Gerontology Module 3
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| What % of pts with Heart Failure (HF) are over 65? | 80% - – Primary or secondary diagnosis in ~3.6 million
hospitalizations – 82% die from heart disease are 65 or older
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| How many people in the US have HF? | 5 million - 550,000 dx'ed each year
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| What are the total and indirect costs for HF? | $27.9 billion - $2.9 billion/year medication
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| What condition is the heart unable to contract strongly enough to meet vascular demands of the body? | Heart failure - – Hypertrophies, affects entire myocardium – Right HF vs. Left HF
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| What are the 3 areas that present with HF? | a) Dyspnea, fatigue
b) Abdominal, peripheral edema
c) No symptoms or symptoms with hypertrophied heart
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| How do changes in the heart rate and rhythm manifest? | – Arrhythmias: Tachycardia, Bradycardia
– Dysrhythmia: Atrial fibrillation, Ventricular fibrillation
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| Which dysrhythmia is a risk factor for stroke? | Atrial Fibrillation
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| Which dysrhythmia is the most serious cardiac disturbance? | Ventricular Fibrillation
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| How many people over 65 have Coronary Artery Disease (CAD) or Ischemic Heart Disease? | Nearly 2/3 - – most are asymptomatic
– Insufficient blood flow to cardiac muscle - sx's include fatigue and dyspnea
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| How does CAD affect the heart? | – Limits ability to withstand ↑ in workload
– ↑ response time to activity decrease ability to
develop and sustain an ↑cardiac output
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| What syndrome has acute MI or unstable angina? | Acute coronary syndrome
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| Which symptom is chest pain associated with CAD? | Angina - – O2 delivery to cardiac muscles is insufficient
– Older population angina can occur at rest
– Attacks are sudden tightness or compression in chest
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| Which type of angina is predictable, occurs during exercise or stress? | Stable
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| Which type of angina is Unexpected, occurs at rest, more severe and prolonged? | Unstable
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| Which cardiovascular condition increases with aging and is associated with cardiac and peripheral diseases? | HTN
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| Which cardiovascular condition has stenosis and insufficiency, where Valve defects restrict or cause backward flow of blood in the heart, Increases workload of the heart and has CHF, arrhythmias, embolism, are most common? | Valvular Disease
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| What is classified as prehypertension? | 120-130 SBP/80-89 DBP - can be treated with lifestyle changes
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| What is mild HTN? | 140-159 SBP/90-99 DBP = can be treated with lifestyle changes and drug therapy
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| What is Moderate HTN? | >160 SBP/100 DBP = can be treated with lifestyle changes and drug therapy
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| What is severe HTN? | >180 SBP/>110 DBP = can be treated with lifestyle changes and drug therapy
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| Which cardiovascular condition has a Decline of cardiac performance and a Slow HR recovery and absence of ↑ SBP with exercise? | Myocardial degeneration
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| Which cardiovascular condition has Partial or complete obstruction of blood flow to limbs, May be arterial or venous disease, More common with age, inactivity, and CAD and includes Buerger's disease? | • Peripheral Vascular Disease (PVD)
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| What are some cardiovascular manifestations of aging? | Acute coronary syndrome, angina, HTN, Valvular disease, Myocardial degeneration, PVD and Arteriosclerosis vascular degeneration
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| What are some pulmonary manifestations of aging? | Pneumonia, obstructive and restrictive lung diseases, lung cancer, cor pulmonale
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| Which pulmonary condition is a lung infection that is the most common infectious cause of death in elderly? | Pneumonia
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| Which pulmonary condition alters airflow in lung volume and capacities, is more common with age and risk factors and includes COPD? | • Obstructive and Resistive Lung Disease- – COPD = emphysema and chronic bronchitis
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| Which pulmonary condition is the most common cancer death in US? | Lung cancer - – Primary Lung Cancer and Secondary Lung Cancer
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| Which pulmonary condition is R ventricular hypertrophy and is part of pulmonary HTN that is a common end stage lung disease? | Cor pulmonale
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| What musculoskeletal manifestation of aging is a chronic painful condition that is a disorder in central pain processing? | Fibromyalgia - Symptoms = chronic wide spread muscular pain, stiffness, low pain threshold – sleep disturbances / fatigue – IBS – memory / concentration loss -
