Into to geriatrics

Question 1

what is aging?

Answer 1

A progressive and insidious decline in cellular processes after reaching sexual maturity

Question 2

what does aging result in?

Answer 2

Decreased homeostatic balance
Decreased reaction to tissue injury
Increased vulnerability to environmental changes
↓’d organ/system reserve (if patient has good organ reserve then the patient will age healthier)
Less specific causes of disease with greater individual variation

Question 3

what is the mutation accumulation theory

Answer 3

We are born with specific vulnerability to a late life disorder
Radiation (sun) is the most common cause of genetic mutation
Free radical theory is the most important reason for aging
Poor eating, exercising

Question 4

what is antagonistic pleitropy

Answer 4

genes undergo role switch

from early life enhanced reproductive fitness to “diseases causing genes” later in life

Question 5

cocoon hypothesis

Answer 5

there is a decline in natural selection forces from decreased immobility with aging
decreased environment risk
air conditioning, heating, vaccines, preventive care

Question 6

hypomorphic mutations

Answer 6

decreased physiological process during environment stressor by conservation of energy results in decreased resting metabolic rate
food shortages results in decreased insulin

Question 7

what is demographic transition

Answer 7

rate of population aging
shift in age distribution world-wide
factors influencing population age shifts:
decreased fertility rates and infant mortality
decreased mortality rates in the oldest of old

Question 8

what is the most important systems that indicates decline

Answer 8

brain function

Question 9

what happens with brain and spinal cord as we age?

Answer 9

reactive gliosis- glial cells are hyperactive and cause scarring leaving amyloid plaques
dural meningeal fibrosis
brain atrophy- occurs in someone without any memory impairment
decreased peripheral nerve conduction velocity

Question 10

what happens to endocrine function as we age.

Answer 10

decrease hormonal secretion
decreased receptors
decreased efficacy and efficiency

Question 11

what happens to cardiovascular system as we age

Answer 11

decreased cardiac muscle contractility
myocardial fibrosis
atherosclerosis/arteriosclerosis
conduction abnormalities

Question 12

what happens to glucose regulation as we age

Answer 12

decreased pancreatic function

decreased counter regulatory mechanisms

Question 13

what happens to the muscular skeletal system

Answer 13

sarcopenia- the loss of lean body mass if you lose 15% of lean body mass you’re at risk of death
decreased muscle strength and coordination
osteoporosis
osteoarthritis

Question 14

what happens to our immune system as we age

Answer 14

decreased defense mechanism

Question 15

what happens to out senses as we age?

Answer 15

decreased hearing, smell, vision, taste, touch and vibration

Question 16

what happens to the respiratory system as we age

Answer 16

interstitial fibrosis

cough less effective, decreased PFT

Question 17

what happens to the renal system as we age

Answer 17

interstitial fibrosis
glomerular sclerosis
decreased creatinine clearance and GFR 10ml/decade

Question 18

what happens to male reproductive system as we age?

Answer 18

testicular atrophy
BPH
prostate cancer

Question 19

what happens to female reproductive system as we age?

Answer 19

ovarian atrophy
endometrial hyperplasia
uterine fibroids

Question 20

what happens to GI system as we age?

Answer 20

mucosal atrophy
decreased emptying, hormonal secretion and HCL acid
hyperplastic polyps
colorectal adenomas

Question 21

what happens with cytokines and inflammatory mediators as we age

Answer 21

they increase because it may be in response to radical oxygen species and less effective anti-oxidative stress

Question 22

who loses more lean body mass faster men or women

Answer 22

women because they start out with less

Question 23

what is prognostic indicator of frailty?

Answer 23

grip strength

Question 24

what happens to resting metabolic rate as we age?

Answer 24

is decreased because we no longer need a faster heart rate and can no longer respond to situations as fast

Question 25

what happens to the brain volume as we age?

Answer 25

decreased brain volume and hippocampus

Question 26

what areas are important in brain function

Answer 26

fusiform gyrus, inferior temporal cortex, orbitofrontal these structures will decrease 50% in size in 5years

Question 27

what happens to memory impairment in men and women as they age

Answer 27

men have greater memory impairment then women its theorized that it has to do with estrogen

Question 28

skin homeostatic function

Answer 28

``` environmental protection absorption- may not be able to absorb through skin as effective temp regulation biochemical synthesis immune process sensory water balance ```

Question 29

disturbance with skin as we age

Answer 29

``` atrophy eccrine gland atrophy statsis dermatitis cancer hair loss and graying ```

Question 30

oxidative stress

Answer 30

decreased synthesis of antioxidants against reactive oxygen species disrupts DNA molecule-nuclear and mitochondrial DNA-cell membrane disruption -decreased ability to neutralize radical oxygen species Obesity increases oxidative stress Oxidative stress disrupts cellular growth regulation

Question 31

decreased cellular function is significant risk for?

