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Pathophys II > Geriatric considerations > Flashcards

Geriatric considerations Flashcards

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1
Q

Elderly patients disproportionately utilize

A

more medical care

40% of surgery/procedures performed on elderly

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2
Q

Describe oxidative damage*

A

free radicals (reactive oxygen species) that are byproducts of oxygen use/metabolism that can damage chromosomal DNA–> impair gene function, damage mitochondrial DNA & damage telomeres

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3
Q

Describe DNA damage & repair**

A

age related increases in somatic mutations & other DNA damage occur–> permanent alterations in DNA sequences & function

  • centenarians who have good health have higher levels of PARP-1
  • telomere length related to mortality
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4
Q

Describe environmental factors in the biology of aging:

A

lower calorie diet leads to longer lifespan

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5
Q

Describe malfunction of proteins in the biology of aging:

A

damaged, misfolded or malfunctioning proteins accumulate over time; seen in Parkinson’s disease, Alzheimer’s disease, & senile cataracts

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6
Q

Describe mitochondrial senescence as it relates to the biology of aging

A

increased incidence of mutated mitochondrial DNA noted in aging brain tissue, muscle cells, and gut epithelium

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7
Q

Physiologic effects of aging affect the

A

CNS, CV, respiratory, renal system, fluids & electrolytes, GI, immune, endocrine, body composition, and frailty

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8
Q

___________ in the brain undergo structural changes

A

all major cell types*****

neuronal death, synaptic loss, glial cell reactivity

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9
Q

With aging, there is a _____ in neuronal regenerative capacity

A

reduction

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10
Q

Mass of brain ____ 15% with aging with ____ in CSF volume

A

decreases; increases

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11
Q

Neural plasticity

A

decreases

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12
Q

_______ in nerve conduction velocity

A

decrease

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13
Q

Elderly patients have an increased risk of

A

postoperative delirium or cognitive dysfunction

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14
Q

There is a ________number of myelinated fibers

A

decreased

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15
Q

In the CNS, there are decreased

A

alpha 2 agonist receptors

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16
Q

_____ signaling becomes impaired in the eldelry

A

Cholinergic & dopamine

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17
Q

In the CNS for elderly patients, there are decreased

A

neurotransmitter activity- decreased glutamate & GABA binding sites
decreased cerebral blood flow
decreased cerebral metabolic rate

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18
Q

Elderly patients have an increase in susceptibility to

A

metabolic stress

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19
Q

Intellectual functioning, attention, memory, & psychomotor function ______ with age

A

decline

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20
Q

Describe the anesthetic considerations for elderly patients:

A

increased sensitivity to drugs

  • Decreased number of receptors
  • BBB more permeable
  • Exaggerated response to CNS-depressant drugs
  • Decrease induction agents 50%**
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21
Q

With neuraxial anesthesia in the elderly:

A

decreased myelinated nerve fibers causes a risk for neural damage
volume of CSF decreases
Enhanced spread of LAs
DECREASE dose of LA’s for spinal/epidural block
difficulty with placement due to anatomic changes

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22
Q

Describe the two major structural effects in blood vessels in the elderly patient:

A

stiffening & atherosclerosis**

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23
Q

With the CV system in elderly patients, they will have

Study These Flashcards
A

decreased tissue elasticity/less compliance
-increased stiffness in tissues
will see stiffening & atherosclerosis of blood vessels
INCREASED afterload due to stiffer arteries

24
Q

Describe changes to the left ventricle with aging:

Study These Flashcards
A

LVH develops*

myocardium prone to ischemia*

25
Describe how blood pressure changes in the elderly individual.
systolic blood pressure increases 5 mmHg per decade until age 60, & then increases 10 mmHg per decade systolic function is abnormal
26
Elderly individuals have mismatch
between supply & demand
27
Describe increases you may see for CV in the elderly.
incidence of heart failure increases increase in ventricular septal thickness increase in LA size increased incidence of aortic sclerosis & stenosis
28
Describe the electrical system of the heart in the elderly.
Electrical system of heart DECLINEs with age -pacemaker cells reduced prolongation of PR, QRS, & QT intervals INCREASED incidence of dysrhythmias**** resting heart rate slows increased incidence of pacemakers and/or AICD increased heart rate variability decrease in maximum heart rate in response to exercise
29
The most common complication and leading cause of death in the postoperative period for elderly patients is______
myocardial infarction******
30
Describe the anesthetic implications of the CV system.
decreased end-organ adrenergic responsiveness prolonged circulation time widened pulse pressure decreased sensitivity to baroreceptors in aortic arch in response to BP changes decreased CO & SV decreased sensitivity to beta-adrenergic modulation****
31
Changes in cardiovascular physiology include:
decrease in peak heart rate & CO slower resting heart rate decreased ability to increase CO by change in HR decreased ability to withstand stress
32
Describe chest wall compliance in the elderly.
decreased chest wall compliance due to calcifications decreased intercostal muscle mass further decreasing chest wall compliance due to flattening of diaphragm & loss of intervertebral disc height
33
Describe the relationship between FRC & closing volume.
Residual volume, closing volume and FRC increase**** with age TLC remains the same Closing volume exceeds FRC in supine position at age 45 & exceeds FRC in upright position at 65
34
Describe mechanical changes of the respiratory system in the elderly.
progressive decrease in elasticity changes respiratory mechanics & alveolar architecture - chest wall compliance & vital capacity decrease - lung compliance, work of breathing, and residual volume increase - decreased endurance of respiratory muscles
35
Elderly individuals are more prone to
respiratory failure****
36
Describe changes in gas exchange of the respiratory system of the elderly.
Reduced oxygen exchange at alveolar level********* reduced functional alveolar surface area for gas exchange reduction in arterial oxygen tension reduced elastic tissue in lung increased intrapulmonary shunting increase in V/Q mismatch
37
PaO2 decreases at a rate of
0.35 mmHg per year
38
Elderly individuals have an increased tendency for airways
to close closing volume exceeds FRC More prone to atelectasis******
39
Decreased how residual volume & FVC & Fev1 change in gas exchange.
residual volume increases | FVC & FEV1 are decreased
40
Describe changes in the respiratory sensing mechanism of the elderly.
decreased ability to clear secretions increased risk of aspiration******** reduced respiratory drive in response to hypoxia, hypercarbia, & resistive load increased airway reactivity
41
Describe changes in the renal system of the elderly.
decreased function with normal aging decreased renal blood flow decreased renal mass reduced clearance of hydrophilic agents & hydrophilic metabolites
42
The renal system is unable to
self-regulate due to renal vascular dysautonomy- attenuated autonomic renal vascular reflexes that protect from hypo/hypertensive events
43
The renal system in the elderly has
tubular dysfunction medullary hypotonicity tubular frailty
44
The aging kidney is more susceptible to
injury*******
45
The renal system has a decreased ability to
accommodate hemodynamic changes -decreased renin & aldosterone production decreased GFR & decreased ability to excrete free water
46
Describe thirst response and volume sensitivity in the elderly.
diminished thirst response | decreased sensitivity to volume & osmoreceptors
47
The best indicator of drug clearance is
creatinine clearance
48
Patients with renal impairment, may be at increased risk for:
1. fluid overload 2. accumulation of metabolites & drugs 3. decreased drug elimination 4. prolonged effects of anesthetic drugs & adjuncts 5. electrolyte imbalances 6. arrhythmias
49
Describe the hepatic function of the elderly.
``` liver mass decreases decreased blood flow decreased functional hepatic reserve in elderly decreased drug metabolism prolonged half-life ```
50
Describe phase 1 & phase 2 drug metabolism in the elderly.
phase 1 drug metabolism is variable | phase 2 drug metabolism is not significantly altered
51
Describe serum albumin & alpha-1 acid in the elderly
serum albumin decreases | and alph-1 acid glycoprotein increases
52
Describe the GI system of the elderly.
decreased motility of upper esophageal decreased colonic function decreased GI immunity decreased GI drug metabolism
53
Describe the immune system of the elderly.
reduced activity of immune cells increased levels of cytokines & chemokines decreased T & B cell function reduced ability to fight infection & control cancers
54
Describe the endocrine system of the elderly.
reduce hormone production impaired endocrine function impaired glucose homeostasis deficiencies of insulin, thyroxine, GH, renin, aldosterone & testosterone
55
Resting metabolic rate decreases
1%/year after 30 | decreased lean body mass
56
_____ is a major risk factor for CV disease.
Diabetes******
57
Describe what happens to the pancreas in the elderly.
decline in number and function of pancreatic islet beta cells -decreased insulin secretion -increased hepatic production of glucose -impaired production of fats/proteins increased incidence of glucose tolerance or diabetes

Pathophys II (43 decks)

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