AGE Flashcards

Question

# The Ageing Heart and Lungs by Dr Cheng Immunological changes ## Footnote *LOB: Explain the functional consequences to the cardiovascular and respiratory systems in relation to age-related changes

Answer 1

Reduced Mucocillary transport Blunted cough reflex Increased swallowing error Decreased no and funct T Cell, Mφ Total exposure to pollutants over years **Therefore** chronic low-grade inflammation Bronchoalveolar lavage has demonstrated increased levels of neutrophils, IL-1 and IL-8 as well as neutrophil elastase

Answer 2

Increased work of breathing Decreased exercise tolerance Increased risk of infection Subsequent increased risk of a variety of respiratory diseases VO2Mac decreases (quicker if sedentary)

Answer 3

Physiological decline happens across all body systems Expending reserves to compensate for primary age changes **Reduced ability to maintain homeostasis when disturbed by physiological insult** (Also known as… frailty)

Answer 4

Dysregulation in multiple physiological systems (e.g. cardiac, respiratory, metabolic, renal, musculoskeletal etc etc) results in reduced reserve **Older age ≠ frailty**

Answer 5

1-9, scores slightly differently in dementia Depends on active disease and activity Includes terminal illness

Answer 6

**Homeostasis + Stenosis** Homeostasis has a physiological limit Physiologic reserve decreases with time Stress (biologic) can overwhelm the reserve

Answer 7

Pathology may be mistaken for ‘normal ageing’ (by patients, relatives or healthcare staff) Fatigue, memory problems, incontinence et.c Symptoms are often multifactorial in origin Same symptoms can be caused by different disease processes E.g. dyspnoea – COPD/ heart failure / anaemia The same disease process can cause different symptoms in different patients.

Answer 8

An older person may have the same presentation for varied underlying causes * Dyspnoea (pneumonia, COPD, heart failure) * Falls (infection, postural hypotension, arrhythmia) * Fatigue (infection, anaemia, malignancy, MS) * Delirium (almost anything you can think of) Or the same disease may present in different ways in differnet patients **ATYPICAL is typical in older patients**

Answer 9

Immobility Instability Intellectual impairment Incontinence (Iatrogenesis)

Answer 10

**Causes** Acute or chronic illness Medication side effects Pain Delirium or dementia Sarcopenia Mood Lack of mobility aid **Consequences** Pressure ulcers Pneumonia Increased dependence Death

Answer 11

**Causes** Age-related changes: Gait, Sarcopenia, Visual impairment etc Medical conditions Environmental causes Medications Alcohol **Consequences** Fractures Immobility Fear of falling (FFF) and reduced confidence Traumatic intracranial haemorrhage Dependence Death

Answer 12

*illness caused by medication* Polypharmacy More than half of >65 take 3 medications Increases ADR risk Changes in pharmacokinetics/dynamis with age

Answer 13

Fever, cough, and dyspnoea may be absent despite respiratory disease Only 20-30% of geriatric patients with infection present with fever Delirium, falls, malaise, functional decline, conjunctivitis, dizziness, headache, rhinorrhoea, chest pain, haemoptysis, diarrhoea, nausea/vomiting, abdominal pain May be covid positive when other plausible explanation for presentation (remember – often >1 cause for syndromes) Older adults may present with mild symptoms that are disproportionate to the severity of their illness Regional Geriatric Program of Toronto

Answer 14

**DIAPPERS** *think diapers* Delirium Infection - urinary (symptomatic) Atrophic urethritis and vaginitis Pharmaceuticals Psychiatric disorders, especially depression Excessive urine output (eg, from heart failure or hyperglycemia) Restricted mobility Stool impaction

Answer 15

Not a normal part of ageing Urge, stress, mixed, functional **Consequence** Damage to skin Infection Embarrassment Instability Social isolation

Answer 16

**PINCH ME** Predisposing factors Polypharmacy Acute illness Constipation Electrolyte or fluid imbalance Change in environment Pain

Answer 17

**Causes** Age-related changes: Gait, Sarcopenia, Visual impairment etc Medical conditions Environmental causes Medications Alcohol **Consequences** Fractures Immobility Fear of falling (FFF) and reduced confidence Traumatic intracranial haemorrhage Dependence Death

Answer 18

**Causes** delirium Delirium affects >25% of people in hospital Disturbed consciousness, cognitive function or perception, which has an acute onset and fluctuating course **Consequences** Significant mortality (> cancer, #NOF, STEMI) Instability Immobility Longer stay Increased level of dependence (e.g. nursing home) Poor PO intake Death

