9. Geriatric Considerations Flashcards
Geriatric Considerations
Introduction – Life expectancy
• When the United States was founded, life expectancy was about ____ years.
• By the mid-1800s it increased to 42 years.
• In 1950 it jumped to 68 years.
• By 1991 the average was 75.5 years.
• In 2016, the most recent year for which life expectancy statistics are available, the average life expectancy in the United States was ____ years (81.1 years for females, 76.1 years for males).
35
78.6
Geriatric Considerations
Introduction
• Classically, age ____ is considered the beginning of the geriatric period.
• Adults age 65 and older are the ____- growing segment of the United States population.
• Based on several variables, including fertility rate, mortality rate, immigration activity, and the aging of the baby boomer generation, the United States Census Bureau projects that the elderly will constitute ____% of the population by 2050.
65
fastest
20.4
Geriatric Considerations
Introduction
• Aging causes changes at a ____ and ____ system level that must be recognized and compensated for so that effective management and treatment of an elderly patient can proceed safely.
cellular
organ
Geriatric Considerations
Introduction
• The aging process involves both ____ and ____ changes that may alter a patients’ ability to respond to stress as well as their response to drug administration.
physiologic
pathologic
Geriatric Considerations
Medications
• Adverse drug interactions are more common in ____ patients than in younger patients.
• One reason is that geriatric patients take more ____.
-More than one-third of prescriptions drugs used in the US are taken by elderly patients.
-The ambulatory elderly fill between 9-13 prescriptions a year (new prescriptions and refills).
-The average elderly patient is taking more than ____ prescription medications.
-The average nursing home patient is taking ____ medications.
elderly medications prescription five seven
Geriatric Considerations
Medications
• Since its publication in 1991 the Beers Criteria for Potentially Inappropriate Medication (PIM) Use in Older Adults has been the most consulted source of information about the safety of prescribing medications for older adults.
• There have been several updates and it uses a comprehensive, systematic review and grading of the evidence on drug-related problems and ____ in older adults.
adverse drug events (ADEs)
Geriatric Considerations
Evaluation
• The aging process affects all ____ systems.
• Of greatest concern are the effects of aging and the insufficient response to stress within the ____, pulmonary, renal, hepatic, and neurological systems.
organ
cardiovascular
Common Health Care Issues in the Geriatric Population Body mass • Changes that occur with aging include: -A \_\_\_\_ in lean body mass -An \_\_\_\_ in body fat -A \_\_\_\_ in total body water
decrease
increase
decrease
Common Health Care Issues in the Geriatric Population
Body mass – Volume of drug distribution
• The central compartment is smaller (decreased total body water) = ____ peak concentration.
• The rapidly equilibrating compartment is smaller (decreased lean body mass) = ____ drug effect.
• The slowly equilibrating compartment is larger (increased body fat) = ____ volume of distribution and ____ drug effect.
higher
longer
increased
longer
Common Health Care Issues in the Geriatric Population
Neurologic
• Pharmacodynamic sensitivity ____ with age for all drugs that act within the central nervous system.
• There is an age-related decrease in the ____ at 1 atmosphere preventing ____ in 50 percent of patients exposed to a surgical incision (termed “MAC”) for all volatile anesthetic agents.
• The normal ventilatory response of the central nervous system to hypercapnia, and especially to hypoxemia, is ____ with age.
increases
minimum alveolar concentration
movement
diminished
Common Health Care Issues in the Geriatric Population
Neurologic
• The respiratory depressant effects of opioids, benzodiazepines, and volatile anesthetics are ____ in older adults and may further impair the response to ____ and hypoxemia.
• Changes in the peripheral nervous system include a reduction in ____ fibers, with potential alterations in pain perception.
• ____ pain thresholds have been observed in older patients and may contribute to ____ presentation for painful conditions.
exaggerated hypercapnia myelinated higher delayed
Common Health Care Issues in the Geriatric Population
Respiratory
• Although the overall ____ of alveoli does not change with age, ____ changes affect gas exchange.
• Alveolar ducts enlarge and septa collapse due to a loss of elastic tissue, resulting in reduced ____ area.
• The reduction in elastic lung tissue and increased calcifications at rib articulations results in a stiff, less ____ lung.
• The effort to expand the lung increases ____% from 20 to 60 years of age.
number structural total alveolar compliant 30
Common Health Care Issues in the Geriatric Population
Respiratory
• These changes reduce the ____ recoil of the lungs and lead to premature airway closure, air trapping, and increased ____.
• The increase in ____ of the larger central airways (10% from youth to elderly age) also contributes to the overall physiologic ____.
• Due to earlier ventilatory muscle fatigue, the geriatric patient may not be able to ____ the ventilation rate efficiently to address a hypoxic event.
elastic dead space diamete dead space increase
Common Health Care Issues in the Geriatric Population
Renal
• After the age of 50 years, there is a significant decrease in ____ mass and functional nephron units.
• The glomerular filtration rate (GFR) gradually ____ through the age of 60 years (1% per year) and more abruptly thereafter.
• Coupled with decreasing ____ function, renal blood flow ____ by 10% per decade.
• This reduces the concentrating ability, impairs the ability to buffer ____ and base loads, and decreases the capacity to resorb ____ and conserve sodium.
renal declines cardaic decreases acid glucose
Common Health Care Issues in the Geriatric Population
Renal
• In patients 75 years of age, renal blood flow has decreased to less than ____ compared to a 30 year old.
• This decrease in renal perfusion is significant for drugs in which ____ excretion is a principal means of removing the drug from the body.
• Drugs such as ____, tetracycline, and ____ exhibit greatly increased terminal elimination half lives.
half
urinary
penicillin
digoxin
Common Health Care Issues in the Geriatric Population
Hepatic
• Age-related declines in hepatic mass and function, as well as decreased hepatic blood flow, result in ____ metabolism of most drugs.
slower
Common Health Care Issues in the Geriatric Population
Hepatic
• In addition, diminished albumin levels may result in ____ free-drug concentrations of highly protein bound drugs.
• For example:
Diazepam is approximately 98.5% bound (1.5% free to exert its effect) in younger individuals. In elderly individuals, it is only ____% bound.
This leaves ____ as much diazepam available (3% versus 1.5%) to produce its clinical actions.
larger
97
twice
Common Health Care Issues in the Geriatric Population
Cardiovascular
• According to The American Heart Association (AHA), ____ is the primary cause of death in elderly patients.
• 16% of patients older than 65 have ischemic heart disease.
• 25% of patients older than 80 years have some degree of coronary disease.
• ____ affects 35% of people older than 65 years.
• Older patients with hypertension are 2-3 times more likely to have a ____ event than younger patients with similar hypertension.
ischemic heart disease
hypertension
cardiovascular
Common Health Care Issues in the Geriatric Population
Cardiovascular
• The high prevalence of cardiovascular disease in the elderly is a direct result of the ____ related changes that occur in each component of the cardiovascular system.
• As the heart and blood vessels age, their ____ gradually declines due to a decrease in the content of elastic tissue and an increase in the amount of ____, calcium, and smooth muscle.
age
elasticity
collagen
