Title: Atypical Presentation of Illness in Older Adults

Biography:

She is Chief Compliance Officer (Director) at Premier Geriatric Solutions. 
And Medical Author at Jones and Bartlett Publishers

Abstract

 

Define Atypical Presentation of Illness

Main Point 1:  Symptoms of Hypoactive Delirium: The person “isn’t right” – sudden change in thinking/ mental status, tired (lethargic), staying bed

 May or may not have a fever
Change in baseline vital signs (heart rate, weight loss, change in appetite)
Constipation
Underlying Infection

Main Point 2: Symptoms of Hyperactive Delirium: Behaviors are trying to get out of bed, fighting, fluctuating mental status (CAM)

WILD: Doesn’t stand for the behavior #lol

o   Water depletion (dehydration)

o   Infection

o   Labs, abnormal (hyponatremia, WBCs)

o   Drugs (new medications, toxicity, adverse effects)

Main Point 3: Other common presentations in older adults that are different than younger adults

“Not being right” or “something’s off”

EXAMPLES OF HOW INFECTIONS PRESENT DIFFERENTLY:
o   Pneumonia:
Younger adult: Fever, cough, having trouble breathing (shortness of breath); vital signs will be different
Older adult: She’s not right, sudden incontinence, unusually tired, fall.
May not see a fever, hypoxia (low oxygen), tachycardia (high heart rate); may or may not have a cough
o   Urinary Tract Infections:
Younger adult: Pain or burning with urination, frequency, urgency, flank pain, blood in urine (on lab, not usually visible with naked eye)
Older adult: Sudden loss of bladder control, change in mental status, unusually tired, fall

HOW DEPRESSION PRESENTS DIFFERENTLY

o   Younger adults: May say they are depressed,

o   Older adults: Less social, more stigma, “are you feeling sad or blue?”, changes in appetite, flat affect, weight loss or gain, change in functional status, pain without an identifiable underlying cause (e.g., pain due to a fall, injury)
Could be caused by a medication, situational, grief process, adjustment to living arrangements.

Bladder Infections: to Treat or Not to Treat?

Define UTI and compare to asymptomatic bacteriuria (ASB)

• Discuss urinalysis
• Mention McGreer Criteria
• Role of cognition in treating ASB
• Definition of fever per IDSA of adults in long-term care
• How are antibiotics harmful?