Geriatrics

Branch of medicine dealing with aged and problems of aging

Geriatric patients are persons over age 65

Population is increasing

Radiographer’s Role

Adapt procedures to accommodate disability and disease

Understand physiology and pathology of aging

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

Most common health complaints of elderly

Decrease in balance, coordination, strength, and reaction time

Weight gain

Fatigue

Loss of bone mass

Joint stiffness

Loss of hearing

Presbycusis - gradual, progressive hearing loss of tone discrimination

Problems Facing Seniors

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

Fixed incomeFew choices in personal living arrangementsDependencyLoneliness Medical emergenciesIllnessSenility

Rheumatoid Arthritis

Common inflammatory joint disease

Causes severe deformity

Limits flexibility

Osteoarthritis

Degenerative joint disease caused primarily by wear and tear on joints

Body creates additional bone tissue in response to stress on joints

Can lead to complete fusion of joints

Osteoporosis

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

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

Increased risk of fxs, kyphosis

Alzheimer’s Disease

Chronic, organic mental disorder

Due to atrophy of frontal and occipital lobes

Occurs between ages 40 and 60

Progressive loss of memory leads to complete loss of intellectual function

Vision Problems

Presbyopia - age-related farsightedness (lens less flexible)

Cataracts

Distorted color perception

Decreased ability to adapt to light changes

Decline in sensitivity to taste and smell

Taste loss- due to decrease in number of taste buds, decrease in saliva, and dry mouth

Hyposmia - loss of smell accounts for decreased appetite and irregular eating habits

Anemia

A major hematologic concern in elderly!Symptoms:

Pale skinShortness of breathFatigue easily

Caused by:

Insufficient dietary intakeInflammation or destruction of GI lining to absorb vitamin B12

Cardiovascular System Disorders

Most common cause of death worldwide

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

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

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

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

Cerebrovascular Accident (CVA) -stroke

Gastrointestinal System Disorders

Peptic ulcer diseaseBleedingPancreatitis

Gallstones

HepatitisColorectal cancer- 2nd to lung cancer as cause of cancer-related mortality

Gastrointestinal System Disorders cont’d

DiverticulitisGastric outlet obstructionEsophageal foreign bodiesConstipationFecal incontinence

Dehydration

Difficulty swallowing

Immune System Declines

Increases vulnerability to: Diabetes mellitus Pneumonia Nosocomial infections Influenza Pneumonia Tuberculosis Meningitis Urinary tract infections

Respiratory System Disorders

Lungs lose elasticity:

Decreases oxygen–carbon dioxide exchange

Breathing muscles and rib cage stiffen:

Increases shortness of breath

Respiratory System Disorders cont’d

Emphysema

Chronic bronchitis

Pneumonia

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

Integumentary System Disorders

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

Horrid age spots!

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

Integumentary System Disorders cont’d

Most common skin diseases

Herpes zoster (shingles)

Malignant tumors

Decubitus ulcers- bedsores

Varicose veins

Integumentary System Disorders

Decrease in fat pad on feet increases foot conditions

Graying, thinning, and loss of hair

Skin tumorsBasal cell carcinomaMalignant melanomaSquamous cell carcinoma

Genitourinary System Disorders

Benign prostatic hyperplasia (BPH) common in men over age 70

Enlargement of prostate gland -obstructs urine flow

Prostate cancer is 3rd most common cancer in malesOver 80% of tumors are found after age 65

Genitourinary System Disorders

Acute and chronic renal failure not uncommon

IncontinenceLeads to social and hygiene concerns

Number of nephrons in kidneys decrease

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

Awareness of death closing in

Chest

PA- wrap arms around upright device- increases support and security

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

Perform exam in wheelchair - note projection change

Hyperkyphosis changes positioning landmarks

Spine

Use sponges and table pad

Upright more comfortable if able

Or Seated position may be used for exam requiring upright position

Pelvis/Hip

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

Cross-table lateral often more comfortable

In nontrauma pts, sandbags useful to support rotation of limbs

MRI- fx would have been missed by radiograph

Upper extremity

Limited flexibility and mobility present positioning challenge

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

Sponges, sandbags, and use of cross-table projections useful

Lower extremity

Limited flexibility and mobility present positioning challenge

Cross-table projections useful

Feet and ankle exams can be performed in wheelchair

Pt Care of Elderly

Explain everything you are about to doDecreases pt stress and anxiety

Increases compliance and satisfaction

Treat pt with respect and dignityCommunicate with warmth, empathy, and positive attitude

For the hard of hearing:

Give one instruction at a time Reduce background noise Speak slowly, distinctly, and directly to pt

Not all elderly patients are hard of hearing Adjust voice volume as needed

Exposure time becomes more critical

Why use shorter times?

- reduce risk of imaging involuntary and voluntary motion

- elderly may have difficulty maintaining required position

Breathing instructions must be carefully communicated and practiced

Technical factors

Adjust to accommodate disease and normal age-related changes

Radiographer must know whether disease/change is additive or destructive

Emphysema

Patient Care of Elderly

Provide rest time between projections and procedures

Avoid use of adhesive tape-Can easily damage skin

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

Increases comfort and compliance

Pt Care of Elderly: Quick Tips cont’d

Carefully check pt history before administering contrast!

Reduces adverse reactions: -dehydration, induced kidney failure

Assess for swallowing difficulty

Administer drinking liquids in upright position to reduce risk of aspiration

Conclusion:

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