Demographics, Ageism, and the Physiologic Changes of Aging Practice Questions

25 multiple-choice questions on Demographics, ageism, and the physiologic changes of aging for paramedic and EMT students, from Chapter 45 (Geriatric Emergencies). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. A new EMT assumes most of her older patients come from nursing homes. In fact, the share of US adults 65 and older living in nursing homes is about:

   1. A. About 1 in 50
   2. B. About 1 in 3
   3. C. About 1 in 2
   4. D. About 1 in 10
   Show answer

   Answer: A. About 1 in 50

   Only about 2 percent of adults 65 and older live in nursing homes (about 1 percent at 65 to 74, rising to about 8 percent at 85 and older); the great majority live in the community, many alone, so most geriatric calls come from private homes where the paramedic is the first to see the home environment. One in 3 and 1 in 2 reflect the ageist assumption that older adults are mostly institutionalized. One in 10 overstates the overall rate fivefold; it is closer to the figure for the oldest old. (ACL Profile of Older Americans.)

2. As the older adult population grows, EMS systems should expect:

   1. A. Fewer calls that require lift assistance
   2. B. Less need for interfacility transport
   3. C. A drop in medication-related calls
   4. D. More calls for falls and chronic illness
   Show answer

   Answer: D. More calls for falls and chronic illness

   Older adults already make up a disproportionate share of EMS calls, mostly falls, chronic disease flare-ups, and medication problems, and that share is rising. Lift assists and interfacility transfers increase, not decrease, as the population ages.

3. A paramedic tells a partner that an 84-year-old's new confusion is 'just old age' and skips the glucose check. This is an example of:

   1. A. Appropriate use of a baseline history
   2. B. Ageism leading to a missed assessment
   3. C. A reasonable triage of a chronic issue
   4. D. Respect for patient autonomy
   Show answer

   Answer: B. Ageism leading to a missed assessment

   Ageism is stereotyping based on age; assuming new confusion is normal aging can miss hypoglycemia, stroke, infection, or drug toxicity. Nothing in this scenario establishes a baseline, and new confusion is never a normal part of aging.

4. You are caring for an alert 79-year-old woman. The most respectful way to address her is:

   1. A. With a warm term such as 'dear' or 'honey'
   2. B. By her first name to build rapport fast
   3. C. By title and last name, such as Mrs. Lopez
   4. D. Through her daughter, who relays questions
   Show answer

   Answer: C. By title and last name, such as Mrs. Lopez

   A title and last name convey respect; then ask what she prefers to be called. Terms such as 'dear' are elderspeak that many older adults find patronizing, and routing questions through family ignores a capable patient.

5. An 84-year-old with a stiff, thickened left ventricle became hypotensive after 2 days of vomiting. After only 500 mL of fluid she now has crackles. The best explanation is that her heart:

   1. A. Has a dilated, floppy ventricle with low resistance
   2. B. Pumps more forcefully when it is given extra fluid
   3. C. Can raise its rate to handle the extra volume
   4. D. Tolerates too little or too much volume poorly
   Show answer

   Answer: D. Tolerates too little or too much volume poorly

   With age the left ventricle stiffens and thickens (diastolic dysfunction), so filling depends on adequate preload, yet the stiff chamber cannot accept extra volume without a steep rise in filling pressure; the patient becomes hypotensive when dry and congested with modest fluid, so give small boluses and reassess lung sounds and work of breathing. A dilated, floppy ventricle describes dilated cardiomyopathy, not the stiff aging heart. A stiff ventricle does not pump harder with extra fluid; the pressure backs up into the lungs. Older adults cannot raise their heart rate as much as younger adults, so rate compensation is limited.

6. Stiffening of the large arteries with age typically produces:

   1. A. A lower systolic pressure and narrower pulse pressure
   2. B. A higher systolic pressure and wider pulse pressure
   3. C. A higher diastolic pressure with no systolic change
   4. D. Lower pressures in both systole and diastole
   Show answer

   Answer: B. A higher systolic pressure and wider pulse pressure

   Stiff arteries cannot buffer each ejection, so systolic pressure rises while diastolic pressure stays the same or falls, widening the pulse pressure (isolated systolic hypertension). A rise in diastolic pressure alone is not the typical pattern.

