Ageing, Dementia and Falls Flashcards
What happens to the respiratory system of someone ageing?
What are the complications due to this?
- Lung and chest wall compliance decreases - TLC, FVC, FEV1 and VC decrease - due to reduced elastic support - increased collapsibility of alveoli and terminal conducting airways
- Loss of elastic tissue in upper airways
- Atelactasis, PE and pneumonia are common post-op in elderly (increased if they’re a smoker or have a chronic chest disease)
- Sleep apneoa
What happens to the skin with ageing?
- Thin skin and fragile subcutaneous blood vessels - bruise easily - difficult to get venous access
- warfarin, steroids, aspirin and statins can make this worse
What happens to the cardiovascular system with ageing?
- Large and medium sized vessels become less elastic - less compliant - raised systemic vascular resistance and hypertension - left ventricular strain and hypertrophy
- Cardiac conducting cells number decreases - more likely to get afib (reduced CO), arrhythmias, ectopic beats and heart block
- Reduced CO due to reduced stroke volume and ventricular contractility - this increase the arm-brain circulation time for drugs so IV anaesthesia is achieved more slowly
What happens to the renal system with ageing?
- GFR decreases by 1% each year over the age of 20 - loss of renal cortical glomeruli
- Reduced renal perfusion due to reduced CO and atheromatous disease
- Increased use of nephrotoxic drugs with age e.g NSAIDs and ACEi
- DM is more common with age
What happens to the CNS with ageing?
- More common to get cerebrovascular disease due to hypertension and diffuse atherosclerosis
- Neuronal density is reduced by 30% by 80 years
What happens to the endocrine system with ageing?
- BMR falls by 1% per year after 30 years - fall in metabolic activity and reduced muscle mass leads to poor thermoregulatory control
What are the common types of dementia and which regions are more commonly affected in each?
- Alzheimer’s - hippocampus and cerebral cortex - memory, language and reasoning issues
- Lewy-Body - cortex, limbic system, basal ganglia, hippocampus, midbrain - hallucinations and disordered sleep
- Vascular - blood vessels - impaired judgement, difficulty with motor skills and balance
- Frontotemporal - frontal and temporal lobes - behaviour, speech/language and personality
What is the MUST nutritional score?
- Measure height and weight - workout BMI
- What was the percentage of unplanned weight loss?
- What is the disease score?
- Add steps 1-3 together to get risk of malnutrition
- Use local guidelines to work out how to proceed and develop a care plan
Why are the elderly more likely to be malnourished?
Longer hospital stays, more likely to develop complications after surgery
What is malnutrition?
Deficiencies/excesses in a person’s intake of energy and/or nutrients
What are some common causes for falls?
- Syncopal - reflex (can be caused by drugs), orthostatic hypotension, cardiac/cardiopulmonary disease
- Non-syncopal - drugs, seizures, poor mobility (trips and slips), infection/other illness
What are the pre-syncope symptoms?
- light headedness
- sweating
- pallor
- blurred vision
What is reflex syncope?
Disorder of the autonomic regulations of postural tone
- vasovagal - prolonged standing, stress, pain, sight of blood
- situational syncope - coughing, straining, lifting heavy weight
- carotid sinus massage
Why does orthostatic hypotension occur?
Blood pools to legs, reduced EDV, reduced cardiac stretch and so reduced SV and CO (normally managed by the baroreceptor reflex but if that fails, cerebral BP drops and syncope occurs)
Baroreceptors become less sensitive with age and with hypertension and impaired by antihypertensives and dehydration
What are some examples of cardiac syncope?
- Electrical - bradycardia, tachycardia
- Structural - aortic stenosis, hypertrophic cardiomyopathy
- Coronary - MI or ischaemic heart disease
