23 Geriatrics

Question 1

What are the ages included in the following Age categories:

• Young Old:
• Middle-Old
• Old-old
• Centenarian
• Super-centenarian
• Semi-supercentenarian

Answer 1

What are the ages included in the following Age categories:

• Young Old: 65-74
• Middle-Old: 75-84
• Old-old: 85+
• Centenarian: Someone who has lived to be 100
• Super-centenarian: Someone who has lived to 110
• Semi-supercentenarian: Someone aged 105-109

Question 2

What is frailty?

Answer 2

Losing the ability to maintain homeostasis

• increased vulnerability from age-associated decline in reserve and fxn resulting in reduced ability to cope with everyday or acute stressors

Question 3

What is the typical approach to care for older people?

Answer 3

1. Economy of diagnosis
   
   • “what is the patients DRP”
2. Fragmentation of care
   
   • Break up care by expertise/resource
3. Disease management model
   
   • Psychosocial factors often overlooked

Question 4

What is geriatric syndrome?

4 key features?

Answer 4

A multifactorial condition that involves the interaction between identifiable situation-specific stressors and underlying age-related risk factors, resulting in damage across multiple organ systems

• 4 key features:

1. Clinical and multifactorial conditions in older persons
2. associated with poor health outcomes
3. do not fit into disease categories (comorbidities)
4. Require a multidimensional tx approach

Question 5

What are the top 3 categories at risk for ADR (adverse drug reaction)?

Answer 5

1. People with multiple chronic conditions
2. Women (understudied)
3. People over the age of 65 (understudied and taking many meds - polypharmacy)

Question 6

What is polypharmacy?

Answer 6

• Literal definition:
  
  • taking 2+ meds
• Most commonly accepted definition:
  
  • 5+ meds (Rx or OTC)
• Proposed definitions:
  
  • use of 2+ drugs w/o indications or for the same purpose
  • use of a drug to treat the adverse rxns of another drug
  • use of 2+ drugs from the same class to treat different indications

Question 7

What is a polypharmacy Prescribing Cascade?

Answer 7

Use of one drug to treat the adverse effects of another drug

Question 8

How does body composition change with aging?

Answer 8

• ↑ fat
• Loss of muscle mass
  
  • may be due to inactivity vs physiological aging
• Fxn & quality of muscle changes
  
  • neural stimulation slows

Question 9

What are sensory changes associated with aging?

Answer 9

• taste
  
  • loss of lingual papillae
  • diminution of ability to taste
  • ↓salivation
  • use of dentures
  • ↓interest in food
  • ↓ taste of salt - may lead to ↑NaCl intake
• Hearing Loss
  
  • Stria vascularis highly vascular tissue; greater O2 demand than the brain
• Vision (anticholinergic meds)
  
  • Decreased ability to adapt to light
  • reduced depth perception
  • increased sensitivity to glare

Question 10

Cardiac changes associated with aging?

Answer 10

• Stiffening of aorta - predisposition
• Decreased Cardiac output