Answer 19

**Changes**: Thinning of the epidermis (outer layer) Decreased collagen and elastin in the dermis (middle layer) Reduction in subcutaneous fat (bottom layer) Reduced sweat and oil gland activity **Structure**: Thinner, less elastic skin Less cushioning from fat Reduced moisture **Function**: Weaker barrier against external damage Lower ability to retain moisture Decreased temperature regulation **Consequence**: Increased risk of skin injuries and infections Dry, itchy skin Slower wound healing Greater susceptibility to temperature extremes

Answer 20

**Changes**: Reduced hormone production (e.g., growth hormone) Altered hormone release patterns **Structure**: Degeneration of gland tissue Reduced cell function **Function**: Lowered growth hormone levels affect muscle mass and fat distribution Altered hormone levels influence overall metabolism and stress response **Consequence**: Decreased muscle mass and strength Increased body fat Slower metabolism Potential for disrupted sleep and energy levels

Answer 21

**Changes**: Decreased production of thyroid hormones (T3 and T4) Increased incidence of thyroid nodules **Structure**: Gland may become nodular or atrophic **Function**: Slowed metabolism Altered body temperature regulation **Consequence**: Increased risk of hypothyroidism (fatigue, weight gain, cold intolerance) Potential for hyperthyroidism if nodules produce excess hormones

Answer 22

**Changes**: Decreased production of adrenal hormones (e.g., cortisol, aldosterone) Altered response to stress **Structure**: Degeneration of adrenal cortex Reduced gland size **Function**: Lowered ability to respond to physical and emotional stress Reduced blood pressure regulation **Consequence**: Increased susceptibility to stress-related disorders Potential for low blood pressure and electrolyte imbalances

Answer 23

**Changes**: Decline in immune system function (immunosenescence) Reduced production of immune cells **Structure**: Thinner skin and mucous membranes Weakened barriers against pathogens **Function**: Slower immune response Reduced ability to recognize and attack pathogens **Consequence**: Higher risk of infections (e.g., pneumonia, urinary tract infections) Slower recovery from illnesses Increased severity of infections

Answer 24

Syncope Stroke STEMI Trip Stumble Difficulty raising foot Foot catching furniture/ other foot Tripped by another person Loss of external support Hit or bump Loss of Conciousness

Answer 25

**Ageing Neurological** **BALANCE** **BRADYKINESIA** Brain atrophy, neurone loss, reduced synaptic transmission leading to slower processing speed, loss of proprioception, impaired vestibular system **Ageing Muscles** Sarcopenia, and asymmetrical changes **Ageing posture** **Gait** Reduced stride, speed, fleion and extension, less strength in "pushing off" **Co Mobidities** **Extrinsic** Lighting, pets, headroom, clothing, shoes

Answer 26

**Ageing Hearing/ Presbycusis** With each 10dB of hearing loss, risk increases by 140% Less Spatially Aware, less resource for balance **Ageing Sight** Deterioration in acuity, opaque lens, pupil rigid, slower light reaction, reduced sensitivity **Medications** Exposure to anticholinergic associated in 60% increase

Answer 27

**Posture Changes:** Increased thoracic kyphosis Decreased lumbar lordosis Height loss Forward head position Shoulders more rounded and stooped **Functional Consequences of Posture Change**s: Balance issues Back pain Breathing difficulties **Gait Changes:** Decrease in stride length Reduction in walking speed Widening of the stance Decreased arm swing Joint stiffness **Functional** **Consequences** of Gait Changes: Increased fall risk Reduced mobility Fatigue

Answer 28

Initial Assessment and Stabilization: Pain Management Imaging Medical Stabilization Surgical Management: Type of Surgery Internal Fixation Hemiarthroplasty Total Hip Arthroplasty Timing Post-Surgical Care: Pain Management Antibiotics Anticoagulation Non-Surgical Management: Rehabilitation Weight-Bearing Assistive Devices Comprehensive Care: Nutritional Support Bone Health Multidisciplinary Approach Follow-Up: Monitoring Adjustments

Answer 29

Not living with multiple long-term health conditions. Someone living with frailty may have no other diagnosed health conditions Not a disability

Answer 30

“a distinctive health state related to the ageing process in which multiple body systems gradually lose their in-built reserves”

Answer 31

Aetiology, Mechanisms, Phenotype and Outcome

Answer 32

Comprehensive Geriatric Assessment (CGA) Interdisciplinary, multi-component process, focused on medical, psychological and functional capabilities to develop an integrated plan for treatment and long term follow up NNT is only 17 Can be used in hospitals or in the community

Answer 33

the time-related deterioration of the physiological functions necessary for survival and fertility.