7. A 78-year-old says two glasses of wine now make him unsteady, though they never did when he was 40. The age-related change that best explains this is:

   1. A. Less body water, so blood alcohol rises higher
   2. B. More body water that dilutes the alcohol faster
   3. C. Faster liver breakdown of alcohol with age
   4. D. Greater tolerance from decades of drinking
   Show answer

   Answer: A. Less body water, so blood alcohol rises higher

   Total body water falls and body fat rises with age, so the same amount of alcohol is distributed in a smaller volume and produces a higher blood alcohol level; older brains are also more sensitive to its effects, and alcohol adds to the sedation and fall risk of many medications. Body water decreases, not increases, with age. Liver metabolism slows rather than speeds up. Tolerance does not protect him; he is reporting more effect, not less.

8. Atrial fibrillation is poorly tolerated by many older adults mainly because:

   1. A. Their atria contract more forcefully
   2. B. Their ventricles fill more rapidly in early diastole
   3. C. Stiff ventricles rely on the atrial kick
   4. D. Their coronaries dilate during AF
   Show answer

   Answer: C. Stiff ventricles rely on the atrial kick

   With age the left ventricle stiffens, so early passive filling falls and atrial contraction supplies a larger share of preload; losing it in AF can drop cardiac output sharply. Early diastolic filling decreases, rather than increases, with age.

9. Which respiratory change is a normal part of aging?

   1. A. Increased vital capacity
   2. B. Increased residual volume
   3. C. Stronger cough reflex
   4. D. Greater chest wall compliance
   Show answer

   Answer: B. Increased residual volume

   Loss of elastic recoil and a stiffer chest wall trap more air, raising residual volume while vital capacity falls. Chest wall compliance decreases, not increases, as the costal cartilages calcify.

10. An 85-year-old with pneumonia has a respiratory rate of 32 and is using her neck muscles to breathe. Compared with a young adult in the same distress, she:

    1. A. Can keep up this work for longer than a young adult
    2. B. Has more lung reserve because of a larger chest
    3. C. Is protected from hypoxia by a stronger drive
    4. D. May tire and fail sooner, so watch her closely
    Show answer

    Answer: D. May tire and fail sooner, so watch her closely

    Weaker respiratory muscles, a stiffer chest wall, loss of elastic recoil, and a blunted response to hypoxia and hypercapnia leave older adults with little reserve, so a patient working this hard can fatigue and progress to respiratory failure quickly; reassess often and be ready to assist ventilation (CPAP or BVM per protocol). Older adults cannot sustain the work of breathing longer than the young. Chest wall compliance and vital capacity fall with age, so there is less reserve, not more. Chemoreceptor drive is blunted in older adults, not stronger.

11. An 81-year-old with COPD has an SpO2 of 86% but appears only mildly short of breath. This blunted response is best explained by:

    1. A. Blunted chemoreceptor responses
    2. B. Greater lung elasticity with age
    3. C. Higher hemoglobin oxygen affinity
    4. D. More efficient alveolar gas exchange
    Show answer

    Answer: A. Blunted chemoreceptor responses

    Chemoreceptor responses to hypoxia and hypercapnia decline with age, so older adults may look less distressed than their oxygenation warrants. Lung elasticity and gas exchange both decrease with age, so neither explains the calm appearance.

12. An 83-year-old has dizzy spells. On the monitor you see a slow sinus rhythm with long pauses that alternates with bursts of rapid atrial fibrillation. This pattern most likely reflects:

    1. A. Normal sinus arrhythmia that changes with breathing
    2. B. Anxiety causing short bursts of a fast heart rate
    3. C. Age-related wear of the heart's conduction system
    4. D. An electrode artifact from patient movement
    Show answer

    Answer: C. Age-related wear of the heart's conduction system

    Fibrosis of the sinus node and conduction pathways with age causes sick sinus syndrome, which often shows as tachy-brady syndrome: slow rates and pauses alternating with atrial fibrillation or flutter. It is a common cause of dizziness and syncope in older adults and may need a pacemaker. Sinus arrhythmia varies gently with breathing and does not produce long pauses.

13. An 82-year-old fell on the way to the bathroom at 0300, the third night trip that night. The age-related kidney change that contributes most to this pattern is:

    1. A. More concentrated urine made during the night
    2. B. Less ability to concentrate urine at night
    3. C. A larger bladder that fills more slowly
    4. D. Higher kidney blood flow when lying down
    Show answer

    Answer: B. Less ability to concentrate urine at night

    Aging kidneys concentrate urine less well, and fluid that pooled in the legs during the day returns to the circulation when lying down, so older adults make more urine at night (nocturia); combined with a smaller, less compliant bladder, this sends them walking in the dark when they are sleepy and orthostatic, a common cause of night falls (night-lights and a bedside commode help). Concentrating ability falls, so night urine is less, not more, concentrated. Bladder capacity decreases with age. Renal blood flow declines with age; lying down does not raise it above youthful levels.

