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LC 3 > 3.3 Changes in Structure and Function in Old Age > Flashcards

3.3 Changes in Structure and Function in Old Age Flashcards

1
Q

What can be causative factors of problems in Old Age?

A 
Genetics 
Lifestyle 
Cell damage 
Disease 
Social Factors
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2
Q

What is FEV1?

A

Forced Expiratory Volume in 1 second - the volume of air which can be forcibly be blown out after one full inspiration

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3
Q

What happens to FEV1 with old age?

A

Men have a higher FEV1 , but overall for both men and women the FEV1 decreases - begins at around the age of 30

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4
Q

How are lung and chest functions affected?

A

Decreased elastic recoil
Increased chest wall stiffness
Decreased respiratory muscle strength
Decreased intervertebral space

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5
Q

How is gas exchange affected by old age?

A

Decrease lung elastic recoil
Decreased pulmonary capillary volume
Decreased dispensability of arteries
Decreased Lung surface

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6
Q

How is ventilatory control affected by old age?

A

Decreased responsiveness to hypoxia/hypercapnia
Decreased sensitivity to elastic and resistive loads
Decreased protective reflexes in the airways

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7
Q

What is part of the prognostic score for pneumonia?

A

Confusion, Increased urea, increased respiratory rate and decreased blood pressure, age over 65

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8
Q

Why does diastolic pressure not change?

A

Distal blood vessels don’t show any changes - resting peripheral resistance doesn’t change - diastolic doesn’t change

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9
Q

What other cardiac changes are present in old age?

A

Decreased beta adrenergic stimulation
Left ventricular enlargement - stiffening of main arteries
Ejection fraction at rest remain the same
Decreased response in exercise to cardiac output and heart rate
“STRESS” reveals changes

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10
Q

What do these cardiac changes result in?

A

Symptoms worse on exercise

Greater sensitivity on hypertension, postural hypertension, iischemic heart disease and heart failure

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11
Q

What is carotid sinus syndrome?

A

An exaggerated response to baroreceptor stimulation, causes a drop in blood pressure

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12
Q

What happens to blood pressure in old age?

A

Systolic blood pressure rises steadily with age - This is because larger, elastic, artery walls become thicker and stiffer with increasing age.

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13
Q

Which GI functions change in old age?

A 
Less teeth
Less taste buds 
Less saliva 
Less HCL production
Less gut motility 
Less liver size
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14
Q

How do nutritional requirements change?

A

Malnutrition and nutrient deficiencies are common, usually due to insufficient intake rather than poor absorption

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15
Q

How is the glucose absorption altered?

A

Same amount of insulin is released but it is delayed - higher and longer peak of glucose - meaning that insulin sensitivity has been decreased - less affective packing of glucose into cells, - increased risk of diabetes

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16
Q

What other endocrine changes are there?

A

Osmoregulation
Decreased sensation of thirst
Poorer response to water dehydration - risk of dehydration

17
Q

What happens to bioavailability in old age?

A

Decreased first pass metabolism - decreased liver size and blood flow
Change in distribution volume - low body water, high fat

18
Q

What other changes in drug metabolism are seen?

A

Increased passage across blood brain barrier
Increased tissue sensitivity
Decreased renal and hepatic clearance

19
Q

Give examples of drugs which can be dangerous in elderly….

A 
• Digoxin
• Morphine
• Sedatives (e.g. temazepam, haloperidol)
• Antihypertensives
Warfarin
20
Q

What immune changes are seen in the elderly….

A

Reduction in number of t helper lymphocytes
Reduction in size and function of thymus gland by 60
Reduction in antibody production by B cells
Reduction in mucosal immunity
Less IgE production - less allergies

21
Q

What do the immune changes result in clinically?

A

Higher risk of infection - lower cell mediated immunity

Poorer response of infections

22
Q

What is the risk of shingles of people aged between 45 - 85 ?

A

Five times greater risk of shingles resurfacing due to lowered immunity

23
Q

How does renal function change with age?

A 
Decreased kidney size 
Decreased BF 
Decreased GFR 
Decreased renin and aldosterone 
High levels of variability between people
24
Q

How is renal function measured and how does it change with age?

A

Serum creatinine measured
Creatinine levels reduced due to less muscle
Creatinine clearence varies between individuals

25
Q

What is the Cockcroft and Gault equation?

A 
(140 –age) x body weight (kg) 
 serum creatinine (umol/l)
26
Q

What changes in vision and the eye can be seen in the elderly?

A

Ciliary muscles are weaker
Decreased lens elasticity but increased size - can’t focus
Increased force required to focus at above 40 years
Pupil size decreases - less light
Some retina and optic pathway loss - less detail and contrast

27
Q

What presbyopia?

A

After age 50
Difficulty with near vision
Reading glasses needed

28
Q

How is hearing affected by old age?

A

Degeneration of cochlear cells
Dry impacted wax
Changes in articular cartilage
Degeneration of hair cells and lining cells

29
Q

What is presbycusis?

A

Loss of high frequency hearing with old age

30
Q

What are the changes seen in the brain?

A

Loss of neurones and neuronal connections
Reduced cerebral blood flow
Decreased brain size - bigger ventricles

31
Q

Which aspects of memory are more affected?

A

Working and episodic memory decline

Semantic/procedural memory are less affected

32
Q

What is dementia?

A

Progressive decline in intellectual function

Interferes with daily activities

33
Q

How does old age impact on bone?

A

Peak bone mass - age 25-30

Decreased bone mass accelerated by menopause in women - also smoking, diet, exercise drugs

34
Q

What is WHO definition of osteoporosis?

A

Bone mineral density greater than -2.5 standard deviations from the mean of a healthy young adult

35
Q

How is muscle affected by old age?

A

Loss of muscle strength
Loss of muscle mass
Changes in gait pattern
Increased risk of falls

36
Q

Are age associated changes inevitable?

A

Training can prolong health, so they can be prevented or reversed

37
Q

How is the nervous system altered in old age?

A

Decreased cortical cell count,
Decreased nerve conduction velocity
Decreased sleep duration
Slower psychomotor response

LC 3 (5 decks)

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