advanced physical assessment
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| show | 56% report at least one chronic condition.
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| show | African American and Hispanic adults aged 60 to 69 years.
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| New paradigms also highlight the importance of shifting assessment to geriatric syndromes that fall outside traditional disease models but are strongly linked to | show 🗑
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| Geriatric syndromes are present in almost 50% of older adults and include | show 🗑
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| In aging, decreased cutaneous vasoconstriction and sweat production can impair responses to | show 🗑
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| show | shock.
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| show | rise with aging.
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| show | systolic hypertension with a widened pulse pressure (PP) often ensue (systolic-diastolic >40)
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| In older adults, resting heart rate remains | show 🗑
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| There are declines in the pacemaker cells of the sinoatrial node and the maximal heart rate | show 🗑
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| Rhythm changes= | show 🗑
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| There may be purple patches or macules, termed | show 🗑
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| The pupils become smaller, making it more difficult to examine the ocular fundi. The pupils may also become slightly irregular but | show 🗑
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| show | approximately 70 years and then more rapidly.
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| Near vision begins to blur noticeably for virtually everyone, the lens gradually loses elasticity, with progressive loss of accommodation and the ability to focus on nearby objects | show 🗑
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| show | presbycusis, becomes increasingly evident, usually after age 50 years.
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| show | submandibular are easier
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| show | O2 saturation normally remains above 90%.
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| show | kinking or buckling of the carotid artery low in the neck, especially on the right. The resulting pulsatile mass, occurring chiefly in women with hypertension, may be mistaken for a carotid aneurysm—a true dilatation of the artery.
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| A tortuous aorta occasionally raises the pressure in the | show 🗑
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| show | β-adrenergic catecholamines.
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| show | maximum heart rate during exercise. Although heart rate drops, stroke volume increases, so cardiac output is maintained.
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| show | early diastolic filling and greater dependence on atrial contraction. There is increased myocardial stiffness, notably in the left ventricle, which also hypertrophies.
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| Risk of heart failure increases with loss of atrial contraction and onset of atrial fibrillation due to | show 🗑
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| show | 40 years, especially in women.
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| After age 40 years, however, an S3 strongly suggests | show 🗑
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| a fourth heart sound is seldom heard in young adults other than well conditioned athletes. An S4 can often suggest | show 🗑
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| show | a systolic aortic murmur.
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| In most older adults, the process of fibrosis and calcification, known as aortic sclerosis, does not impede | show 🗑
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| show | but clinically distinguishing these conditions is difficult. Both carry increased risk for cardiovascular morbidity and mortality.
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| show | systole, causing the systolic murmur of mitral regurgitation- may become pathologic as V/O increases in the left ventricle.
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| show | harder and less resilient.
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| There is increased arterial stiffness and decreased endothelial function. The trophic changes of the skin, nails, and hair discussed earlier occur | show 🗑
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| show | not normal changes of aging.
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| show | loss of vision in 15% of patients and headache and jaw claudication.
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| show | he third decade, continues to the seventh decade, then appears to plateau
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| show | strength training
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| show | slightly faster and disappear at rest, and there is no associated muscle rigidity
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| Older adults frequently lose some or all vibration sense in the | show 🗑
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| show | may diminish or disappear.
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| The gag reflex may be | show 🗑
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| Abdominal reflexes may | show 🗑
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| show | symmetrically decreased or absent, even when reinforced- knee reflexes are similarly affected d/t musculoskeletal changes in the feet, the plantar responses become less obvious and more difficult to interpret.
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| If there are associated abnormal neurologic findings, or if atrophy and reflex changes are asymmetric | show 🗑
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| Older patients having a myocardial infarction are less likely to report | show 🗑
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| show | fewer s/s- 1/3 hyperthyroidism present with fatigue, weight loss, and tachycardia instead of classic heat intolerance, sweating, and hyperreflexia & atrial fibrillation.
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| show | osteoporosis, and, in affected women, the risk of hip and vertebral fractures increases X3
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| show | autoimmune thyroiditis (Hashimoto thyroiditis); fatigue, weakness, constipation, dry skin, and cold intolerance are often attributed to other conditions, medication side effects, or aging.
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| show | functional decline. Examples include dizziness, as well as functional impairment, frailty, delirium, depression, cognitive impairment, falls, and urinary incontinence.
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| show | group-labeling by expanding individual history taking to include Explanation, Treatment, Healers, Negotiate, Intervention, Collaborate, and Spirituality.
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| drug–drug interactions- consult the | show 🗑
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| show | >4 comorbid conditions, Heart or renal failure, liver dz, ● ≥80 yo ● polypharmacy >8 ● warfarin, insulins, oral antiplatelet agents, oral hypoglycemic● hx drug rx● Hyperlipidemia ● inc WBC● antidiabetic agents ● LOS ≥
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| show | Frailty- wt loss, exhaustion, weakness, slowness, and low physical activity; broader definition includes mood, cognition, and incontinence.
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| Osteoporotic Fractures | show 🗑
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| “Do you often feel sad or depressed?” has a sensitivity of | show 🗑
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| “Over the past 2 weeks, have you felt down, depressed, or hopeless?” and “Over the past 2 weeks, have you felt little interest or pleasure in doing things?” | show 🗑
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| Dementia is “an acquired condition that is characterized by a decline in | show 🗑
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| Age-related Cognitive Decline ● This diagnosis is suggested by | show 🗑
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| Mild Cognitive Impairment (MCI) -Daily function is preserved, but modest cognitive decline in one or more cognitive domains | show 🗑
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| Vascular dementia is suggested by | show 🗑
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| show | parkinsonism. Visual hallucinations, delusions, and gait d/o- EPS at times, fluctuating mental status, sensitivity to antipsychotic medications.