14. A 79-year-old was given diazepam for anxiety yesterday and is still drowsy today. Because body fat increases with age, a fat-soluble drug like this tends to:

    1. A. Reach lower peak levels
    2. B. Be cleared more quickly
    3. C. Last longer in the body
    4. D. Lose its sedative effect
    Show answer

    Answer: C. Last longer in the body

    Fat-soluble drugs distribute into larger fat stores and are released slowly, prolonging sedation and raising fall risk. Water-soluble drugs, by contrast, reach higher concentrations because there is less body water.

15. An 86-year-old becomes deeply sedated after a dose of midazolam that barely affects a younger adult, even though her blood level is similar. The best explanation is:

    1. A. Her aging brain is more sensitive to the drug
    2. B. She absorbed the drug faster from her muscle
    3. C. Her liver changed the drug to a stronger form
    4. D. Her kidneys removed the drug much too quickly
    Show answer

    Answer: A. Her aging brain is more sensitive to the drug

    Besides slower clearance, the aging brain is more sensitive to sedatives, opioids, and anticholinergics at the same blood level (a pharmacodynamic change), so standard doses can cause oversedation, delirium, and respiratory depression; give smaller doses and titrate slowly. Faster absorption is not the explanation when the blood levels are similar. Midazolam is not converted to a more potent compound in older adults. Faster kidney removal would weaken, not strengthen, the effect, and renal clearance declines with age.

16. A 79-year-old walks steadily during the day but loses her balance when the hall lights go out at night. The age-related change that best explains this is:

    1. A. Better position sense in the feet and ankles
    2. B. Faster balance reflexes that overcorrect
    3. C. Larger pupils that let in too much light
    4. D. Less position sense, so she relies on vision
    Show answer

    Answer: D. Less position sense, so she relies on vision

    Proprioception (joint position sense) and vestibular function decline with age, so older adults lean on vision to stay upright; in the dark that support disappears and they sway or fall, which is why night-lights and a light switch by the bed reduce falls. Position sense declines rather than improves. Balance reflexes slow with age rather than overcorrect. Pupils become smaller with age, and dark adaptation is slower, which makes dim settings harder, not brighter.

17. An 86-year-old with mild dementia fell yesterday and now refuses to stand. She points only to her knee, which looks normal. You should:

    1. A. Splint the knee and treat it as a knee sprain
    2. B. Reassure her since the knee shows no swelling
    3. C. Have her walk to test the knee's function
    4. D. Also examine her hip for a possible fracture
    Show answer

    Answer: D. Also examine her hip for a possible fracture

    Hip pain is often referred to the knee through the obturator and femoral nerves, and older adults, especially those with dementia, may localize pain poorly, so a patient who will not bear weight after a fall needs her hip examined (groin tenderness, pain with gentle rotation, shortening or rotation of the leg) and should be transported for imaging. Treating it as a knee sprain misses the likely hip fracture. A normal-looking knee does not explain her refusal to stand. Making her walk on a possible hip fracture can displace it.

18. A 76-year-old with long-standing glaucoma keeps bumping into door frames and has fallen over a footstool beside her. The visual change most likely responsible is:

    1. A. Loss of the central vision used to read
    2. B. Loss of her side (peripheral) vision
    3. C. Better vision for nearby objects
    4. D. Clouding of the lens with glare
    Show answer

    Answer: B. Loss of her side (peripheral) vision

    Glaucoma damages the optic nerve gradually, narrowing the peripheral field toward tunnel vision while central vision can remain sharp, so patients miss objects beside them and fall; approach from the front, and include the finding in fall-risk assessment. Loss of central vision is the pattern of macular degeneration. Near vision worsens with age (presbyopia), not improves. A cloudy lens with glare is a cataract, which dims vision overall rather than cutting off the sides.

19. A 72-year-old says objects look yellowed and dim and that oncoming headlights cause glare at night. The most likely condition is:

    1. A. Cataracts
    2. B. Presbyopia
    3. C. Macular degeneration
    4. D. Glaucoma
    Show answer

    Answer: A. Cataracts

    Cataracts cloud and yellow the lens, causing glare, dimming, and faded colors. Macular degeneration causes loss of central vision rather than glare, and presbyopia is difficulty focusing on near objects.

