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

Radiographers 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 (menopause), but can appear in men Increased risk of fxs, kyphosis

Alzheimers 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 - agerelated 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
stroke)

(build up of fatty plaques in arterial walls-increasing risk of aneurysm, blood clot formation- which may cause embolism, heart attack,

Congestive heart failure sufficient rate and volume

inability of heart to propel blood at

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 contd

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 oxygencarbon dioxide exchange

Breathing muscles and rib cage stiffen:

Increases shortness of breath

Respiratory System Disorders contd

Emphysema Chronic bronchitis

Pneumonia
Lung cancer -most common cancerrelated 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 contd

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 crosstable 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 tapeCan easily damage skin

Use table pads, blankets, sponges, and hand railsIncreases comfort and compliance

Pt Care of Elderly: Quick Tips contd

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 radiographers competence and knowledge of this special population