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| How is fibromyalgia (FM) treated? | • 90% of all FM subjects are women
• Exercise is beneficial / Medication ineffective
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| What skeletal manifestation is a systemic skeletal disease characterized by low bone mass and micro- architectural deterioration of bone tissue? | osteoporosis
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| What skeletal manifestation has Increase in bone fragility and susceptibility to fracture? | Osteoporosis
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| How does osteoporotic bone present? | – Osteoporotic bone has a clear loss of bone, with larger
spaces and perforation of the struts
– Wrists, hips and spine are at greatest risk of damage from osteoporosis-related fractures
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| How many fractures does osteoporosis cause each year? | • Osteoporosis causes over 2 million fractures each year in men and women over age 50
– Substantial amount of bone loss has occurred
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| What are some demographic risks for osteoporosis? | • Female gender, post menopausal
• Family history of osteoporosis or personal history of fracture
• Petite stature with low body mass
• Caucasian, Asian, or Hispanic/Latino race/ethnicity
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| What are some hormonal risks for osteoporosis? | • Low sex hormones, testosterone and estrogen
• Low estrogen levels in women, including menopause
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| What are some lifestyle or medication risks for osteoporosis? | • Inactive lifestyle, Smoking, Alcohol abuse
• Diet, Low calcium and vitamin D intake, Excessive protein, sodium, caffeine intake
• Certain medications such as steroid medications, some
anticonvulsants, and others
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| What condition is associated with Certain diseases and conditions such as Amenorrhea, anorexia nervosa, rheumatoid arthritis, gastrointestinal diseases, and others? | Osteoporosis
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| What is the World Health Organizations (WHO) T-score rating for Osteoporosis? | +1 to -1 = Normal; -1 to -2.5 = osteopenic; -2.5 or lower = osteoporotic
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| What type of fracture has increased thoracic kyphosis that worsens over time with breathing difficulties, abdominal pain and digestive discomfort? | Vertebral Compression Fractures: Loss of height, distended abdomen, stooped posture; Decreased quality of life, mobility, and energy; Pain and deterioration of physical function; Increased long-term morbidity and mortality
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| What are multiple wedge fractures called? | Gibbus Hump
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| What do studies show are beneficial for osteoporosis? | bone mineral density (BMD) responds/adapts to amount/direction/mechanical load applied - Repetitive loading of bone that occurs with HIT lead to increased BMD - Research effects on walking on osteogenic response
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| What type of strength training will help vertebral compression fractures (VCF)? | • ↑ back extensor strength, ↓ risk for VCF; 89% flexion group had experienced VCF – Only 16 % in extension group; 10 year f/u: risk for VCF control group vs. extension exercise group
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| What did a study on exercise in older women with flexed posture show in terms of frequency, intensity and outcomes of strength training? | • Intervention: 2 x week for 12 weeks
• High-intensity, progressive resistive exercise
principles
• Outcomes of study showed reduced measured kyphosis and improved strength, ROM, and physical performance
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| What skeletal manifestation has Osteoclasts are more active than osteoblasts and Osteoblasts construct haphazardly, excessive, abnormally large and deformed bone? | Paget's disease - Bone afflicted by Paget's disease has an irregular mosaic pattern
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| What skeletal manifestation has Degeneration of articular cartilage and inflammation of synovium and Changes to underlying subchondral bone? | • Degenerative Arthritis / Osteoarthritis • Symptoms:
– Impaired mobility
– Deep ache
– Joint stiffness (inactivity)
– Loss of flexibility and joint surface congruity
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| Which skeletal condition is a chronic inflammatory disease causing joint damage? | rheumatoid arthritis
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| What are the 3 progressive stages of RA? | a. Synovium swelling, stiffness, erythema, joint
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effusion
b. Rapid division and growth of cells, thickening of synovium
c. Release of enzymes from inflamed cells, development of vascular granulation tissue (pannus)
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| What neuromuscular manifestation has fluctuating attentional state causing temporary confusion and loss of mental function? | Delirium - – Acute disorder may be day to day
– Potentially reversible - Measured with JAMCO -(Judgment, Affect, Memory, Cognition, Orientation)
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| What is the etiology of delirium? | drug toxicity, systemic illness, oxygen deprivation to brain, environmental changes and sensory deprivation
