Aging and Cardiopulmonary disease (Mod 3) Flashcards
What are general considerations for the Geriatric population?
Increasing vulnerability to accidents and disease
- age increases susceptibility to disease
- Hard to differentiate between normal aging and pathological process
- Longer recovery periods
What are the general effects of ageing?(10)
- Renal function decline
- Falls/Injury
- Bone mass loss
- Sensory impairment
- Cognitive decline
- Hearing loss
- Polypharmacy
- Loss of muscle mass and strength
- Decreased immunity
- Psychosocial implications
What can occur with renal function decline with age?
- Drugs don’t clear out as fast
- Decreased U/O
- Electrolyte imbalance
- May need dialysis after treatments
- More susceptible to Dehydration
General anatomical/physiological changes to the respiratory system as a result of ageing?
- Increased airway reactivity
- Increased risk of pharyngeal collapse; OSA
- Decreased ciliary number and activity
- Diminished airway reflexes
- Dysphagia
- Cervical spine stenosis/stiffness
What changes can be expected with age?
- Calcification of cartilage in tracheal walls and bronchi
- Functional changes in airway receptors
- Drug admin may need to be adjusted
What altercations can be expected to the Alveoli with a age?
Number of alveoli remain unchanged
- Alveolar ducts and alveoli wider, shallower
- Decrease gas exchange surface area
How are the functions of respiratory muscles affected by aging?
Decreased total muscle mass and muscle strength (muscle atrophy)
- Decreased strength of cough
- Decreased MIP
- Decreased proportion of fast twitch fibres
- Intercostal/Diaphragmatic muscle atrophy (EMG activity reduced by 50%)
How is the Thoracic cage affected by aging?
- Slide 9
- Calcification of costal ligaments
- Kyphosis
- Decreased range of motion for thoracic rib articulations
- Thoracic vertebral height loss
- Increased anteroposterior chest diameter
- Decreased elasticity of intercostal muscles
- Flattened curvature of the diaphragm
How is lung function affected by aging alterations?
- Decreased chest wall compliance; increase in RV
- Recall; chest wall compliance +.Lung = compliance
- Increased AC membrane thickness; DLCO decline
- Senile emphysema?
What are the affects of Senile emphysema?
- Degeneration of elastic fibres, enlargement of air spaces
- Increase of closing capacity -> decreases max. insp. Flow-air trapping
- FEV1 and FVC both decrease (FEV1/FVC only to a small degree)
- TLC unaffected
- RV and FRV increase-decreased VC
Why does RV increase with ageing?
Decreased chest wall compliance increases RV and FRV but decreases VC because of senile emphysema
- Degeneration of elastic fibers enlarges air spaces
- Increase of closing capacity decreases max insp. = flow air trapping
How is Ventilatory response with ageing?
- Increased shunt (senile emphysema)
- Anatomic dead space increases Vd/Vt
- PaO2 declines w/age, P(A-a)O2 increases at rest
- Diminished ventilatory response to PaO2 and PaCo2
How is immunity affected with ageing?
- Increased immunoglobulin content
- Decreased alveolar macrophage population
How is the Cardiovascular system affected by ageing?
- Heart wall thickness increases (especially L ventricle)
- Heart valve thickening and calcification (Mitral, Aortic)
- Arterial collagen content increases-stiffening, high systolic pressure
- Postural hypotension
Polypharmacy issue with aging
patient swallow reflex gets dulled as they get older so they are more vulnerable to aspirations
- many come in with micro aspirations, and get repeated pneumonia which is a first sign that they’re micoaspirating
- Decreased immunity, recommend they get more vaccines than other populations
Why does aging reduce responsiveness to drugs like Ventolin
Alveolar ducts and alveoli are wider and shallower = decreased gas exchange surface area
- leads to decreased DLCO
- secondary cause is because the AC membrane gets thicker with age
Implications of decreased total muscle mass in aging?
Decreased muscle strength =
- Decreased strength of cough and
- Decreased MIP
Implications of a stiffer thorax in geriatric patients (aging)
We get shorter as we age, air trapping is more likely to occur due to decreased chest wall compliance = higher WOB
- Decreased thoracic compliance and increased lung compliance
- resting SpO2 also drops with age
Why does the risk of air trapping increase with age?
Inability to empty lungs on exhalation due to stiffer thorax
Ventilatory response to aging?
Increase shunt due to senile emphysema
- anatomic dead space (vd/vt) increases
- PaO2 declines with age, P(A-a) increases at rest
- Diminished ventilatory response to PaO2 and PaCO2 (They decompensate fast)
Characteristics of senile emphysema?
Degeneration of elastic fibres, enlargement of air spaces
- Increase of closing capacity, decreases max. insp. Flow-air trapping
- FEV1 and FVC both decrease (FEV1/FVC only to a small degree)
- TLC unaffected
- RV and FRV increase-decreased VC
Why do geriatric populations have slower recovery periods?
Since they have a higher immunoglobin (iGe) content, which is normally lower. It means they are highly reactive to allergens.
- A highly reactive immune system = increased inflammation in the lungs and degenerate changes like COPD
- Leads to chronic inflammatory process
- Not only that, Cilia are not doing their job = weak cough and gag meaning they can’t clear junk out.
Why do geriatric patients have thicker left ventricles?
years of work; which also means that ejection fraction lowers (blood leaving the L ventricle)
Implications of mitral valve and aortic valve thickening?
They may need replacements = operations