Answer 34

Increased Body fat Decreased body water, lean body mass, plasma albumin Can increase Vd for lipophilic drugs, increasing halflife Decreases Vd for hydrophilic Less albumin = unbound drug = toxicity risk

Answer 35

Decreased hepatic blood flow and volume with age Decreased activity of Hepatic enzymes first-pass metabolism are most likely to be affected Phase 1 reactions (oxidation, reduction & hydrolysis) are more significantly affected than Phase 2 reactions (conjugation & glucorinidation)

Answer 36

Decreased renal blood flow, kidney size and functioning nephrons Reduced eGFR (calculation may not show change) Poor renal blood flow 2’ to arterial disease (+ RF of diabetes, HTN) Loss of nephrons by focal glomerular sclerosis Most important for medications with a narrow therapeutic range which rely on renal clearance – digoxin, gentamicin, lithium May stay in body longer = longer affects, higher risk of toxicity

Answer 37

**Polypharmacy** Typically defined as a taking 5 or more medications Increasing prevalence in part due to increasing rates of multimorbidity and treatment options Prescribing cascade -> HTN -> Amlodipine -> Ankle swelling -> Furosemide -> incontinence -> Tamsulosin -> Constipation -> Laxatives **Anticholinergic Burden calculator** https://www.acbcalc.com/ What is this patient’s anticholinergic burden? (Answer: 7) (3+ is associated with increased mortality) Chlorphenamine (3) Prednisolone (1) Amitriptyline (3) Aspirin (0) **ADR** A: adverse reaction from an exaggeration of a drug’s expected actions

Answer 38

Complex regimens Multiple prescribers Medication storage / formulation issues Multimorbidity Cognitive impairment Increased risk of ADRs **Start low and go slow**

Answer 39

**Increased Demand for Geriatric Care:** More elderly individuals require specialized medical services, long-term care, and management of chronic conditions. **Strain on Healthcare Resources:** Higher healthcare costs and resource allocation challenges due to the rising number of older patients with complex needs. **Expansion of Healthcare Workforce:** Need for more healthcare professionals trained in geriatric medicine, nursing, and allied health services to cater to the aging population. **Growth in Preventive and Community-Based Services:** Emphasis on preventive healthcare, home care services, and community-based support to manage aging in place and reduce hospital admissions. **Policy and Infrastructure Changes:** Development of policies and healthcare infrastructure to support aging populations, including increased funding, age-friendly facilities, and integrated care models.

Answer 40

By delaying the onset of disabling diseases to later ages when intrinsic ageing has raised fatality by reducing adaptability, the average duration of disability before death will be shortened. In brief, we will spend a longer time living and a shorter time dying J Grimley Evans 1997

Answer 41

Brain Shrinking Neurodegeneration Ventricular Enlargement Volume loss Sulcal Swelling Hippocampal Atrophy Cortical Thinning

Answer 42

Brain Shrinking Neurodegeneration Ventricular Enlargement Volume loss Sulcal Swelling Hippocampal Atrophy Cortical Thinning

Answer 43

Large vessel disease Ischaemic and haemorrhagic strokes Small vessel disease Cerebral arteriosclerosis and atherosclerosis Cerebral amyloid angiopathy Lacunar infarcts

Answer 44

**Syndrome caused by a number of brain disorders which cause memory loss, decline aspects of cognition, and difficulties with activities of daily living.** Cognitive impairment Psychiatric or behavioural disturbances Difficulties with activities of daily living

Answer 45

Healthy Ageing: some impairment, doesnt affect daily living MCI: memory loss, difficulty speaking, disorientation, but does not interfere with normal daily functions and routines Dementia: severe cognitive dysfunction affecting daily life, completing tasks or learning new things

Answer 46

Risk Factors: Apolipoprotein E4 Aetiology: Extracellular beta-amyloid plaques, intracellular neurofibrillary tangles (Tau) Clinical Evolution: Progressive decline Neuropsychological changes: Short-term memory Imaging: Medial temporal lobe atrophy Management: Acetylcholinesterase inhibitors, NMDA receptor antagonistis

