4CPD6Geriatrics2

sudden, transient loss of consciousness followed by spontaneous and typically complete recovery.
33% of elderly injured

is a symptom--not a disease differentiated from a fall with head trauma: brief unconsciousness.
results from several interacting abnormalities or disorders

about 10% but subsequent sudden cardiac death is 25%.
Carotid sinus hypersensitivity

asymptomatic, but it can cause syncope
6% of syncope, many causes (diabetes hurts PNS)
rule out w/multiple BP measurements, lifestyle modifications

syncope after eating a meal Large decreases (> 20 mm Hg)
affects ppl w HTN

due to straining while defecating or urinating, strenuous coughing : Sx: increasing intrathoracic pressure, increasing vagal tone, reducing venous return to the heart, and decreasing cardiac output, thereby reducing BP

stimulation of the vagus nerve (young ppl)
stress or other

Cerebrovascular insufficiency (vertebrobasilar)
many prescription drugs
Hypoglycemia
seizure

broad term
class acute <1 month, acute >1 month
13 to 30%.of elderly

(1) vertigo (2) dysequilibrium
(3) presyncope (4) mixed dizziness (5) nonspecific dizziness

caused by acute disorders
Falls most commonly occur when several different problems
(environmental cuses or events are not considered falls) ??

ask about falls (pt don’t volunteer info)
½ of elderly people who fall cannot get back up

Age-related changes can impair systems involved in maintaining balance and stability
Proprioception

Environmental factors (slippery surface, environment unfaliliar)
situational (rushing to bathroom)

50% of falls among elderly people result in an injury.
Dx: kind of obvious
Performance tests: Get-Up-and-Go Test

slowing of gait speed or a deviation in smoothness, symmetry, or synchrony of body movement. Symmetry of motion and timing between left and right sides is often lost
Difficulties in initiation of gait,Pseudoclaudication symptoms-
Gait initiation failure, Footdrop, Short step length

Irregular and unpredictable trunk instability (CNS)
Deviations from path (cerebellar)

• Discuss the patient's complaints, fears, and goals related to mobility
• Observe gait with and without an assistive device (if safe)
• Assess all components of gait
• Observe gait again with a knowledge of the patient's gait components

from underlying disorders that weaken bone
swelling, deformity, and pain when movement is attempted

limb-threatening complication may results in ischemia

fatal complication due to major hip and pelvic trauma.

low bone mass and microarchitectural deterioration of bone
• dual-energy x-ray absorptiometry.
• Prevention and treatment involve Ca and vitamin D supplements

Primary osteoporosis can be classified as type I or II. Type I
is thought to result mainly from the hormonal changes that occur with aging

small proportion of osteoporosis
due to many causes, including hyperparathyroidism, hyperthyroidism, cancer, immobilization, GI disease, renal abnormality

older age, female sex, white or Asian race, family history
decreased lifelong exposure to estrogen or testosterone, low Ca or vitamin D intake
alcohol, caffeine, etc NO Ca and vitamin D:

Osteoporosis has been termed a silent disease because, until a fracture occurs, symptoms are absent, can cause vertebral compression

Raloxifene Salmon calcitonin Bisphosphonates
Antiresorptive therapy:
Parathyroid hormone (PTH):

• The involuntary leakage of urine.
Eight to 34% of community-dwelling elderly persons suffer from urinary incontinence
transient common in the elderly
intrinsic: urinary tract dysfunction

delirium urinary, tract infection, Atrophic urethritis and vaginitis
Alcohol and drug use, psychiatric disorders ,
Excessive urine output, Restricted mobility, Impacted stool Established incontinence, Detrusor overactivity Outlet obstruction

Dx Incontinence
Keep a diary, Stress testing Observation of voiding

Urinalysis, cystoscopy, urodynamic evaluation

hematocrit decrease. Mean corpuscular volume increases slightly
RBC morphologic characteristics do not change

Age-related changes in the lymphoid system (immune senescence) affect cellular and humoral immunity. decreased marrow reserve

Delusions are false, fixed, idiosyncratic ideas
Hallucinations are false visual, auditory, olfactory, or tactile perceptions

Symptoms of Dementia
intolerable, disruptive actions
Treatment is best accomplished with nondrug therapiespsychosis and aggression are treated with drugs.

indicates another disorder such as a UTI, heart failure, or pain
antipsychotics have adverse effects
increasing BPSD at sundown

Patients with dementia lose adult inhibition
misunderstand visual and auditory cues
impaired short-term memory
may have problems expressing their needs clearly or at all.