Introductory Concepts of Geriatrics

Question 1

Conventional age to define “seniors” or “older adults” is…

Answer 1

65+

Is debatable - spectrum because 65 is relatively young (increased longevity)

Question 2

Seniors have an important implication on healthcare because…

$

Answer 2

They account for a large amount of healthcare spending

(43.6%)

Question 3

Aging is a ____ process

Answer 3

Heterogenous

Higher age does not equal being sick

Question 4

Protocols and guidelines in geriatric care are less useful compared to younger ages because…

Answer 4

Increased diversity of health with aging

Care must be individualized

Question 5

Factors that can affect health as we age include…

Answer 5

Lifestyle
Genetics
Socioeconomic status
Education
Social engagements and support

Question 6

Life expectancy refers to…

Answer 6

Proportion of maximum age a person may live

Male avg 81, Female avg 84

Question 7

Health span refers to…

Answer 7

Number of years that are spent free from functional limitations, morbidity, and pain

Goal of most geriatric models of care is to prolong the health span

Question 8

Functional capacity is an indicator of…

Answer 8

Ability to carry out everyday tasks

Question 9

Activities of Daily Living (ADL’s) may include…

Answer 9

Bathing
Ambulation
Toileting
Transfers
Eating
Dressing

BATTED

Question 10

Instrumental activities of daily living (IADL’s) may include…

Supportive tasks that are required to maintain independence

Answer 10

Shopping
Cooking/Cleaning
Using transportation/communication
Managing money/medication

SCUM

Question 11

The clinical frailty scale is measured based off of…

Answer 11

Degree of functionality and ability to carry out ADL’s and IADL’s, with/without help

Question 12

Functional reserve refers to…

Answer 12

When body systems have capability beyond what is needed for everyday activities

Older adults have a lower functional reserve compared to younger adults

Question 13

Impairment in function relates to functional capacity in that…

Answer 13

An individual experiences Impairment in function when their demands exceed their functional capacity (ability to carry out everyday tasks)

Lower functional reserve in adults (ex: increase risk of decline when faced with illness/injury)

Question 14

Functional decline refers to…

Answer 14

Reduction in ability to perform ADL’s or IADL’s due to decreased physical/cognitive function

Question 15

Changes in the GI system with absorption involve…

Answer 15

Decreased gastric acid secretion
Slower gastric emptying + delayed intestinal transit
Decreased blood flow

Question 16

The extent of absorption for some medications may be impacted due to…

Some examples of medications include…

Answer 16

Decrease in gastric acid secretion

Iron supplements
Calcium carbonate
Ketoconazole

Question 16

Generally speaking, absorption in geriatrics is impacted by…

Answer 16

A decrease in rate of drug absorption
No change in extent of drug absorption (does have some exceptions)

Question 16

Percutaneous absorption is impacted in geriatrics via…

Answer 16

Drier, lower lipid content - decrease rate of percutaneous absorption of lipophilic medications (extent is the same)

Fentanyl
Testosterone
Estradiol

Question 16

Distribution of drugs associated with body composition changes with aging because of…

Answer 16

increase in body fat (lipophilic drugs), and decrease in muscle mass/body water (hydrophilic)

Question 17

Highly lipophilic drugs are impacted by aging via…

Some examples include…?

Answer 17

Distributing out into fat tissues - longer half-life, more re-distribution needed to eliminate

Diazepam, amiodarone

Question 17

Highly hydrophilic drugs are impacted by aging via…

Some examples include…

Answer 17

Less lean body tissue = more drug in bloodstream, increased concentration of drug

Lithium, aminoglycoside antibiotics

Question 17

Metabolizing enzymes that are affected with aging include…

Answer 17

Some reduction in Phase 1 (CYP mediated) - longer half-lives, decreased dose requirements or increase in dosing interval

Phase 2 is NOT affected

Heterogenous - can vary via individual

Question 17

Protein-binding is impacted with aging via…

Some medication examples include…

Answer 17

Decreased albumin levels in frail/malnourished older adults - decreased protein binding of highly bound medications

Phenytoin, warfarin, VPA

Overtime, increased metabolism/elimination compensates for increased free drug
Start low, go slow

Question 18

Elimination in older adults is primarily affected by…

Answer 18

Decrease in renal size, blood flow, GFR and tubular secretion - elimination is slower and may require decreased dosages to avoid toxicity.

Question 18

First-pass extraction in older adults is affected by... | Some examples include...

Answer 18

Decrease in liver size and blood flow; drugs with high first-pass extraction will have increased bioavailability | Metoprolol, morphine, amitriptyline ## Footnote **Start low, go slow**

Question 19

Using serum creatinine alone to estimate kidney function is...

Answer 19

Not reliable - muscle mass tends to decrease with age, so SCr may be falsely low ## Footnote Also does not account for effect of age on kidney function

Question 20

The equation that drug-dosing recommendations are generally based on for estimating renal function is...

Answer 20

Cockcroft-Gault - incorporates SCr, age, gender, and weight to estimate CrCl

Question 21

Pharmacodynamic changes refer to...

Answer 21

Changes in medication response associated with aging

Question 22

Pharmacodynamic changes may be due to...

Answer 22

Changes in receptor sensitivity or altered homeostatic mechanisms

Question 23

Pharmacodynamic changes related to the CV system involve... | (4)

Answer 23

Decreased BP lowering response to beta-blockers Decreased arterial compliance and decreased baroreceptor reflex (predisposition to orthostatic hypotension) Increased stiffness of large blood vessels (isolated systolic hypertension) Increased susceptibility to QT prolongation

Question 24

Pharmacodynamic changes related to CNS involve...

Answer 24

Increased permeability of BBB - increased susceptibility to CNS adverse effects Decreased dopaminergic neurons in substantia nigra - increaed susceptibility to EPS of dopamine-blocking medications

Question 25

Pharmacodynamic changes associated with fluid and electrolyte homeostasis involve...

Answer 25

Decreased thirst response, GFR, response to ADH, and aldosterone More susceptible to dehydration, hyponatremia, SIADH, hyperkalemia

Question 26

Older adults have a lower hematopoietic reserve, which means...

Answer 26

Increased risk of hematological toxicities associated with chemotherapeutic drugs

Question 27

Older adults have an ____ response to antiepiletic drugs at lower serum concentration, which...

Answer 27

Increased response - increases susceptibility to adverse effects

Question 28

Immunosenescence changes with aging, because...

Answer 28

Reduced ability to fight infection Reduced immune response following vaccination Increased susceptibility to malignancy

Question 29

Gastric mucosa changes with aging by...

Answer 29

Decreasing regenerative capacity of gastric mucosa - increased risk of GI bleeds (NSAID, ASA)

Question 30

Therapeutic window changes with aging by...

Answer 30

Narrowing the window between therapeutic response and toxic response | Hence, dosing is important to avoid AE's

Question 31

Geriatric syndromes are...

Answer 31

Common health conditions in older adults that have multifactorial causes, and do not fit into discrete disease categories