Answer 47

Risk Factors: HTN, DM, Stroke, TIA, AF, smoking Aetiology: Infarction, leukoaraiosis, haemorrhage Clinical Evolution: Step-wise decline Neuropsychological changes: Executive function Imaging: infarcts, small vessel disease, white matter changes Management: Reduce cardiac risk factors

Answer 48

**Neurone**Decreased synaptic function **Microglia** Accumulation of insoluble material, pro inflammatory, decreased surveilling **Oligodendrocyte** Decreased myelination, release myelin debris, shorter internodes **Astrocyte** Reactivity features, decreased neuronal synaptic suport, enhanced immune response

Answer 49

Brain Shrinking Neurodegeneration Ventricular Enlargement Volume loss Sulcal Swelling Hippocampal Atrophy Cortical Thinning

Answer 50

Infection Constipation Urinary retention Medications (e.g. anticholinergics, opiates, benzodiazepines) Medication/drug withdrawal Pain Post-operative Hypoxia Electrolyte abnormalities Hormonal imabalances (e.g. thyroid) Thiamine deficiency B12 deficiency Trauma Post-ictal

Answer 51

Delirium is an acute, fluctuating syndrome characterized by disturbed consciousness, attention, cognition, and perception Subtypes: Hypoactive Hyperactive Mixed

Answer 52

View organisms as machines that wear out over time. Example: Elephant's teeth wear down, leading to difficulties in feeding. Limitation: Some animals, like sea anemones, do not exhibit ageing.

Answer 53

Ageing is a result of evolution and natural selection, advantageous for species but not for individuals. Prevents old and worn-out individuals from competing with younger, more vital individuals. Limitation: Ageing is rarely observed in natural populations.

Answer 54

**Mutation Accumulation** Natural selection weakens with age, allowing deleterious mutations to accumulate. Ageing is due to a collection of late-acting, harmful genes. Limitation: Lacks experimental support. **Antagonistic Pleiotropic Genes** Genes beneficial early in life can have adverse effects later, contributing to ageing. Example: Drosophila studies showing increased early fecundity but reduced longevity.

Answer 55

Organisms allocate resources between reproduction and body maintenance. Limited investment in maintenance leads to ageing as repair mechanisms eventually fail.

Answer 56

**specific genes that either promote longevity or contribute to the ageing process.** "geronto-genes" longevity assurance genes in various organisms. **Example**: Telomeres and Telomerase: ends of chromosomes that protect them from deterioration. Each time a cell divides, telomeres shorten. When they reach a critical length, the cell can no longer divide

Answer 57

**maintenance of DNA integrity over time.** As organisms age, the ability to repair DNA damage declines, leading to an accumulation of genetic errors that contribute to the ageing process. **Example**: Free Radical Theory: reactive oxygen species (ROS) produced during cellular metabolism can damage DNA, proteins, and lipids. Over time, the accumulation of such damage leads to genomic instability and contributes to ageing. Enzymes like superoxide dismutase (SOD) and catalase help mitigate this damage, but their efficacy decreases with age.

Answer 58

At the cellular level, ageing manifests through processes such as cell senescence, where c**ells lose their ability to divide and function properly**, contributing to tissue dysfunction. Examples: **Cell Senescence**: Senescent cells cease to divide and can secrete inflammatory cytokines, growth factors, and proteases, collectively known as the senescence-associated secretory phenotype (SASP). This can disrupt tissue structure and function and promote age-related diseases. For instance, increased senescent cell numbers are observed in osteoarthritis and pancreatic dysfunction. **Hayflick** **Phenomenon**: Normal somatic cells have a limited capacity for division, known as the **Hayflick** **limit**. After a certain number of divisions, cells enter a state of senescence due to **telomere shortening.**

Answer 59

At the systems level, ageing can be viewed through the **decline in the function of entire** organ systems and the interactions between them. Examples: **Neuroendocrine Theory:** This theory suggests that ageing is regulated by the decline in neuroendocrine function, particularly involving the hypothalamic-pituitary-adrenal axis. For instance, decreased pulsatile secretion of growth hormone and gonadotropin-releasing hormone (GnRH) is associated with ageing. Experimental interventions such as hypothalamectomy followed by hormone replacement have shown increased lifespan in rats. **Immune System Decline**: The efficiency of the immune system decreases with age, a process known as immunosenescence. This contributes to increased susceptibility to infections, reduced response to vaccination, and a higher incidence of autoimmune diseases in the elderly.

AGE Flashcards

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