Ageing and the body Flashcards
How does ageing affect health care?
- Natural process - happens to everyone
- Body systems change
- Impacts on how well body copes with new and ongoing insults
- Impacts on how we treat and manage patients
- Implications for ongoing care - increasingly challenging
How does ageing affect the skin?
- Elastic tissue becomes less effective as we age
- Skin becomes less tight and thinner
- More susceptible to damage and therefore more fragile
- Causes skin to tear and bruise easily
How does ageing affect the respiratory system?
- Elasticity in lungs is important for normal function
- Lung compliance is determined by elastic tissue
- Elastic recoil allows for passive exhalation
- Reduction in TLC, FVC, FEV1, vital capacity as we age
- Elastic tissue important in holding terminal airways and alveoli open
What factors affect the lungs other than age?
- Work exposure
- Smoke exposure
- Repeated infections
- Chemical/toxin exposure
- Chest infections become more common as we age - causes damage and scarring to lungs
How does reduced lung function affect older people?
- Patients are at greater risk of respiratory infections
- More likely to be acutely unwell
- More likely to need hospitalisation
- More likely to need oxygen/IV antibiotics
- More prone to post operative complications
- Sedating drugs more likely to cause respiratory problems
Which post-operative complications are elderly people more prone to due to reduced lung function?
- Atelectasis
- Pneumonia
- Pulmonary embolism
How does ageing affect the cardiovascular system?
- Blood vessels become more stiff as we age (especially arteries)
- Elastic recoil is reduced so arteries are less expansile
- Increases resistance to blood flow
- Leads to hypertension
- Increased cardiovascular work
- Increased risk of left ventricular hypertrophy
- Decreased left ventricular volume
- Can lead to heart failure
How does left sided heart failure lead to right sided heart failure?
- Blood backs up and pools in lungs
- Right side of heart has to work harder against pressure
- To get blood through lungs to be oxygenated
What are the risks of uncontrolled hypertension?
- Increased risk of stroke
- Increased risk of MI
- CKD
- Heart failure
- AF - increases risk of stroke
- Vascular disease e.g. abdominal aortic aneurysm
- Damage to vision
- Increased risk of vascular dementia
Outline the pathophysiology of atrial fibrillation
- Hypertension causes increased stretch of the atria
- Atrial stretch causes small areas of damage
- New foci of electrical activity
What are the key features on an ECG which shows AF?
- Wavy baseline
- Absence of P wave
- Irregularly irregular heart rate
How does age affect the renal system?
- GFR decreases as we age
- Structural changes
- Atheromatous vascular disease
- Reduced cardiac output
- Lots of medications are renally excreted
Why is decreased kidney function a problem in elderly people?
- A lot of medications are renally excreted e.g. morphine
- Problem because older patients tend to be on multiple medications
- Takes longer for them to excrete drugs
- Can result in toxic effect
How can we avoid issues in elderly patients with renal problems?
- Find out patients’ renal function before prescribing medications
- Use alternative drugs
Which co-morbidities affect renal function?
- Diabetes - leads to diabetic nephropathy and damage to microvascular structures due to hyperglycaemia
- Hypertension - some antihypertensive medications are nephrotoxic (NSAIDS, ACEi)
What happens to bone as people age?
- Bone density decreases
- Gradual decline
- Declines more quickly in women after menopause
What happens to muscle as people age?
- Muscle mass decreases
- Multifactorial
- Use it or lose it
What happens to bone marrow as people age?
- Bone marrow changes
- Becomes less cellular and more fatty
- Decreased cellular production
What are the consequences of decreased bone density and muscle mass?
- Increased risk of fracture (fragility fractures)
- Increased falls risk
- Decreased strength
- Increased risk of trauma
- Osteoporosis
How does GI function change with age?
- Liver function gradually reduces over time
- Decreasing blood flow to liver
- Decreased mass of functional liver cells
- Slower transit through intestines - increased constipation
- Decreased absorption e.g. of nutrients and medication
Why is malnutrition an issue in the older person?
- Good nutrition is essential for recovery from illness
- More malnourished patients are, longer recovery takes
- Wound healing particularly affected
- Must screen all patients on admission
How does malnutrition affect wound healing?
- After surgery more likely to have wound breakdown or delayed healing
- Increased risk of pressure ulcers
- Pressure ulcers difficult to heal without nutrition
How does ageing affect the neurological system?
- Brain undergoes changes as we age
- Some parts shrink - particularly areas related to learning and complex mental activities
- Senescence of some cells
- Reduced communication between neurones
- Reduction in blood flow
- Neuronal density reduces by almost 1/3 by the age of 80
What are the different types of dementia?
- Alzheimer’s
- Vascular
- Fronto-temporal
- Lewy body
How do we diagnose dementia?
- Needs comprehensive assessment
- History, examination, investigations
- Determine the type of dementia and possible medication options
How does ageing make management of older patients more complex?
- Body systems are interdependent
- Need to consider side effects and unintended consequences
- Operations cause high physiological stress but elderly patients have low physiological reserve
- Often multimorbid - can’t focus on one system
- Needs a holistic approach
How should we approach prescribing for elderly patients?
- Can be particularly challenging
- Have to balance proposed benefit with side effects
- More likely to be on medications already - risk of interactions and unintended consequences/worse side effects
- Reduced renal and liver excretion of drugs
How can we get around reduced renal and liver excretion of drugs in elderly patients?
- Dose reduction
- Alternate medications
- Close monitoring - titration and monitoring for effects
- General rule is to start at a lower dose
What questions should we ask before prescribing something?
- Does something need prescribing?
- Is there an alternative strategy?
- If not what is the lowest possible dose?
- Does that drug interact with any other medications?
- If there is an interaction, which medication is most important?
- Is there a more suitable alternative
How can we make treatment a patient centred approach?
- What does the patient want?
- How can we achieve it?
- What are the person’s beliefs?
- Treating with dignity
- Working in accordance with best interests
- Is hospital the best place for your patient
- What social needs does the patient have?
- Loneliness is a big factor
What does compassionate care allow patients to do?
- Can think about planning for the future
- Emergency healthcare plans
- Reduce admissions to hospital
- Allows clinicians to know what is important to patient
- Resuscitation
- Involve family/carers/friends
