Internal Medicine 18: 75-year-old male with memory problems User: Ralph Marrero Email: email@example.com Date: March 9, 2022, 8:50 PM
The student should be able to:
Describe typical changes in each organ system that occur as part of the normal aging process. Perform a functional status assessment of the geriatric patient. Identify risk factors for falls in an older adult patient. Recognize the presentation of each type of urinary incontinence. Differentiate among the subtypes of major neurocognitive disorder and their associated findings. Propose lab work to evaluate for reversible causes of major neurocognitive disorder. Participate in discussing basic issues regarding advance directives with the patients and their families.
Initial Approach to Evaluation of Memory Problems
1. Focused history 2. Cognitive assessment 3. Functional evaluation
You go to the exam room and introduce yourself to Mr. Caldwell and his daughter, Kathy. Focused History
Mr. Caldwell admits to occasional memory issues, such as misplacing keys or forgetting items at the grocery store, but he reports no concerns with long-term memory recall, such as his anniversary or grandchildren’s names. He also reports difficulty with higher-level tasks such as balancing his checkbook and managing his medications, both of which his daughter now manages.
How Aging Affects Organ Systems
Learn more about major changes that occur in each organ system with aging.
Organ System Changes with Aging Functional Implications
Increased pulse pressure (increased systolic pressure with stable diastolic pressure).
Decreased arterial compliance.
Decreased baroreceptor sensitivity.
Increased pulse pressure is usually not harmful.
Other changes can lead to increased propensity for orthostatic hypotension.
Multiple medications, decreased physical activity, and concomitant illness can contribute to constipation, which is common, although not “normal” in elderly patients.
Weakening of internal and external anal sphincters.
May lead to frequent physician visits and use of OTC medications, including laxatives.
Incontinence of bowels.
Hepatic Reduced hepatic blood flow.
Impaired hepatic microcirculation.
Impaired metabolism of many medications.
© 2022 Aquifer, Inc. – Ralph Marrero (firstname.lastname@example.org) – 2022-03-09 20:50 EST 1/11
Atrophy of labia, vagina, uterus, and ovaries.
Weakening of pelvic floor muscles, especially in women who have given birth.
Enlarged prostate (benign prostatic hypertrophy (BPH)).
Decreased lubrication and possible dyspareunia.
Urinary incontinence or urgency, dribbling due to BPH.
Decreased renal salt retention/regulation.
Decreased ADH secretion at night.
Decline in renal function.
Decreased ability to retain salt can predispose patients to orthostatic hypotension.
Changes in medication metabolism and excretion.
Increase in body fat with decrease in lean mass.
Increase in joint deformities and stiffness. Loss of flexibility.
Decreased bone mineral density.
Stable weight/BMI does not imply stable body composition.
Risk of osteoarthritis.
Risk of osteoporosis and fractures.
Imbalance, gait difficulty, and risk of falls.
Mild loss of short-term memory.
Mild decrease in vibratory sensation.
Mild muscle atrophy.