Geriatric Imaging

1. Geriatric Imaging

2. Geriatrics Branch of medicine dealing with aged and problems of aging Geriatric patients are persons over age 65 Population is increasing

3. 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

4. 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

5. 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

6. Rheumatoid Arthritis Common inflammatory joint disease Causes severe deformity Limits flexibility

7. 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

8. 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

9. 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

10. Vision Problems Presbyopia - age-related farsightedness (lens less flexible) Cataracts Distorted color perception Decreased ability to adapt to light changes

11. 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

12. Anemia Symptoms: Pale skin Shortness of breath Fatigue easily Caused by: Insufficient dietary intake Inflammation or destruction of GI lining to absorb vitamin B12

13. 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

14. Gastrointestinal System Disorders Peptic ulcer disease Bleeding Pancreatitis Gallstones Hepatitis Colorectal cancer- 2nd to lung cancer as cause of cancer-related mortality

15. Gastrointestinal System Disorders cont’d Diverticulitis Gastric outlet obstruction Esophageal foreign bodies Constipation Fecal incontinence Dehydration Difficulty swallowing

16. Immune System Declines Increases vulnerability to: Diabetes mellitus Pneumonia Nosocomial infections Influenza Pneumonia Tuberculosis Meningitis Urinary tract infections

17. Respiratory System Disorders Lungs lose elasticity: Decreases oxygen–carbon dioxide exchange Breathing muscles and rib cage stiffen: Increases shortness of breath

18. Respiratory System Disorders cont’d Emphysema Chronic bronchitis Pneumonia Lung cancer -most common cancer-related death in men and women

19. 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

20. Integumentary System Disorders cont’d Most common skin diseases Herpes zoster (shingles) Malignant tumors Decubitus ulcers- bedsores Varicose veins

21. 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

23. 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

24. 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

25. Awareness of death closing in

26. Radiographic Positioning for Geriatric Pts

27. 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

28. Spine Use sponges and table pad Upright more comfortable if able Or Seated position may be used for exam requiring upright position

29. 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

30. 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

31. Lower extremity Limited flexibility and mobility present positioning challenge Cross-table projections useful Feet and ankle exams can be performed in wheelchair

32. 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

33. 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

34. 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

35. Technical factors Adjust to accommodate disease and normal age-related changes Radiographer must know whether disease/change is additive or destructive

36. 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

37. 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

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