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| What neuromuscular condition is an Acute onset, often at night, fluctuating course with lucid intervals, may be hypo/hyper alert, distractible, fluctuates over course of day and orientation is usually impaired? | Confusion/Delirium - Illusions/hallucinations,periodsofagitation
– Memory deficits / immediate and recent
– Disorganizedthinking,incoherentspeech
– Sleep wake cycles disrupted
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| What neuromuscular condition has a Loss of cognitive functions and memory causing dysfunction in ADLs, and Deterioration of intellectual function, impoverished thinking, disorientation, confusion, impaired social functioning? | Dementia - – Disturbances in higher cortical functions
– Memory impairment recent and remote
– Personality changes, alterations or accentuation of premorbid traits, behavioral changes
– Alertness and sleep often fragmented
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| What can cause dementia? | Alzheimer’s disease, CVA, Genetic factors, Korsakoff’s psychosis, Parkinson’s disease
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| What type of dementia is a Vascular infarct in both gray and white matter of brain associated with hx of stroke, CVD and HTN? | Multi-infarct dementia - – Sudden onset vs. insidious, step-wise progression – Spotty and patchy distribution of deficits, areas of
preserved ability along with impairments – Focal neurological signs and symptoms – Emotional lability is common
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| How many people are affected by Alzheimer's disease (AD)? | 5.5 million people in US – Total projected to increase to 15 million by 2050• Estimated cost of care at over $60 billion per year
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| Which neuromuscular condition is a deterioration of memory and other cognitive domains that leads to death within 3 to 9 years after diagnosis? | Alzheimer's - • AD incurable disease, very difficult to cope with
• Drugs treatment has not proved to be useful
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| What are 2 markers for AD? | – Amyloid clumps and tau neurofibrillary tangles – Clumps cause cell death in disease process
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| Which condition has Atrophy and loss of nerve cells hippocampus and a Genetic contribution from chromosome 1, 14, 19, 21? | AD
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| What are NON-modifiable risk factors for AD? | Age, Genetics, Down’s Syndrome, Gene mutation, Head trauma, Exposure to metals, infections, toxins
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| What are modifiable risk factors for AD? | HTN, obesity, insulin resistance, smoking, and inactivity
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| What is the most prominent change in cognitive function with AD? | Loss of memory - document with MMSE
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| What are the 3 stages of AD? | 1. Noticeable deterioration in thinking capacity
2. Impairment in memory, attention, language, or ability to plan
3. Loss ability to function independently
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| What are the first 5 warning signs of AD? | 1. Memory loss w/ ADLs disrupted 2. challenge w/ planning/problem solving 3. difficulty completing familiar tasks 4. confusion w/ time/place 5. difficulty w/ visual images and spatial relation
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| What are the last 5 warning signs of AD? | 6. difficult with words in speaking or writing 7. misplacing objects and losing ability to retrace steps 8. poor judgment 9. withdrawal from work or social activities 10. changes in mood and personality
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| What condition is a Sudden focal neurologic deficit resulting from ischemic or hemorrhagic brain lesions? | CVD - – Blocked or loss of blood flow to brain tissue results in cell damage or death from ischemia
– Thrombotic and embolic stroke or Hemorrhagic stroke
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| What is the most common cause of disability in the US? | CVD - – Incidence of stroke increases dramatically with age most stroke occur in person > 74 years
– 1/3 die, 1/3 severe disability, 1/3 mild disability
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| What are risk factors for CVD? | Atrial fibrillation, Diabetes, genetics, High cholesterol, age, race
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| What are 6 common signs and symptoms of CVA? | 1. Decreased level of consciousness
2. Aphasia / Dysarthria
3. Acute onset of hemiparesis / hemisensory loss 4. Monoparesis or quadriparesis
5. Nystagmus, visual changes 6. Ataxia and vertigo
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| What condition is caused by lesions in substantia nigra producing deficits in motor behavior that are Associated with several pathological process that damage extrapyramidal system? | Parkinson's Disease - Most prevalent type of parkinsonism, 80% of cases
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| What condition has a Loss of melanin-containing brain cells in substania nigra and locus caeruleus and Decrease of dopamine in the caudate nucleus and putamen? | Parkinson's disease
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| What are the 4 categories of PD? | Primary, secondary, Parkinson-like syndrome, Heredodegenerative diseases
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| What does TRAP stand for? What is it for? | Tremor, Rigid, Akinesia, Postural reflex - For PD pts
