
| screening tool used to asses instrumental ADLs: |
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Definition
| FAQ - functional activities questionaire |
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Term
| age group where orthostatic hypotension is common: |
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Definition
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Term
| 2 respiratory findings that dont necessarily indicate a pathology: |
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Definition
1. decreased breath sounds
2. dry basilar crackles |
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Term
| which heart sound always indicates CHF |
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Definition
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Term
| 3 processes indicated in the cause of dementia: |
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Definition
1. B-amyloid plaques
2. Tau proteins metabolism and neurofiber tangles
3. depletion of NTs, particularly in the cholinergic p-ways |
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Term
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Definition
1. FHx
2. Down's syndrome
3. head trauma
4. CVD
5. HRT
6. Age |
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Term
| 5 factors that may decrease risk for AD: |
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Definition
1. higher education
2. leisure activities
3. exercise
4. statins
5. maintaining lab values (Glu, BP, etc.) |
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Term
| conditions and defects that may reflect intermediate and possibly transient states between normal aging and dementia |
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Definition
| mild cognitive impairment |
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Term
| 5 features of mild cognitive impairment: |
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Definition
1. memory loss
2. objective deficit in a cognitive domain
3. no impairment in ADLs
4. no dementia
5. no delirium |
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Term
| 4 conditions of reversible dementia: |
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Definition
1. hypothyroidism
2. B12 def
3. neurosyphilis
4. SDH |
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Term
| most common etiology of dementia: |
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Definition
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Term
| 4 cognitive declines of dementia: |
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Definition
1. memory
2. language
3. visuospacial
4. executive function |
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Term
| what is required for definative dx of AD? |
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Definition
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Term
| requirements for probable dx of AD: |
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Definition
| deficits in memory and absence of comorbidities that would explain sx. present >6mo, slow onset |
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Term
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Definition
| fluctuating cognitive deficits, parkinsonian signs, attn deficits and visual halucinations |
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Term
| when does dementia from parkinson's occur? |
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Definition
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Term
| disinhibition, apathy, ececutive dysfunction: |
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Definition
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Term
| describe primary progressive aphasia: |
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Definition
| progressive aphasia, hand/motor abnormalities, resembles frontal/prefrontal CVA |
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Term
| triad: urinary incontenance, dementia, apraxic gait: |
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Definition
| normal pressure hydrocephalus; pressures can be decreased with shunt |
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Term
| chorea, progressive cognitive decline, behavioral/psych problems: |
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Definition
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Term
| etiology of Creutzfeld-Jakob dz: |
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Definition
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Term
| MMSE score for mild dementia: |
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Definition
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Term
| MMSE score for moderate dementia: |
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Definition
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Term
| MMSE score for severe dementia: |
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Definition
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Term
| dull flat facies and cogwheel rigidity |
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Definition
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Term
| 2 classes of drugs approved for dementia tx: |
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Definition
1. cholinesterase inhibitors
2. NMDA receptor antagonist (memantine) |
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Term
| 2 common types of advanced directives: |
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Definition
1. appoint surrogate
2. living will |
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Term
| elderly patients account for what portion of flu deaths? |
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Definition
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Term
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Definition
| blocks nicotine receptors; reduces withdrawl and no pleasure from smoking |
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Term
| why do the elderly have increased sensativity to etoh? |
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Definition
| smaller vol of distribution and decreased liver fxn |
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Term
| med for alcoholism that is contraindicated in the elderly: |
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Definition
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Term
| what are the first 2 choices in BP medications: |
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Definition
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Term
| LDL goal for heart dz pt: |
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Definition
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Term
| are statins useful in elderly? |
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Definition
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Term
| quantitative dx for osteoporosis: |
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Definition
| >2.5 SD below the young adult peak for bone density |
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Term
| distribution of meds is altered in the elderly due to: |
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Definition
| decreased lean to fat ration and total body water |
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Term
| medications that are affected by decreased distribution in the elderly: |
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Definition
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Term
| meds that are affected by increased fat content (vol dist. |
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Definition
| psycoactive medications (valium increases concentration) |
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Term
| phase I rxn in liver metabolism: increased or decreased in elderly? |
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Definition
| decreased CYP450; affects diazapam |
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Term
| Phase II rxns in elderly: increased/decreased? |
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Definition
| do not diminish with age; |
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Term
| loarzapam: phase I or II rxns? |
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Definition
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Term
| 4 meds to consider renal fxn: |
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Definition
1. FQs
2. AGs
3. Vanco
4. Cephs |
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Term
| why should caution be used in prescribing NSAIDs to the elderly? |
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Definition
| increased risk for gastritis and GI bleeds |
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Term
| tylenol doses should not exceed: |
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Definition
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Term
| diabetic meds in elderly run the risk of: |
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Definition
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Term
| which diabetic med in particular should be avoided? |
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Definition
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Term
| when is metformin contraindicated? |
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Definition
| circulatory failure or renal insufficiency |
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Term
| first line HTN med and dose: |
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Definition
| HCTZ 12.5mg/day max dose 25mg/d |
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Term
| which CCB for HTN should be avoided? |
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Definition
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Term
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Definition
| peripheral edema and constipation |
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Term
| which B-blockers are to be used if no other choice? |
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Definition
| atenolol or metropolol NOT propanolol |
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Term
| what are considerations for anti-psychotic agents: |
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Definition
| pick ones that have low anticholinergic side effects least sedating |
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Term
| what is the DOC for antipsychotics? dose? |
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Definition
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Term
| which antipsychotic meds should be avoided? |
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Definition
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Term
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Definition
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Term
| H2 antagonists that shoudl be avoided: |
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Definition
| tagamet; multiple Rx interactions and 70% renally eliminated |
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Term
| describe the get up and go test: |
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Definition
| rise from a chair and walk 10ft return to the chair and sit most elderly within 11-20s, >14s = increased risk for falls, >20 needs further eval |
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Term
| gait disorders considered low sensorimotor level: |
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Definition
peripheral sensory
peripheral motor |
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Term
| gait d/o included in middle sensorimotor level: |
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Definition
1. spacticity
2. parkinsonism
3. cerebellar ataxia |
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Term
| gait d/o considered high sensorimotor level: |
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Definition
| cautious gate and frontal related gait d/o |
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Term
| class of medications that are implicated in increasing the risk for falls> |
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Definition
1. benxodiazepines
2. Antidepressives
3. antipsychotics |
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Term
| wide based gate w increased trunk sway & irregular stepping: |
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Definition
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Term
| use of __ or more meds is a RF for dizziness: |
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Definition
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Term
| syncope that occurs in any position and has <5second warning, faint pulse, flaccid tone |
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Definition
| syncope caused by arrhythmia |
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Term
| syncope with seconds to minutes of warning and precipitate nausea, sweating, visual changes: |
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Definition
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Term
| syncope: no warning, rigid tone, rapid pulse, elevated BP, tonic eye deviation: |
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Definition
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Term
| recommendations for post prandial syncope: |
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Definition
1. avoid Etoh
2. avoid high carb meals
3. remain recumbent after meals |
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