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
Depression1 in 5 persons over age 65 shows signs of clinical depression
Fixed income
Few choices in personal living arrangements
Dependency
Loneliness
Medical emergencies
Illness
Senility
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
Increased risk of fxs, kyphosis
(menopause),
but can appear in men
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 skin
Shortness of breath
Fatigue easily
Caused by:
Insufficient dietary intake
Inflammation 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 disease
Bleeding
Pancreatitis
Gallstones
Hepatitis
Colorectal cancer- 2nd to lung cancer as cause of cancer-related mortality
Gastrointestinal System Disorders cont’d
Diverticulitis
Gastric outlet obstruction
Esophageal foreign bodies
Constipation
Fecal incontinence
Dehydration
Difficulty swallowing
Immune System Declines
Increases vulnerability to:
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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 tumors
Basal cell carcinoma
Malignant melanoma
Squamous 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 males
Over 80% of tumors are found after age 65
Genitourinary System Disorders
Acute and chronic renal failure not
uncommon
Incontinence
Leads 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
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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 do
Decreases pt stress and anxiety
Increases compliance and satisfaction
Treat pt with respect and dignity
Communicate with warmth, empathy,
and positive attitude
For the hard of hearing:
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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 tapeCan easily damage skin
Use table pads, blankets, sponges,
and hand railsIncreases 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