Geriatric ImagingGeriatric Imaging

11 3 2015

GeriatricsGeriatrics

Branch of medicine Branch of medicine dealing with aged and dealing with aged and problems of agingproblems of aging

over age 65over age 65

Population is increasing Population is increasing

Radiographer’s RoleRadiographer’s Role

Adapt procedures to accommodate disability and Adapt procedures to accommodate disability and diseasedisease

Understand physiology and pathology of agingUnderstand physiology and pathology of aging

Be aware of social, psychological, cognitive, and Be aware of social, psychological, cognitive, and economics of agingeconomics of aging

Problems Facing SeniorsProblems Facing Seniors

Depression- Depression- 1 in 5 persons over age 65 shows signs1 in 5 persons over age 65 shows signs of clinical depressionof clinical depression

Fixed incomeFixed incomeFew choices in personal living arrangementsFew choices in personal living arrangements

DependencyDependencyLoneliness Loneliness

Medical emergenciesMedical emergenciesIllnessIllnessSenilitySenility

Most common health complaints of elderlyMost common health complaints of elderly

Decrease in balance, coordination, strength, and reaction timeDecrease in balance, coordination, strength, and reaction time

Weight gainWeight gain

FatigueFatigue

Loss of bone massLoss of bone mass

Joint stiffnessJoint stiffness

Loss of hearingLoss of hearing((presbycusis - gradual, progressive hearing loss of tone discrimination)presbycusis - gradual, progressive hearing loss of tone discrimination)

Rheumatoid ArthritisRheumatoid Arthritis

Inflammatory joint disease

Causes severe deformity

Limits flexibility

OsteoarthritisOsteoarthritis

Degenerative joint disease Degenerative joint disease caused primarily by caused primarily by wear wear and tear on jointsand tear on joints

Body creates additional Body creates additional bone tissue in response to bone tissue in response to stress on jointsstress on joints

Can lead to complete fusion Can lead to complete fusion of jointsof joints

OsteoporosisOsteoporosis

Loss of bone volume and mass- Loss of bone volume and mass- Often, kVp must be reduced Often, kVp must be reduced for x-ray examsfor x-ray exams

4 times more common in women4 times more common in women (menopause),(menopause), but but cancan appear in men appear in men

Increased risk of fxs, kyphosisIncreased risk of fxs, kyphosis

Alzheimer’s DiseaseAlzheimer’s Disease

Chronic, organic mental disorderChronic, organic mental disorder

Starts with progressive loss of memory leads to complete loss of intellectual Starts with progressive loss of memory leads to complete loss of intellectual function due to atrophy of frontal and occipital lobesfunction due to atrophy of frontal and occipital lobes

Early onset between ages 40 and 60Early onset between ages 40 and 60

After age 85 – 50 % chanceAfter age 85 – 50 % chance

Can be fatal – brain unable to run body systems- probably die of something Can be fatal – brain unable to run body systems- probably die of something else firstelse first

1/3 people die with Alzheimer’s or dementia1/3 people die with Alzheimer’s or dementia

Vision ProblemsVision Problems

Presbyopia – Presbyopia – age related age related farsightedness (lens less flexible)farsightedness (lens less flexible)

CataractsCataracts

Distorted color perceptionDistorted color perception

Decreased ability to adapt to Decreased ability to adapt to light changeslight changes

Decline in sensitivity to taste Decline in sensitivity to taste

due to decrease in number of taste buds, decrease in saliva, and due to decrease in number of taste buds, decrease in saliva, and dry mouthdry mouth

Loss of smell (Hyposmia) Loss of smell (Hyposmia) contributing to decreased appetite and irregular eating habitscontributing to decreased appetite and irregular eating habits

AnemiaAnemia lowered ability of blood of carry oxygenlowered ability of blood of carry oxygen

Cardiovascular System Disorders Cardiovascular System Disorders

Most common cause of death worldwideMost common cause of death worldwide

Loss of arterial elasticity increases systolic blood pressure -Loss of arterial elasticity increases systolic blood pressure -greater greater risk for heart disease and strokerisk for heart disease and stroke

Postural hypotension Postural hypotension - - fall in blood pressure when rising from supine to fall in blood pressure when rising from supine to standing positionstanding position