20. A 90-year-old has flat, dark purple patches on the backs of both hands and forearms that appear after minor bumps. She is otherwise well. These are most likely:

    1. A. A sign of a dangerous drop in platelets
    2. B. Raised purpura from a vasculitis
    3. C. Fragile-vessel bruises common in aging skin
    4. D. Deep bruising from a clotting-factor deficiency
    Show answer

    Answer: C. Fragile-vessel bruises common in aging skin

    Senile (actinic) purpura results from thin, sun-damaged skin and fragile vessels that bleed under the skin with minor shear, typically on the backs of the hands and forearms; it is common and benign, though document it and still look at the pattern, history, and other areas, because grip marks on the upper arms or injuries in protected areas suggest abuse. A low platelet count causes petechiae and bleeding elsewhere, not patches limited to exposed forearms after bumps. Vasculitis produces raised (palpable) purpura, often on the legs, rather than flat patches after bumps. A clotting-factor deficiency, as in liver disease, causes deep bruises and bleeding at other sites, not flat patches in a woman who is otherwise well. Location on exposed forearms after minor trauma fits aging skin and does not by itself suggest abuse.

21. An 83-year-old living alone becomes hypothermic in a home kept at 18°C (64°F). Which aging change contributes most?

    1. A. Increased basal metabolic rate
    2. B. Impaired shivering and heat production
    3. C. Greater subcutaneous fat insulation
    4. D. Enhanced skin blood vessel constriction
    Show answer

    Answer: B. Impaired shivering and heat production

    Older adults have a lower metabolic rate, blunted shivering, and less effective vasoconstriction, so they can become hypothermic indoors at temperatures a younger adult tolerates. Vasoconstriction becomes weaker, not stronger, with age.

22. An 80-year-old says she now gets sleepy earlier in the evening, wakes at 5 a.m., and takes a short afternoon nap, yet she feels rested and alert. This is most consistent with:

    1. A. Major depression needing urgent treatment
    2. B. Early dementia affecting her sleep cycle
    3. C. Obstructive sleep apnea from weight gain
    4. D. Normal sleep changes that come with aging
    Show answer

    Answer: D. Normal sleep changes that come with aging

    With age, deep sleep shortens, the sleep cycle shifts earlier, and brief naps become common. When the person feels rested and functions well, these are normal changes. Depression usually brings low mood, loss of interest, and poor function along with sleep problems; sleep apnea causes loud snoring and daytime sleepiness.

23. A 74-year-old woman broke her wrist when she fell from standing onto a carpeted floor. A fracture from this little force most strongly suggests:

    1. A. Normal bone that was struck hard
    2. B. Unusually dense, brittle bone
    3. C. Weakened bone from osteoporosis
    4. D. A healed fracture from childhood
    Show answer

    Answer: C. Weakened bone from osteoporosis

    A fracture from a fall from standing height or less is a fragility fracture, the hallmark of osteoporosis, and it predicts future hip and spine fractures; mention it in the handoff so the hospital can start fall and bone-health follow-up. Normal bone rarely breaks from a ground-level fall onto carpet. Osteoporotic bone is less dense, not more. An old childhood fracture does not explain a new break from minimal force.

24. Because older long-term care residents have a blunted febrile response, IDSA guidelines define fever in them as a single oral temperature above about:

    1. A. 37.8 °C (100 °F)
    2. B. 38.9 °C (102 °F)
    3. C. 39.4 °C (103 °F)
    4. D. 36.1 °C (97 °F)
    Show answer

    Answer: A. 37.8 °C (100 °F)

    The IDSA long-term care guideline sets a lower bar: a single oral temperature above 37.8 °C (100 °F), repeated oral readings above 37.2 °C (99 °F), or a rise of more than 1.1 °C (2 °F) over the resident's baseline counts as fever and should prompt a search for infection. Waiting for 38.9 °C (102 °F) or 39.4 °C (103 °F) misses many serious infections in older adults. A reading of 36.1 °C (97 °F) is in the normal range, although a low temperature in a septic patient is ominous. (IDSA 2009.)

25. A nursing home resident's care plan says she must drink only thickened liquids. During transport she asks for a cup of water. You should know the order is mainly meant to:

    1. A. Prevent choking on pieces of solid food
    2. B. Reduce reflux of acid up from her stomach
    3. C. Lower her risk of aspirating thin liquids
    4. D. Treat the chronic constipation she has had
    Show answer

    Answer: C. Lower her risk of aspirating thin liquids

    Age-related and neurologic changes slow and weaken the swallow (oropharyngeal dysphagia), and thin liquids move too fast to control, so they are easily aspirated; thickened liquids flow more slowly and are safer, and the care plan should be followed during transport. The order targets thin liquids during the swallow, not the chewing of solid food, which is handled by a separate diet texture order. It is meant to protect the airway as she swallows rather than to treat reflux of stomach contents. It does not treat constipation; if anything, limited fluid intake can worsen it.