Ageing Dementia And Nutrition In Older People

Question 1

What changes occur to the respiratory system with ageing?

Answer 1

• lung and chest wall compliance decrease with advancing age, TLC, FVC, FEV1, VC reduce
• easily collapsed upper airway in sleep/ sedative state -> partial or complete obstruction (increased arterial desaturation during sleep)
• reduction in elastic support of airways and leads to increased collapsibility of alveoli and terminal conducting airways

Question 2

What are common post-operative respiratory complications in elderly?

Answer 2

Atelectasis, pulmonary emboli, pneumonia

Increased smokers/ chronic chest disease/ abdo or thoracic surgery

Question 3

How can ageing affect pharmacokinetics?

Answer 3

Elderly have increased sensitivity to CNS depressant drugs

Reduced hepatic and renal function leading to slower metabolism and elimination of drugs

Question 4

How does skin change with old age?

Answer 4

Loss elasticity
Thinning

Fragile subcutaneous blood vessels -> bruise easily

Achieving and securing venous access can be difficult

Question 5

How does ageing affect the CVS system?

Answer 5

Large and medium sized vessels become less elastic and therefore less complaint -> raised systemic vascular resistance and hypertension -> ventricular strain and LV hypertrophy

Cardiac conducting cells decreased -> heart block, ectopic beats, arrhythmias, AF more prevalent

CO falls 3% each decade due reduced stroke volume/ ventricular contractility -> increases arm-brain circulation time for drugs and means IV anaesthetic slower and with reduced dose

Question 6

How does ageing affect pharmacology?

Answer 6

Reduced CO results in delayed onset IV anaesthetic

Reduced total body water and increased adipose tissue -> altered volume of distribution some drugs

Plasma proteins reduced -> decreased protein binding and increased free drug availability

Question 7

How does ageing affect the renal system?

Answer 7

GFR decreased 1% per year after 20yrs due: progressive loss renal cortical glomeruli/ hyaline and sclerotic glomeruli increase, reduced renal perfusion secondary reduced CO/ atheromatous vascular disease

Diabetes mellitus increasingly common and use nephrotoxic drugs (NSAIDs, ACE inhibitors)

Prostatism -> obstructive nephropathy and dehydration

Question 8

How does ageing affect CNS?

Answer 8

Cerebrovascular disease common secondary to diffuse atherosclerosis and hypertension

Neuronal density reduced 30% by 80yrs

Question 9

How does ageing affect metabolic rate?

Answer 9

Basal metabolic rate falls 1% per year after 30yrs - fall metabolic activity and reduced muscle mass -> impaired thermoregulatory control

Question 10

How is dementia diagnosed?

Answer 10

Hx
Ex examinations
Cognitive and MSE (mental status examination)

Blood tests
Imaging

Question 11

What is malnutrition? How many older people are malnourished?

Answer 11

Malnutrition is any condition caused by an in-balance between what an individual eats and what they require to maintain health

Can be eating too little or too much and may also be caused by incorrect balance of nutrients

1/10 older people are suffering or at risk from malnutrition

Question 12

What consequences are there of malnutrition?

Answer 12

Likely to have longer hospital admissions, respond less well to treatment, 3 times more likely develop complications post surgery, higher mortality rates

Question 13

What is the only evidence based tool for screening for malnutrition?

Answer 13

MUST - malnutrition Universal Screening Tool