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Geriatric Imaging

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					Geriatric Imaging




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                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 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       (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
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:
     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
Vitiligo
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
Radiographic Positioning for
       Geriatric Pts
                            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: Quick Tips

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:
   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