Answer 31

Immunosenescence- decreased ability to respond to antigen and threat and launch immune responsive, decreased immune memory

Question 32

what happens to co-mordibities as we age

Answer 32

they increase

Question 33

what is the aging phenotype

Answer 33

4 functional physiological domains are the basis of the approach and assessment the older person

Question 34

what are the 4 aging phenotypes

Answer 34

body composition changes Energy Reserve Neurologic Integrity Homeostasis

Question 35

body composition phenotype

Answer 35

``` decreased lean body mass, BMI, waist circumference, muscle strength testing decreased insulin sensitivity decreased functional capacity decreased metabolic rate correlated with mortality,illness adipokine= decreased cognitive function ```

Question 36

energy reserve phenotype

Answer 36

availability vs. demand | measure cardiac, pulmonary function

Question 37

neurological integrity phenotype

Answer 37

CNS,PNS pre-frontal and hippocampus atrophy amyloid plaques and neurofibrillatory tangles seen in normal and demented patients decreased autonomic system regulation CNS degeneration: decreased hypothalamic hormonal regulation and sympa/parasympathetic NS fnx

Question 38

homeostasis phenotype

Answer 38

hormonal, nutritional, inflammatory decreased testosterone=decreased lean body mass decreased temp regulation have lower body temp even in infection

Question 39

what is the definition of frailty?

Answer 39

when there is > 1 disruption in physiological domain Example: decreased wt, LBM, fatigue, impaired grip strength, physical activity, gait impairment

Question 40

frailty and attendant co-morbidities

Answer 40

they complicate diagnosis example Fe+ and B12 together result in a normocytic anemia this result in a prolonged illness slow recovery overlapping relationship between disease and frailty

Question 41

frailty can result in

Answer 41

``` multiple multiple morbidities need polypharmacological approach physical disability geriatric syndromes vulnerable to hospitalization decreased tx options complicated dug therapy ```

Question 42

disability and impaired recovery from acute illness

Answer 42

``` females>males because of less body mass increased with age cognitive and physical impairment are important biomedical measures that predicts institutionalization healthcare utilization mortality ```

Question 43

what are geriatric syndromes

Answer 43

reflect the complex interplay physiologic vulnerabilities and exposure to stressors increases risk for morbidity and mortality decrease quality of life presents with atypical symptoms and signs due to multiple functional pathology d/t frailty and disease

Question 44

geriatric syndromes

Answer 44

``` urinary incontinence delirium/dementia falls pressure ulcers sleep disorders ```

Question 45

persistent pain results in

Answer 45

``` poor sleep depression increased fatigue decreased motor function delirium social isolation increased risk of ADR ```

Question 46

what is the #1 cause of persistent pain | other causes

Answer 46

MSK | ischemia and neuropathic

Question 47

what is the treatment according to WHO

Answer 47

Tx does not completely alleviated but made tolerable!!! always start with acetaminophen pt, splints, exercise heat, glucocorticoids injections

Question 48

urinary incontinence

Answer 48

involuntary voiding females>males 50% females will have some type of UI over a lifetime increased physical functional and psychological morbidity

Question 49

RF for urinary incontinence

Answer 49

Childbirth, increased age, white race, obesity, UTI, co-morbidities

Question 50

stress incontinence

Answer 50

sphinceter failure with increased abdominal pressure=females decreased pelvic floor strenght prostate surgery

Question 51

urge incontinence

Answer 51

sudden sensation of need to urinate detrusor muscle over activity lack of neurological inhibition local irritation, inflammation

Question 52

overactive bladder

Answer 52

incomplete bladder emptying urine dribbling after micturation or constantly impaired detrusor contractility usually d/t denervation bladder outlet obstruction BPH Cystocele/uterine prolapse

Question 53

pathophysiology as related to aging phenotypes in UI

Answer 53

``` body composition atrophy of bladder and pelvic floor neurodegeneration CNS (conscious control) PNS (denervation) ```

Question 54

UI treatment

Answer 54

``` life modification -weight loss, avoid drinking before bed, limit alcohol, caffeine/tea, tobacco Behavior modifications Kegel exercises bladder training biofeedback Tx UTI antimuscarinics oxybutinin surgery ```

Question 55

under nutrition and anorexia

Answer 55

there is a overall decrease in appetite d/t decreased energy demand poor mirconutrient intake increased mortality

Question 56

under-nutrition and anorexia tx

Answer 56

``` regular weight monitoring nutritionist nutritional supplements life dietaty restrictions these Rx increase fat not muscle ```

Question 57

what is the most common type of ADL that is supported in the elderly

Answer 57

81%Meds least was eating 12%

Question 58

what increased potential to promote healthier aging

Answer 58

exercise and good nutrition

Question 59

screening in primary care setting

Answer 59

``` influenza yearly BMD > 65 year old women yearly BP DM A1C>40yrs old lipid every 5 yrs ```

Question 60

future directions in disease precention for elder

Answer 60

dietary restrictions without malnutrition | decrease weight over lifetime