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| What systems are affected by nutritional deficiencies in Folic Acid and Vitamin B12? | Peripheral nervous systems
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| What is condition includes sensory polyneuropathy affects hands and feet with diminished sensation and burning pain? | Diabetic Neuropathy
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| What condition is an Adverse effect associated chemotherapeutic agents, has Damage to sensory, motor and/or autonomic nerves and Pain, paresthesias, and dysesthesias? | • Chemotherapy-induced peripheral neuropathy
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| What condition has a decline in cell-mediated immunity, with a rash that persists for 2 weeks, has postherpetic neuralgia (pain and allodynia) and can be prevented with vaccinations? | Herpes Zoster “shingles”: caused by varicella- zoster virus
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| What condition is a benign epidermal neoplasm of the head, neck, and trunk with verrucous surface with a "stuck on" appearance; and is tan to dark brown in color? | Seborrheic Keratosis
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| What is the leading cause of blindness in 55 and over and what does it involve? | Macular degeneration – Breakdown of layer of retinal pigment epithelial cells – Affects central vision
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| What condition causes 70% vision impairments > 75 and is a Clumping of proteins clouding lens? | Cataracts
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| What condition is Increased intraocular pressure, and blocked outflow in eye’s drainage canal? | Glaucoma - Damage to optic nerve = blindness – Open angle 90% of all cases
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| What condition is an Inability to hear high-frequency sounds and is in 60% of people age 65 and older? | Presbyacusis
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| What condition is a Constant crackling, buzzing, ringing, or whistling in one or both ears? | Tinnitus
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| What condition has ear pain from an otologic process which is referred along a neural pathway? | Otalgia - outer ear inflammation and TMJ
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| An accumulation of what results in hearing loss? | Cerumen
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| What condition is difficulty swallowing? | dysphagia
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| What do urinary tract infections effect? | – Lower GI = urethritis and Cystitis “bladder infection”
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| What does DIAPPERS stand for? | Delirium, Incontinence, Atrophic Vaginitis, Pharmaceuticals, Psychological factors, Excess fluid output, Restricted Mobility, Stool
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| What condition is an increased bladder pressure greater than sphincter resulting in 30% of nursing home admittance? | Urinary incontinence (DIAPPERS)
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| What is an inability to control bowel movements? | Fecal incontinence
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| What condition is a Rapid build up of toxic waste products and drugs, fluid overload, and elevation of serum potassium? | Acute renal failure
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| What condition is a Slow deterioration of renal function, permanent loss of nephrons? | Chronic renal failure – DM and HTN leading cause
– 4 stages: 4th stage ESRD
– 90% of kidney function has been loss
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| What are some signs and symptoms of kidney problems? | anemia, fatigue, wasting, reduced work capacity, low exercise capacity
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| What is levels of SBP and DBP are contraindicated with kidney problems? | Exercise SBP at rest is >200 mm Hg and/or DBP is >110 mm Hg
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| How many older adults are dx'ed with DM? | 10.9 million - 26.9% of total pop of older adults in US
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| What condition is an inability to produce or properly use insulin causing hyperglycemia where the β-cells lose ability to produce insulin? | DM
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| What population is Type 2 DM most prevalent in? | 65-79 y.o.- May have DM for up to 10 years before actual diagnosis
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| What is the current name of Type 1-1/2 diabetes? | Latent autoimmune diabetes in adults (LADA)
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| What are the signs of aging? | • Vision changes
• Increased urination frequency
• Decreased endurance and muscle strength
• Decreased sensation
• Atherosclerosis
• Restlessness, confusion, slower cognition
• GI abnormalities
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| What are the signs of diabetes? | • Blurred vision
• Polyuria and nocturia
• Fatigue
• Neuropathy and foot deformities
• CAD/CVA↑4times
• Restlessness, confusion, slower cognition with high and low blood glucose
• Diabetic neuropathic gastroparesis
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| What how many women and men will be affected by cancer? | 1 in 3 women and 1 in 2 men
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| What % of people will be dx'ed with cancer at 55+? 65+? And what is the median age of dx for cancer? | 77% will be dx'ed 55+; 53.2% will be 65+, Median age is 66 y.o.