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| Frontotemporal lobar degeneration is suggested by | show 🗑
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| show | 3 important areas-cognitive, psychosocial, and physical function. It includes vision, hearing, and questions about urinary incontinence, an often hidden source of social isolation and distress.
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| To identify incontinence pneumonic■ DIAPERS: | show 🗑
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| show | Delirium, Drug side effects, Retention of feces, Restricted mobility, Infection of urine, Inflammation, Polyuria, and Psychogenic
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| Joint National Committee (JNC8) recommends blood pressure targets of | show 🗑
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| those aged 80 years and older, other experts cite studies showing that blood pressure targets of | show 🗑
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| A red reflex is seen with | show 🗑
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| show | left ventricular hypertrophy (LVH).
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| A tortuous atherosclerotic aorta can raise pressure in the | show 🗑
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| show | LVH; a diffuse PMI and an S3 signal left ventricular dilatation from heart failure or cardiomyopathy.
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| An S4 often accompanies | show 🗑
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| A systolic crescendo–decrescendo murmur in the second right interspace suggests | show 🗑
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| A harsh holosystolic murmur at the apex radiating to the axilla suggests | show 🗑
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| show | atherosclerotic vascular disease.
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| show | abdominal aortic aneurysm, especially in older male smokers.
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| show | evidence of a causative genetic mutation from family history or genetic testing, or the presence of cognitive decline in two or more cognitive domains, with all three features
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| show | (1) decline in memory/learning & @least one cognitive (2) steady progressive decline in cognition (3) no evidence of mixed etiology from other neurodegenerative, cerebrovascular, mental, or systemic disease.
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| show | Alertness and attention is preserved, Other dementias are unlikely AD
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| show | repeating questions, losing objects, confusion when performing tasks (shopping). Later stages- impaired judgment, disorientation progressing to aphasia, apraxia, left–right confusion, dependence of IADLs. Psychosis and agitation
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| Carotid bruits can occur in | show 🗑
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| A sustained PMI is present in | show 🗑
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| An S4 often accompanies | show 🗑
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| show | aortic sclerosis or aortic stenosis- Both are associated with an increased risk of cardiovascular disease and death
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| show | mitral regurgitation, the most common murmur in older adults.
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| show | condylomata, fibromas, leiomyomas, and sebaceous cysts. Bulges and Swellings of the Vulva, Vagina, and Urethra
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| Erythema with satellite lesions results from | show 🗑
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| show | may be precancerous
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| Estrogen-stimulated cervical mucus with ferning is seen in | show 🗑
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| Mobility of the cervix is restricted with | show 🗑
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| show | malignant leiomyosarcoma; ovarian masses or enlargement are seen in ovarian cancer.
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| Rectal masses are found in | show 🗑
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| show | unequal pupil size, decreased arm swing and spontaneous movements, increased leg rigidity and abnormal gait, snout and grasp reflexes, ↓ toe vibratory sense.
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| show | Tremor, Rigidity, Akinesia, and Postural instability, or TRAP- Also bradykinesia, the most characteristic clinical sign, micrographia, shuffling “freezing” gait, difficulty rising from a chair.
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| Memory impairment in delirium vs dementia | show 🗑
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| show | Characterized by age-related, lack of adaptive physiological capacity occurring by an age-identifiable illness- three elements: Weight loss of more than 5% over 3 years, Inability to do five chair stands, Self-reported exhaustion.
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| Palliative care | show 🗑
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| Dementia and cognition definition | show 🗑
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| Influenza-Tri/Quadrivalent -Adults 50+ | show 🗑
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| Pneumococcal- PVC 13-Adults 65+ | show 🗑
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| Zoster Vaccine-Adults 60+ | show 🗑
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| Tdap-60 + /every | show 🗑
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| show | Annually at age 40-75 ACOG
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| Cervical CA-PAP- | show 🗑
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| show | Every q 10 years or sigmoidoscopy every 5 yrs w/FOBTs. Recommends against routine screening for those 76-85 due to poor net benefit. Do not screen if life expectancy is less than 10 yrs.
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| Prostate CA-PSA | show 🗑
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| Lung CA- | show 🗑
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| show | Both USPSTF & AAFP given no recommendation for routine screening.
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| show | 2 questions- Question 1- Sensitivity 69% Specificity 90%- Combined-Sensitivity 100% and 77% Specificity
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| show | Alzheimer’s, Vascular Dementia, Frontotemporal Dementia, Dementia with Lewy Bodies, Parkinson w/dementia, Dementia of Mixed Etiology
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| show | 1st degree relative has it
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| Mild cognitive impairment | show 🗑
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| Alzheimer’s criteria | show 🗑
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| Dementia and sleep | show 🗑
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| show | Best-91% Sensitivity & 86% Specificity
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| show | economic, environmental, cognitive, medical, affective, social support, spirituality
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| orthostatic B/P changes | show 🗑
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| show | Unequal pupil size, ↓arm swing, Spontaneous movements, ↑ leg rigidity, Gait abnormality, ↓ toe vibratory sense
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| show | Vision-Visual Acuity 20/60on Snellen, Hearing-Cannot hear Whisper voice either ear. Audiometry if done. Leg Mobility-Scored 9 seconds on Timed Get-Up & Go Test. Urinary Incontinence-no self wetted in 20/30 days.
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