Normal Age-Related Changes
Normal Changes of Aging – in anatomy, physiology, or lab values — can produce misleading information on physical exam and investigations:
Fewer peripheral sensory nerve cells
In the peritoneum: like children, older people are less able to localize abdominal pain. They may not even complain of abdominal pain in cholecystitis, diverticulitis, or appendicitis.
In skin: older people are often less aware of pain from a skin or soft tissue infection – be sure to LOOK for ulcers or cellulitis.
In skin: older people are often less aware of pain from a skin or soft tissue infection – be sure to LOOK for ulcers or cellulitis.
Thin abdominal muscles
Older people have less ability to produce guarding or react to rebound trigger.
Thin gastric mucosa
Older people have thin gastric mucosa and increased acid secretion so they are more likely to bleed or perforate with minimal trigger (such as a few doses of NSAIDs). They may have minimal symptoms.
Smaller omentum
Older people are less able to wall off intra-abdominal infection so they develop peritonitis earlier, even without localized pain initially.
Decreased blood flow
Older people have decreased blood supply to all tissues and organs — bowel, kidney, liver, skin, brain — because of peripheral vascular disease and normal age-related vascular narrowing. Infections are easy to start, slow to heal, and late to cause symptoms.
Decreased immune system
Older people rarely mount a significantly increased WBC count even with severe infection. Don’t look for it – you won’t find it!
Changes in urine exam
Around half of ALL community-living men and women over 75 have white cells and bacteria in their urine ALL THE TIME. You can’t attribute everything to “it’s just a UTI!” since white cells and bacteria in the urine are likely normal findings. The diagnosis of UTI should be based on new symptoms referable to the urinary tract – frequency, dysuria – OR new weakness, confusion, or falls that cannot be otherwise explained after a thorough workup.
Changes in lab values
An elevated erythrocyte sedimentation rate (ESR) can be normal in older people. In women (age +10)/2 and in men age/2 will give you the upper limit of normal.
A seemingly normal serum creatinine may indicate significant kidney disease particularly in a frail older woman. (See Pharmacokinetics for more detail.)
Troponin and D-dimer can be difficult to interpret unless “negative.”
A seemingly normal serum creatinine may indicate significant kidney disease particularly in a frail older woman. (See Pharmacokinetics for more detail.)
Troponin and D-dimer can be difficult to interpret unless “negative.”
Discussion: Normal Age-Related Changes
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ok
very interesting
nothing to tell you whats missing so you can complete module
great info
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good points to remember when assessing your elderly patient.
interesting
presence of white blood cells/ bacteria in urine all the time in large segment of population of 75 is interesting
interesting
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thorough review
GOOD INFO
HYEAH
challenging
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NONE
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yes
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okay
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history from others and purpose of ED visit, frequency of ED visits, most extraordinary sx pt has
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Ok
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informative
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very very useful
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Yes they do!
useful
good info
interestion
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xxx
k
okay
agree
With the elderly always do a full history and physical examination. the natural aging process when assessed with the patients comorbidities can become a challenge.
These are valuable information to consider when assessing older adults
yes
great summary above
interesting
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I have seen this in practice.
Ok…
Ok
informative
investigate
great points
good points
good points
good points
great points
useful points
it is a matter of knowing what diagnostic exam should be done.
good point
good points
thanks for these points
•Hypothroidism on thyroxin
•Depression on SSRI
•Chronic pain on opioids
•Polymyalgia rheumatica on prednisone
•Adrenal insufficiency from a pituitary microadenoma
•NIDDM on insulin
interesting
Was not aware of the age adjusted ESR
Was also unaware of age adjusted ESR. Am familiar with age adjusted D-Dimer though.
I didn’t know you should age adjust ESR.
challenging
excellent questions
They are important to be aware of
Challenging
Interesting
all makes sense. We cannot rely on just lab results. It takes a complete work up and history. The whole picture.
lots of interesting info
So if WBC in urine is normal and elderly are less likely to become symptomatic at what point is an elevated WBC count in the urine concerning or indicative of a UTI?
I think with the clinical diagnosis MCS urine can gives us good indicatives
Great tip for elderly physical examination.Think d/d keeping in with the age related physiologic changes.
ok, great ponts
Makes sense.
A number of excellent points
makes sense
Be prepared to thoroughly investigate
less and less of everything good is a good way of remembering.
very helpful
Great notes.
excellents directions and recommendations
muy buenas recomendaciones
buenos concejos
Excelentes consejos
Good Pearls to take in consideration
Difficult issues
Normal age related changes are important to kee in mind at all times
I agree with Abufayed
cool
We are not robots so we have to think beyond the picture.
This is very challenging for the health team
hx, physical, and tests are unreliable leaving the clinician with a challenge!