AtherosclerosisAtherosclerosis (build up of (build up of fatty plaques in arterial walls-ifatty plaques in arterial walls-increasing risk of ncreasing risk of aneurysm, blood clot formation-aneurysm, blood clot formation- which may cause embolism, heart attack, stroke) which may cause embolism, heart attack, stroke)))

Congestive heart failure - Congestive heart failure - inability of heart to propel blood at sufficient rate and inability of heart to propel blood at sufficient rate and volumevolume

Cerebrovascular Accident (CVA) Cerebrovascular Accident (CVA) -stroke-stroke

Gastrointestinal System DisordersGastrointestinal System Disorders

Peptic ulcer diseasePeptic ulcer disease

GI BleedingGI Bleeding

PancreatitisPancreatitis

GallstonesGallstones

HepatitisHepatitis

Colorectal cancer- Colorectal cancer- 2nd to lung cancer as cause of cancer-related mortality2nd to lung cancer as cause of cancer-related mortality

Gastrointestinal System Disorders Gastrointestinal System Disorders cont’dcont’d

DiverticulitisDiverticulitis

Gastric outlet obstructionGastric outlet obstruction

Esophageal foreign bodiesEsophageal foreign bodies

Constipation or fecal incontinenceConstipation or fecal incontinence

DehydrationDehydration

Difficulty swallowingDifficulty swallowing

Immune System DeclinesImmune System Declines

Increases vulnerability to:Increases vulnerability to:

Diabetes mellitus

Nosocomial infections

Influenza

Pneumonia

Tuberculosis

Meningitis

Urinary tract infections

Respiratory System DisordersRespiratory System Disorders

Lungs lose elasticity:Lungs lose elasticity:

decreasing oxygen–carbon dioxide exchangedecreasing oxygen–carbon dioxide exchange

Breathing muscles and rib cage stiffen:Breathing muscles and rib cage stiffen:

increasing shortness of breathincreasing shortness of breath

Respiratory System Disorders Respiratory System Disorders cont’dcont’d

EmphysemaEmphysema

Chronic bronchitisChronic bronchitis

PneumoniaPneumonia

Lung cancer -most Lung cancer -most common common cancercancer related death in men related death in men and womenand women

Integumentary System DisordersIntegumentary System Disorders

Skin membranes flatten, wrinkle and Skin membranes flatten, wrinkle and thin out - more vulnerable to thin out - more vulnerable to abrasions and blistersabrasions and blisters

Horrid age spots!Horrid age spots!

Gradual loss of function in sweat Gradual loss of function in sweat glands and skin receptors-glands and skin receptors- increases increases risk of heat strokerisk of heat stroke

Integumentary System Disorders Integumentary System Disorders cont’dcont’d

Most common skin diseasesMost common skin diseases

Herpes zoster (shingles)Herpes zoster (shingles)

Malignant tumorsMalignant tumors

Decubitus ulcers- Decubitus ulcers- bedsoresbedsores

Varicose veinsVaricose veins

Integumentary System DisordersIntegumentary System Disorders

Decrease in fat pad on feet Decrease in fat pad on feet increases foot conditionsincreases foot conditions

Graying, thinning, and loss Graying, thinning, and loss of hairof hair

Skin tumorsSkin tumorsBasal cell carcinomaBasal cell carcinomaMalignant melanomaMalignant melanomaSquamous cell carcinomaSquamous cell carcinoma

Vitiligo

Genitourinary System DisordersGenitourinary System Disorders

Benign prostatic hyperplasia Benign prostatic hyperplasia (BPH) (BPH) common in men over age common in men over age 7070

Enlargement of prostate gland -obstructs urine flowEnlargement of prostate gland -obstructs urine flow

2013 Prostate cancer was 2nd highest cause of cancer 2013 Prostate cancer was 2nd highest cause of cancer death in males death in males (colorectal?)(colorectal?)

