Geriatrics: biological changes of age

Question 1

what is the fastest growing age group?

Answer 1

the “old-old” > 85 years.

Question 2

what are the demographics of the population 65+ (gender, race, economic status, education)

Answer 2

Mostly female.
Increasing numbers of African Americans and Hispanics.
More affluent, Less dependent on Social Security.
More educated and literate.

Question 3

geron vs gerontology vs geriatrics

Answer 3

Geron: A Greek word meaning “old man”.
Gerontology: The study of social, physiological, and biological aspects of aging.
Geriatrics: Branch of medicine that studies disease in the elderly.

Question 4

define “aging”

Answer 4

The process that occurs after maturation.

-A progressive decline in the ability of an organism to adapt to environmental changes.

Question 5

2 categories of aging processes

Answer 5

1. Genetically programmed processes.

2. Accumulation of damage to critical cellular tissue constituents. (genetic theory, damage theory, etc)

Question 6

what are the 4 changes in body composition with aging?

Answer 6

• decline in lean body mass (sarcopenia)
• increase in body fat
• dec. height (and posture)
• dec. bone mass and density

Question 7

what is the cause of sarcopenia?

Answer 7

decr. O2 consumption with exercise

Question 8

what is the cause of incr. body fat?

Answer 8

• Infiltration of fat into muscle causing loss of strength.
• Increases the volume of distribution of lipophilic drugs and prolongs pharmacological action. (ativan, benzos, etc)

Question 9

what is the cause of decr. bone mass + density?

Answer 9

New bone is not produced by osteoblasts as quickly as old bone is removed (resorbed) by osteoclasts.

Question 10

3 changes in homeostatic body temp

Answer 10

1. Increased loss of subcutaneous fat causes heat loss and HYPOTHERMIA
2. Loss of the ability to sweat causes HYPERTHERMIA
3. Unable to mount a fever in the face of infection.

Question 11

incr. of ___ degree(s) over avg. can indicate a fever in the elderly

Answer 11

1 degree

Question 12

3 changes in HR

Answer 12

1. Maximum heart rate is lower.
2. Longer amount of time to elevate heart rate.
3. Increased recover time after elevated heart rate.

Question 13

3 changes in homeostatic control: BP

Answer 13

1. Impaired baroreceptor.
2. Orthostatic hypotension.
3. Increased systolic blood pressure with stiffer arteries.

Question 14

should vital signs be different for elderly?

Answer 14

in general, no but they may have lower HR and higher systolic BP

Question 15

Resp. rate in elderly. what is the normal range?

Answer 15

Normal can be RR of 16-25.
Maybe more shallow in the elderly.
Anything greater than 25 is concerning for illness. (pneumonia specifically)

Question 16

why do old people have a lower HR?

Answer 16

Declining β-adrenergic response.

Question 17

4 part multifactorial cardiac changes in aging ?

Answer 17

1. Early diastolic filling is reduced.
2. More reliance on atrial contraction to maintain LV filling.
3. Needs higher pressures for the same degree of filling.
4. High systolic blood pressures.

Question 18

Older persons may develop signs and symptoms of congestive heart failure with a normal _______ ______. why? what does this mean for txt? (kinda weeds)

Answer 18

Older persons may develop signs and symptoms of congestive heart failure with a normal ejection fraction.

Diastolic dysfunction. so you need GENTLE diuresis

Question 19

pulmonary changes with aging. (elastic recoil, total lung capacity)

Answer 19

-Elastic recoil decreases = stiffer lungs.
Alveoli collapse sooner with expiration.
-Total lung capacity decreases.
(overall: “we just can’t get the air out”)

Question 20

pulmonary changes with aging (residual lung vol, FVC and FEV1

Answer 20

-Residual lung volume increases.
Volume of air remaining after normal expiration.
-FVC and FEV1 decreases.

Question 21

what can result from the PaO2 (arterial O2 tension) decrease with aging? what causes this?

Answer 21

Ventilation/perfusion imbalance from early airway collapse.

• ->Decreased response to hypoxia (low O2) and hypercapnia (high CO2 trapped in lungs).
• caused by: Decreased chemoreceptor function.

Question 22

anatomic changes in kidney

Answer 22

gets smaller

Question 23

changes in creatine clearance and renal blood flow

Answer 23

Decreasing creatinine clearance.
Decreasing renal blood flow.
(so Creatinine levels SHOULD be lower - assume theyre kidney fxn isn’t good. if they are normal it may mean that decr. muscle mass and decr. renal fxn are balanced)

Question 24

why is dehydration is more frequent in elderly?

Answer 24

Renal response to vasopressin decreases causing impaired ability to concentrate urine in a water depravation state.
*decr. sense of thirst

Question 25

5 GI changes.

what one organ fxn remains unchanged?

Answer 25

Salivary production.
Esophageal motility.
Gastric acid production.
Pancreatic enzyme production.
Gastric transit time.

Liver functions remain unchanged.

Question 26

why are circulating insulin levels unchanged in old people?

Answer 26

A decrease in production is balanced by a decrease in renal clearance.
(insulin resistance is increased)

Question 27

endocrine changes

Answer 27

decr. hormones levels

Question 28

neurological changes

Answer 28

cerebral atrophy, slow thought process and memory

-slow rxn time

Question 29

4 changes of the eye

Answer 29

Cornea flattens and lets in less light.
Loss of lens transparency (cataract).
Reduced elasticity of the lens (presbyopia).
Less efficient retina.

Question 30

3 results of less efficient retina

Answer 30

Decreased spatial discrimination.
Decreased black and white discrimination.
Decreased adaptation to bright to dark.

Question 31

what is prebycusis? what does it result in?

Answer 31

Decreased perception of high frequency tones.

Loss of speech discrimination.

Question 32

sensory changes?

Answer 32

decr. in taste, touch, pain and smell

Question 33

4 changes in dermatology

Answer 33

1. Increased skin fold thickness; Decreased collagen and elastic; Decreased dead cell turn over. (AKA wrinkles)
2. Decreased subcutaneous fat layer.
3. decr. moisture (less oil production)
4. decr. blood supply (fragile blood vessels)

Question 34

immune changes in elderly, what is the one thing that actually increases?

Answer 34

BUT make more auto-antibodies (have positive ANA and rheumatoid factors but DONT have the disease)

Question 35

decr. subQ fat later causes what?

Answer 35

Causes loss of heat., Changes in drug absorption

Question 36

is anemia part of aging?

Answer 36

NO! blood counts remained unchanged

Question 37

bone marrow changes

Answer 37

marrow mass decr, marrow fat increases

Question 38

what is frailty?

Answer 38

A gradual loss of functional reserve and increased susceptibility to illness combined with decreased ability to rebound from illness.

Question 39

what is homeostenosis?

Answer 39

A decreased range of physiological response available to maintain homeostasis. (clinically relevant when syst. is stressed)

Question 40

why are those at the extremes of age most vulnerable?

Answer 40

they have the least amount of physiologic reserves (babies don’t have any yet, old people have used theirs up)

Question 41

what is the “hallmark” of frailty?

Answer 41

sarcopenia

Question 42

define sarcopenia

Answer 42

progressive increase in the discrepancy between the muscle mass and the force it generates.

Hypothesized to be related to increase in fat infiltration into the muscle.
Increased intramuscular fat may have the same metabolic consequences as visceral fat.