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| When do most cancer deaths occur? | Between 55 and 75 - rate declines after 75
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| What condition is characterized by rapid growth, uncontrolled proliferation, and impaired ability to heal cellular damage? | Cancer! – Dysplastic cells may have proliferative controls that are relaxed or uncoupled from appropriate regulatory cues
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| What type of cancer is the most common where cells cover external and internal body surfaces and can effect Lung, breast, and colon, Epithelial cells? | Carcinomas
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| What type of cancer is found in supporting tissues (bone, cartilage, fat, connective tissue, and muscle)? | Sarcomas
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| What kind of cancer is found in lymph nodes and tissues of immune system? | Lymphomas
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| What kind of cancer is found in immature blood cells that grow in bone marrow that Accumulate in large numbers in bloodstream? | Leukemias
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| What type of tumor resembles tissue of origin, is well differentiated, slow-growing, well circumscribed, HAS a capsule, and remains localized to the site of origin? | Benign tumors
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| What type of tumor is poorly/completely undifferentiated (anaplastic), faster growing, poorly circumscribed, invades surrounding normal tissues, locally invasive and can metastasize to distant sites? | Malignant tumors
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| What type of cancer can metastasize to lung, liver, bones, brain and ovary? | Breast
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| What type of cancer can metastasize to liver, peritoneum and lungs? | Colon, ovary, pancreas, stomach, uterus
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| What type of cancer can metastasize to lungs, liver and bones? | Kidney, thyroid, prostate (esp in spine and pelvis),
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| What type of cancer can metastasize to adrenal gland, liver, lungs, bone and brain? | Lungs, rectum
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| What type of cancer can metastasize to lungs, skin/muscle, and liver? | Melanomas
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| What is the most common type of cancer in the US? | Skin cancer - Skin cancer is estimated to be diagnosed in up to
50% of those over 65
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| What are the ABCDE method of evaluating a mole? | – Asymmetry
– Border irregular, ragged or notched edges – Color = brown, tan, or black
– Diameter of > 6 mm
– Evolution, enlargement, or elevation
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| What condition has a Core body temperature of 95 degrees F or lower which can occur in older adults after relatively short exposure to cold weather or even a small drop in temperature? | Hypothermia - Body's heat production decreases response to cold due to aging, medical conditions, medication
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| What are the signs of hypothermia? | – Slowed or slurred speech
– Sleepiness or confusion
– Shivering or loss of mobility in extremities – Poor control over body movements
– Slow reactions
– Weak pulse
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| What condition is a Body temperature increases significantly > 104° Fahrenheit? | Hyperthermia - associated with Heat stroke = life-threatening form of hyperthermia
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| What are symptoms of hyperthermia? | – Mental status changes – Strong rapid pulse
– Lack of sweating
– Dry flushed skin
– Faintness
– Staggering
– Coma
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| What is affected by endurance training and how often should you do it? | Axial muscles, CP training – Strengthening spine 1 to 2 sessions per week was adequate
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| What is affected by strength training and often should you do it? | Peripheral muscles – Strengthening LE 3 x week was optimal when working at sufficient intensities to produce strength gains
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| What type of exercise helps osteoporosis? | Power - – Increase bone mass and function – Extension exercises
– 6 sets of 2 reps
– 5 sets of 5 reps
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