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GM2 Geriatric Medicine
Acronyms
Toronto Notes 2019
Acronyms
ACEI angiotensin converting enzyme inhibitor ADL activities of daily living
ADR adverse drug reaction
ARB angiotensin receptor blocker
BMI body mass index
BP blood pressure
BPH benign prostatic hypertrophy BUN blood urea nitrogen
CBC complete blood count
CBT cognitive behavioural therapy CHF congestive heart failure
CKD chronic kidney disease
CNS central nervous system
CO cardiac output
CPR cardiopulmonary resuscitation CVA cerebrovascular accident
CXR chest x-ray
dBP diastolic blood pressure
DM diabetes mellitus
DNR do not resuscitate
ESAS Edmonton symptom assessment
scale
GABA gamma-aminobutryic acid
GCA giant cell arteritis
GERD gastroesophageal reflux disease GFR glomerular filtration rate
GI gastrointestinal
HR heart rate
IADL instrumental activities of daily living ICU intensive care unit
IBD inflammatory bowel disease
IBS irritable bowel syndrome POA ICP intracranial pressure PPI IV intravenous PPS INR international normalized ratio PTH LOC level of consciousness PSW LV left ventricle RA MMSE mini mental status examination sBP MS multiple sclerosis SNRI NE norepinephrine
NG nasogastric SSRI NMDA N-methyl-D-aspartic acid TIA NSTEMI non-ST elevation myocardial infarction TCA N/V nausea/ vomiting UI OTC over the counter UTI PCI percutaneous coronary intervention
power of attorney
proton pump inhibitor
palliative performance scale parathyroid hormone
personal support worker
rheumatoid arthritis
systolic blood pressure serotonin-norepinephrine
reuptake inhibitor
selective serotonin reuptake inhibitor transient ischemic attack
tricyclic antidepressant
urinary incontinence
urinary tract infection
Physiology and Pathology of Aging
Definition
• majorcategoriesofimpairmentthatdevelopwitholdageandaffectthephysical,mental,andsocialdomainsoftheelderly,usuallydueto many predisposing and precipitating factors rather than a single cause
Table 1. Changes Occurring Frequently with Aging
System
Neurologic Special Senses
Cardiovascular
Respiratory Gastrointestinal
Renal and Urologic
Reproductive Endocrine Musculoskeletal Integumentary
Psychiatric
Physiological Changes
Decreased wakefulness, brain mass, cerebral blood flow, increased white matter changes
Decreased lacrimal gland secretion, lens transparency, visual acuity, dark adaptation, sense of smell and taste, detection of higher frequency sounds, vestibular function, vestibulospinal reflexes
Increased sBP, decreased dBP, HR, CO
Decreased vessel elasticity, cardiac myocyte size and number, β-adrenergic responsiveness
Increased tracheal cartilage calcification, mucous gland hypertrophy Decreased elastic recoil, mucociliary clearance, pulmonary function reserve
Increased intestinal villous atrophy
Decreased esophageal peristalsis, gastric acid secretion, liver mass, hepatic blood flow, calcium and iron absorption
Increased proteinuria, urinary frequency
Decreased renal mass, creatinine clearance, urine acidification, hydroxylation of vitamin D, bladder capacity
Decreased androgen, estrogen, sperm count, vaginal secretion Decreased ovary, uterus, vagina, breast size
Increased NE, PTH, insulin, vasopressin
Decreased thyroid and adrenal corticosteroid secretion
Increased calcium loss from bone Decreased muscle mass, cartilage
Atrophy of sebaceous and sweat glands
Decreased epidermal and dermal thickness, dermal vascularity, melanocytes, collagen synthesis
Increased bilateral brain activity for memory tasks and loss of synaptic plasticity
Pathological Changes
Increased insomnia, neurodegenerative disease, stroke, decreased reflex response
Increased glaucoma, cataracts, macular degeneration, presbycusis, presbyopia, tinnitus, vertigo, oral dryness
Increased atherosclerosis, CAD, MI, CHF, hypertension, arrhythmias, orthostatic hypotension, wide pulse pressure
Increased COPD, pneumonia, pulmonary embolism
Increased cancer, diverticulitis, constipation, fecal incontinence, hemorrhoids, intestinal obstruction, malnutrition, weight loss
Increased urinary incontinence, nocturia, BPH, prostate cancer, pyelonephritis, nephrolithiasis, UTI
Increased breast and endometrial cancer, cystocele, rectocele, atrophic vaginitis
Increased DM, hypothyroidism, impaired stress response
Increased arthritis, bursitis, osteoporosis, muscle weakness with gait abnormalities, polymyalgia rheumatica
Increased lentigo, cherry hemangiomas, pruritus, seborrheic keratosis, herpes zoster, decubitus ulcers, skin cancer, easy bruising
Increased depression, dementia, delirium, suicidality, anxiety, sleep disruption
Screening Tool for Frailty - FRAIL
Fatigue: “Are you fatigued?”
Resistance: “By yourself and without aids, do you have any difficulty walking up 10 steps without resting?”
Ambulation: “By yourself and without aids, do you have any difficulty walking several hundred yards?”
Illnesses: more than five
Loss of weight: greater than five percent Frailty:“Yes”to3ormorequestions Pre-frailty: “Yes” to 1-2 questions
A simple frailty questionnaire (FRAIL) predicts
outcomes in middle aged African Americans. J Nutr Health Aging 2012 Jul; 16(7):601-8
Differential Diagnoses of Common Presentations
Frailty
Definition
• frailty:clinically-recognizablestateofdecreasedreserveinolderadultswithincreasedvulnerabilityto acute stressors resulting from functional decline across multiple physiologic systems
• functionaldecline:progressivelimitationintheabilitytocarryoutbasicfunctionalactivities