Basic of Geriatrics and Internal Medicine for Physiotherapist by Rasheedy D - HTML preview
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The definition of an atypical presentation of illness is: when an older adult presents with a disease state that is missing some of the traditional core features of the illness usually seen in younger patients.
1. Examples for altered presentations of diseases
- Dwindles (Functional decline)
- Weakness
- Falls
- Immobility
- Incontinence
- Cognitive Change
- Mood Change
2. Examples for non-specific presentations of diseases: e.g. Fatigue which can be a presentation of any of the following:
|
Organic conditions Cardiopulmonary (heart failure, COPD, IPF) Neurological (MS, Parkinsonism) metabolic/ (DM, hypothyroidism toxic (chronic lead exposure) infections (HCV, HBV, HIV) Deficiency states (Vitamin D deficiency) neoplasm |
Psychogenic: depression |
|
|
Drugs: beta-blockers, diuretics, chemotherapy |
3. Examples for silent presentations of diseases:
During preoperative assessment, the presence of ECG changes suggestive of previous myocardial infarction in elderly patient without history suggesting coronary ischemia.
Osteoporosis is usually silent until fracture occurs.
Prevalence of atypical presentations in elderly:
Atypical presentations were found in approximately 20% of elderly patients in the Emergency Department (ED), with (35%) of older adults with infectious diseases presented atypically.
Silent MI in elderly, detected incidentally on electrocardiogram (ECG) is high, ranging between 38% and 60%.
Consequences of atypical presentations in elderly:
Delayed diagnosis, misdiagnosis, and mismanagement with increased morbidity.
Presentations of ischemic heart disease in elderly:
|
Typical |
Pain is usually substernal chest pain/discomfort with exercise, relief by nitroglycerin or rest |
|
Non specific |
Fatigue , Shortness of breath |
|
silent |
Minimal or no chest pain, no shortness of breath or acute confusion, silent ECG or Echo findings |
|
Altered |
Acute confusion Syncope Acute functional decline Attack of Epigastric pain Attacks of back pain Attacks of jaw pain Attacks of neck pain |
Presentation of Pneumonia
|
Typical |
Productive cough of purulent sputum The temperature may rise to 38.9°–39.4°C |
|
Non specific |
Minimal cough, no sputum production, no fever No leucocytosis May appear tired or confused |
|
Altered |
Dwindles, delirium |
Causes of atypical presentations in elderly:
- The aging process: fever is usually absent in elderly due to lower basal body temperature, thermoregulatory center aging, lower skeletal muscle mass
- Multiple Co-morbidities: presence of severe osteoarthritis of the knee with reduced physical performance may delay the presentations of heart failure and peripheral arterial disease until symptoms are present during minimal activity or even at rest.
- Poly-pharmacy: (use of beta blockers mask tachycardia in anemia or infections)
