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ICA > Ageing and the body > Flashcards

Ageing and the body Flashcards

1
Q

What does ageing impact?

A

How well the body copes with new and ongoing insults

How we treat and manage pts

Ongoing care - more challenging

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2
Q

Why is it important to consider the implications of ageing?

A

Will be treating lots of older people - over
50% of older people have at least 2 chronic conditions

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3
Q

What happens to skin as you age?

A

Elastic tissue = less effective
Skin becomes less tight = wrinkles
Skin thins - more susceptible to damage and more fragile

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4
Q

What issues does ageing skin cause?

A

Skin tear - upper layer epidermis comes off exposing underlying layers
Easily bruising
Difficulty getting vascular access
Ulcerations

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5
Q

What effect does reduced elasticity have on the lungs?

A

Decreased lung compliance

Elastic tissue also important in holding terminal airways and alveoli open - collapse = impaired ventilation

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6
Q

What values (measured on resp graph) would be affected in ageing patients?

A

Reduced total lung capacity
Reduced force vital capacity (FVC)
Reduced forced expiratory volume (FEV1)

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7
Q

What factors can cause respiratory effects of ageing to occur earlier?

A

Work exposure - eg dust, asbestos, sawdust
Smoke exposure
Repeated infections
Chemical/toxin exposure - eg medications causing fibrosis (amiodarone, chemo etc)

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8
Q

What does decrease elastic tissue mean for coughing?

A

Ineffective cough - cannot remove unwanted mucus filled with bacteria
Stasis of mucus = infection

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9
Q

What will older people often have due to their greater risk of resp infections?

A

More likely to be acutely unwell
More likely to need hospitalisation
More likely to need O2/ IV abx

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10
Q

Association with operations and ageing?

A

More likely to have post op problems eg:
Atelectasis - squashed/collapsed lung, folded over itself
Pneumonia
Pulmonary embolism - also more sedentary

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11
Q

Sedative drugs and ageing problem

A

Sedative drugs more likely to cause resp problems

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12
Q

CXR sign of atelectasis

A

White lines on lungs showing lung is folded over itself due to collapse of alveoli/airway

Pt needs to cough, stand up and do deep breathing exercises

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13
Q

Effects of ageing on the CVS

A

Blood vessels become more stiff as we age - particularly arteries (loss elastic tissue, deposition of Ca2+)

Elastic recoil is reduced = less expansible arteries

= increased resistance to blood flow
= HTN
= CV work for heart
= LVH
= Decreased ventricular volume - thick and stiff
= heart failure (left then right)

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14
Q

Risks of uncontrolled HTN

A

HF
Vascular disease - eg AAA
Organ damage - esp renal CKD
Stroke
Myocardial infarction
Atrial fibrillation –> stroke
Damage vision
Vascular dementia

(macro and microvascular damage)

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15
Q

How does HTN cause atrial fibrillation?

A

HTN = increased atria stretch
Stretch = small areas of damage
New foci of electrical activity in these areas - generates its own AP

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16
Q

Signs of AF on ECG

A

Irregularly irregular rhythm
Wavy baseline
No P waves

17
Q

what happens to renal system as we age?

A

Glomerular filtration rate decreases - 1ml/min/m2 from 30-40

18
Q

Cause of decreased GFR as we age

A

Structural changes to glomerulus
Atheromatous vascular disease
Reduced CO
(some unknown)

19
Q

Problem with decreasing GFR with age and medication

A

Lots of meds are renally excreted - if cannot filter out of blood well this could cause increased toxic levels of drugs in the plasma

20
Q

How to avoid drugs reaching toxic levels due to renal decline?

A

Smaller doses?
Less often?
Alternative medicine?

21
Q

What two diseases majorly impact renal function?

A

Hypertension -
medication can reduce BP (then poorly perfuse kidney)
some meds are nephrotoxic - ACEi, NSAIDs
Review regularly and prescribe with caution

Diabetes -
Diabetic nephropathy if poorly controlled - damage to microvascular structures

22
Q

Ageing effects on bone

A

Bone density decreases
Declines quicker in post menopausal women (oestrogen protective)

23
Q

Ageing effects on muscle

A

Muscle mass decreases
Use it or lose it/nutrition

24
Q

Bone marrow changes during ageing

A

Bone marrow becomes less cellular and more fatty
= less cell production

25
Q

Problems with decreased bone density and muscle mass

A

Increase risk of fracture
Decreased strength - fall risk
Increase risk of trauma
Osteoporosis
= overall increase fall risk

26
Q

Affects of ageing on GI system

A

Liver function gradually reduces - due to less blood flow to liver, decreased mass of functional cells

Slower transit time through intestines -> constipation

Decreased absorption - nutrients and medications (also eat smaller meals)

27
Q

why is malnutrition important in ageing population?

A

Malnutrition is commonly an issue for elderly
Good nutrition is essential for recovery from illness
More malnourished = longer in hospital
SLOW WOUND HEALING TIME

28
Q

What are the particular risks associated with slower wound healing in elderly?

A

Wound breakdown after surgery/delayed healing likely
Increase risk of pressure ulcers
Pressure ulcers difficult to heal without good nutrition

29
Q

How do we try and prevent/reduce malnutrition in hospital admissions?

A

MUST screening tool - assess who is at risk

30
Q

What happens to the brain as we age?

A

Some parts shrink - learning and complex mental activities areas
Senescence of some cells - inactive
Reduced communication between neurons
Reduced blood flow
Neuronal density reduces by almost 1/3 by 80

31
Q

4 hallmark features of cerebral atrophy associated with ageing

A

Ventricular enlargement - holes in brain get bigger
Cortical thinning
Volume loss
Sulcal widening

32
Q

4 types of dementia

A

Alzheimer’s - most common
Vascular
Lewy body
Fronto-temporal

33
Q

How is prescribing more difficult with ageing?

A

Balance proposed benefits with side effects

Risk of interactions - likely to be on medication already

Reduced renal and liver excretion of drugs = dose reduction needed, alternatives?, close monitoring, start at low dose

34
Q

What do you do if there is an interaction with a proposed drug prescription?

A

If no alternative - which medication is more important?

35
Q

What does care for ageing people look like?

A

Patient centred - what does the patient want, but work with best interests
Is the hospital best place for them?
Loneliness is big factor - sometimes people want to stay in hospital because of this

36
Q

How can we ensure patients get the care they want?

A

Planning:
Advance care planning - what would you like if X were to happen?

Emergency healthcare plans - reduces admissions to hospital unless no other option

RESPECT forms - what is important to the patient (treatment vs symptom control), DNR?

Involve family and friends - they know loved ones well

ICA (13 decks)

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