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Flashcards in Elderly Deck (29):
1

What % of pop is pensionable?

18%

2

What is fastest growing age segment?

Over 80s

3

How often do over 80s attend hospital?

once per week

4

By 2036, what % change in 60-75yr olds?

50% increase

5

By 2036, what % change in 75+yr olds?

75% increase

6

By 2036, what % change in 15-44yr olds?

8% decrease

7

How many years can a 60yr old male / female expect to live?

Male = 19 more years
Female = 23 more years

8

What are the 4 personality types of the elderly?

1. Integrated - active, satisfied, flexible, functioning, ok with aging

2. Armoured - fights aging, preoccupied with loss, eg celebrities

3. Passive - dependent, low life satisfaction, 'I'm old, so others will have to do things for me'.

4, Angry - low activity, low life satisfaction, bitter, Mr Meldrew!

9

What physiological changes happen to skin when aging? (x4)

- Wrinkles
- Dry
- Cambell de Morgan spots (red elevated areas)
- Seborrhoeic Keratosis (thickening of skin, esp on face)

All of above are normal

10

What changes occur in the mouth with aging? (x6)

- reduced saliva production
- decrease in taste buds
- reduced sense of smell
- impaired muscles of mastication
- tongue enlargement
- tooth loss

11

What changes occur to the body with aging? (x20)

- decline in hepatic drug metabolism (liver)
- decline in GFR (glomerular filtration rate) by 50% (kidneys)
- prostate enlargement
- decreased bladder capacity
- bone loss
- thickening of heart valves
- dilatation / dilation of large elastic arteries
- increased systolic BP
- reduced CO
- reduced cardiovascular response to stress
- fall in FVC and FEV1 (forced vital capacity / forced expiratory volume in 1 sec)
- reduced brain weight
- presbyacusis (hearing loss)
- hardening of lens (impaired near vision)
- flatter cornea (astigmatism)
- reduced lean body mass
- increase in fat mass
- reduced ability to control body temp
- reduced oestrogen levels
- poor immune system

12

What happens to IQ with aging?

Cross sectional studies - IQ declines
Longitudinal studies - IQ preserved

Verbal abilities are preserved, but speed of response reduces

13

What are the non specific features of disease presentation in the elderly?

The 4 Is:
- Intellectual failure
- Incontinence (due to pressure, tumours, brain issues)
- Immobility
- Instability

May not be due to age! Look for other diseases

14

Name atypical presentations of disease in the elderly

ie diseases present differently in the old.

MI - without chest pain (still gets dyspnoea (hard to breath), confusion, hypotension)

Infection without increase in white blood cells / temp.

Silent perforation (eg stomach ulcers perforate, but no pain - painful in young ppl)

15

What symptoms are often mistaken for old age? (mistaken = erroneous)

Hypothyroidism - reduced energy
Anaemia - reduced energy
Bowel issues - could be cancer
Urinary problems
Shortness of breath
Forgetfulness

16

What single illnesses / event can lead to catastrophic consequences in the elderly? x9

Pneumonia
Delirium / confusion
Postural instability
Fall
Fracture neck of femur (50% die within 2 yrs!)
Immobility
DVT / PE

17

What are the physical signs of age?

Small irregular pupils
Reduced vibration sensation
Displaced apex - kyphoscoliosis (outward and lateral curvature of the spine)
Absent ankle reflexes

18

What % of hospital admissions are caused by adverse drug reactions?

5-15%

19

What % have adverse drug reactions in hospital?

6-17%
Risk of adverse drug reactions increases with age and no. of drugs prescribed

20

How does drug metabolism change in elderly?

reduced renal drug clearance
changes to hepatic drug metabolism
changes in volume of distribution

21

What type of dosage should you use on elderly?

child dose

22

How is the volume of distribution affected in drug pharmacology? Give drug examples

Increase in fat, decrease in lean muscle
- lipid soluble drugs have an increased vol of distribution (can cross cell mem) and a prolonged effect eg diazepam
- water soluble drugs have a reduced vol of distribution and a more rapid peak eg digoxin

23

What % of drug - drug interactions result in an adverse effect?

10%
NB use BNF - predictable and preventable

24

What % don't comply with their prescriptions?

40-75%
esp if 3+ drug types (25% of elderly)

25

What % of elderly are on 3+ drugs?

25%

26

How many drugs is a typical elderly pt on in hospital?

8 drugs

27

What % of elderly take prescription drugs meant for others?

10%
esp in nursing home / partners tablets

28

What % take drugs not prescribed by physician?

20%

29

Why are elderly at increase risk of drug reaction?

bodies reduce in size
capacity to metabolise drugs in liver / excrete drugs in kidney