3 - Sensory Impairment in Older Patients Flashcards
How does skin change as it ages?
Get reduced vascular tissue
Disorganisation and loss of collagen fibres
Decreased number sweat glands
Decreased number of immunological cells
Dec in subdermal fat and elastin
Thinned epidermis
Weakness in the dermo-epidermal junction
What are the clinical implications of ageing skin?
Get dry skin that cracks easily
Can cause
- Xeroxes cutis (dry skin)
- Pruritis (itchy skin)
- inc risk of cellulitis
- inc susceptibility to trauma
- delayed wound healing -> pressure sores
How is body temperature affected by ageing skin?
How is this clinically relevant?
Heat delivery to epidermis for excretion = impaired (loss of dermal capillaries)
Dec # sweat glands
Subdermal fat reduced
–> Impairment in thermoregulation
Hypothermic in winter
Hyperthermic in summer
How is sensory perception affected by ageing?
What is the clinical implications of this?
Large dec in # Meissiner’s & Pacinian corpuscles
=> impaired sensory perception
=> inc in falls
=> inc in foot ulcers
What happens to Vit D levels as we age? Why?
What are the clinical implications of this?
By 80 there is a 50% decrease in Vit D levels
Due to a decrease in Vit D precursors in the skin (cholecalciferol etc)
–> inc risk of Vit D deficiency
= sarcopenia
= fragility fractures
Why is excessive sun exposure not advised?
=> Ageing of the skin
- inc cellular dysplasia
- Atypical cells
- Disorganisation in epidermis
- Elastosis in dermis
What benign skin tumours are common in older Ps?
Seborrhoeic keratosis
Campbell de Morgan spots
What is seen here?
Seborrhoeic kertaosis
What is seen here?
Campbell de Morgan spots (cherry angioma)
Which pre-cancerous skin tumour can be seen in older Ps?
Actinic kertaosis (early form of squamous cell carcinoma)
What is seen here?
Actinic kertaosis (early form of squamous cell carcinoma)
Which cancerous tumours can be found in older Ps?
BCC
SCC
Melanoma
In elderly Ps - changes in the oropharynx can cause
- reduced taste and smell
- reduced saliva production
- inc oral transit time
- reduced cough reflex
- inc levels of dental disease
What are the clinical implications of this?
Can develop xerostomia (dry mouth)
Can get inc candidasis => dec intake of food
Can contribute to malnutrition
What changes can occur to the oesophagus in ageing?
What are the clinical implications of this?
Can get decreased waves of peristalsis (due to loss of enteric neurons)
Can get laxity of the GOJ
Can also get oesophageal dilation
–>
Aspiration pneumonia
GORD
What happens to the stomach as we age?
What are the clinical implications of this?
Inc atrophic gastritis => reduction in gastric acid production
+
Delayed gastric emptying
Implications =
- Malabsorption - lower iron and calcium
- Risk of bacterial overgrowth
- Inc incidence of coeliac - suspect if P presents with low iron
As we age -
- there is a loss of neurons in the myenteric plexus
- requirements for intra-abdominal pressure to excrete stools increases
- is increased gut transit time
- reduced stool water content
- inc prevalence of diverticular disease.
What are the clinical implications of this?
Inc prevalence of
- constipation
- diverticulitis
Why does there appear to be a decline in appetite and food intake in older age?
There is earlier satiety and less hunger
Thought to be multiple causes
= inc in CCK, leptin and insulin
= less gastric compliance -> early satiety
When does muscle mass and strength peak?
Early adulthood
How much does muscle mass decrease per year after 50?
1-2% per year
What molecular changes occur to muscles with ageing?
Is a reduction in muscle mass (esp fast-twitch T2 muscle fibres)
Muscle gets infiltrated with fat and connective tissue
Reduction in motor neurons => reduction in myocyte numbers
What hormonal changes occur in older age that affect muscle mass?
Reduced
- testosterone & oestrogen
- growth hormone
How can you assess sarcopenia?
How can you prevent sarcopenia?
Resistance exercises
Nutrition (esp protein)
Vit D - can reduce sarcopenia
Which is the commonest joint disorder in older Ps?
OA
What are the four signs of OA on Xray?
The four cardinal signs of osteoarthritis seen on x-rays are the following:
* Asymmetric joint space narrowing.
* Osteophytes.
* Subchondral sclerosis.
Subchondral cysts.
Why is OA of the knee important?
Has significant functional consequences - limits mobility, independence and contributes to frailty
When is peak bone mass achieved?
Between 20-30
What can expedite bone loss with age?
Menopause
Chronic illnesses (Cushing’s, Anorexia, Thyroidtoxicosis, Steroid drugs, Anti-epileptics, Breast Cancer)
Vit D Deficiency exacerbates
What causes bones to age?
An inc in osteoclastic activity and lack of inc of osteoblastic activity to match this
How is Vit D made in the body?
Synthesised in the skin or taken from diet as D3 (Cholecalciferol) - converted in liver and kidney to 1,25-dihydroxycholecalciferol (vitamin D active form)
What illnesses of older age is Vit D deficiency implicated in?
Sarcopenia
Osteoporosis
Is important for BOTH bone health AND muscle function
Why can Vit D deficiency occur in older Ps?
Reduced production of D3 in the skin
Decreased dietary intake of Vit D
Reduced renal function in older adults
Liver disease
What percentage of care home residents have severe Vit D deficiency
Up to 40%
Why are fragility fractures important?
Ass with
- inc mortality & morbidity (chronic pain)
- disability
- change in posture
- gait disorder
- progression of frailty
Which are the common osteoporotic frailty fractures?
NOF
Vertebral
Colles
Humeral shaft
Pubic ramus
Rib fractures
What is the definition of a frailty fracture?
Fracture obtained from falling from standing height
What are the markers of frailty?
Weight loss
Reduced muscle strength
Reduced gait speed