Over 80% of tumors are found after age 65Over 80% of tumors are found after age 65

Genitourinary System DisordersGenitourinary System Disorders

Acute and chronic renal Acute and chronic renal failure not uncommonfailure not uncommon

IncontinenceIncontinenceLeads to social and hygiene Leads to social and hygiene concernsconcerns

Number of nephrons in Number of nephrons in kidneys decreasekidneys decrease

Can cause normal dose of Can cause normal dose of medicine to be an overdose in medicine to be an overdose in elderlyelderly

Awareness of death closing inAwareness of death closing in

Radiographic Positioning for Radiographic Positioning for Geriatric PtsGeriatric Pts

ChestChest

PAPA- wrap arms around - wrap arms around

upright device- increases upright device- increases support and securitysupport and security

LateralLateral- provide support - provide support and stability in moving and stability in moving arms up and forward arms up and forward

Perform exam in Perform exam in wheelchair -wheelchair - note note projection change on projection change on requestrequest

HyperkyphosisHyperkyphosis changes changes positioning landmarkspositioning landmarks

SpineSpine

Use sponges and Use sponges and table padtable pad

UprightUpright more more comfortable if ablecomfortable if able

Or Seated positionOr Seated position may be used for exam may be used for exam requiring upright requiring upright positionposition

Pelvis/HipPelvis/Hip

Fxs common -Fxs common -do not do not rotate limbrotate limb until fx. ruled until fx. ruled out!out!

Cross-table lateral often Cross-table lateral often more comfortablemore comfortable

In In nonnontrauma pts, trauma pts, sandbags useful to sandbags useful to support rotation of limbssupport rotation of limbs

MRI- fx would have been missed by radiograph

Upper extremityUpper extremity

Limited flexibility and mobility present Limited flexibility and mobility present positioning challengepositioning challenge

Contracture of limbs caused by stroke Contracture of limbs caused by stroke must not be forced into positionmust not be forced into position

Lower extremityLower extremity

Limited flexibility and Limited flexibility and mobility present mobility present positioning challengepositioning challenge

Cross-table Cross-table projections usefulprojections useful

Feet and ankleFeet and ankle exams exams can be performed can be performed in in wheelchairwheelchair

Pt Care of ElderlyPt Care of Elderly

Explain everything you are Explain everything you are about to doabout to do

Decreases pt stress and anxietyDecreases pt stress and anxiety

Increases compliance and Increases compliance and satisfactionsatisfaction

Treat pt with respect and Treat pt with respect and dignitydignity

Communicate with warmth, Communicate with warmth, empathy, and positive attitudeempathy, and positive attitude

For the hard of hearing:For the hard of hearing:

Give one instruction at a timeGive one instruction at a time

Reduce background noiseReduce background noise

Speak slowly, distinctly, and directly to ptSpeak slowly, distinctly, and directly to ptadjust voice volume as neededadjust voice volume as needed

Not allNot all elderly patients are hard of hearingelderly patients are hard of hearing

Exposure time becomes more criticalExposure time becomes more critical

Why use shorter times?Why use shorter times?

- reduce risk of imaging involuntary and voluntary motion- reduce risk of imaging involuntary and voluntary motion

- elderly may have difficulty maintaining required position- elderly may have difficulty maintaining required position

Breathing instructions must be carefully Breathing instructions must be carefully communicated and practicedcommunicated and practiced

Technical factorsTechnical factors

Adjust to accommodate Adjust to accommodate disease and normal age-disease and normal age-related changesrelated changes

Radiographer must know Radiographer must know whether whether disease/change is disease/change is additive or destructiveadditive or destructive

Emphysema

Patient Care of ElderlyPatient Care of Elderly

Provide rest time between projections Provide rest time between projections and proceduresand procedures

Avoid use of adhesive tape-Avoid use of adhesive tape-

Use table pads, blankets, sponges, and Use table pads, blankets, sponges, and hand rails-hand rails-

- check for possible adverse reactions: - check for possible adverse reactions: -dehydration, induced kidney failure-dehydration, induced kidney failure

Assess for swallowing difficultyAssess for swallowing difficulty

Administer drinking liquids in upright position to reduce Administer drinking liquids in upright position to reduce risk of aspirationrisk of aspiration

When using contrast carefully check pt history before administering!

Conclusion:Conclusion:

Successful imaging of elderly pts depends upon radiographer’s Successful imaging of elderly pts depends upon radiographer’s competence and knowledge of this special populationcompetence and knowledge of this special population