Aging Physiology, Health Maintenance and Prevention, Cancer in the Elderly

Question 1

Unstable processes with age

Answer 1

Reduced baroreceptor responsiveness - postural HOTN

Thermoregulatory response - hypo/hyperthermia

Cardiac reserve - fluid overload

-diastolic dysfunction or weak pump

Thirst - dehydration

Dark adaptation

Question 2

Signs of aging - 30s

Answer 2

Easier weight gain

Graying/thinning hair

Wrinkling forehead and eyes

“Weekend warrior” injuries

Question 3

Signs of aging - 40s

Answer 3

Mid-life crisis - reflection on mortality, life’s limitations, unreached dreams and goals

Skin/vision changes - presbyopia

Osteoarthritis - visible on xray

Question 4

Signs of aging - 50s

Answer 4

Aging

Menopause

Grandparenting

AARP

Question 5

Signs of aging - 70-80s

Answer 5

>1 chronic disabling condition

Psychologic and social loss

Question 6

Theories of aging

Answer 6

Disengagement theory - voluntary cutting back on work, social, family

Activity theory - staying as active as possible

Continuity theory - adaption to aging as a personal preference

-activity or disengaged according to personality

Question 7

Rule of Thirds

Answer 7

1/3 functional decline as a result of the disease

1/3 due to inactivity

1/3 decline caused by aging itself

Question 8

Screening and life expectancy

Answer 8

65 yo life expectancy - 15-20 years

85 yo life expectancy - 5-7 with average 3-5

Focus on preventing major cause of death

Reduce premature mortality, maintain function, enhance quality of life, extend active life expectancy

Question 9

Cardiac and cerebrovascular screening

Answer 9

Yearly BP

Low dose daily ASA

Question 10

Serum cholesterol screening

Answer 10

Lipid levels less likely to increase after 65 yo if not already increased

Only screen those who have already tested positive >65 and are on medication

Question 11

Diabetes Screening

Answer 11

Screen high risk

A1C and glucose for established diabetics

Question 12

Cancer Screening

Answer 12

2nd leading COD in elderly, common in >40 yo

Breast: yearly until 75, then only w/ >10 yr expectancy

Cervical: DC with 3 previous normals over 10 years and >65 yo

Prostate: 50-69 yo benefit from screening - discuss risk v benefits

Colorectal: 50-75 w/ >5yr life expectancy, don’t screen >85 yo

Lung: smoking cessation, spiral CT of high risk 55-80 yo until 15 yrs out from quitting

-high risk: >30 yr pack hx w/in 15 yrs quitting

Skin/Oral: yearly skin exam

Question 13

Ages of highest cancer incident rates

Answer 13

Incidence increases until age 75,m then levels off

Highest death rates in elderly

-due to organ vulnerability, co-existing illnesses, more aggressive/advanced tumors

Question 14

Most common cancers in elderly

Answer 14

Breast

Prostate

Lung/bronchus - most common 55-74 yo and COD

Colon

Rectum

Question 15

More aggressive and more indolent forms of cancer

Answer 15

More aggressive: AML, large cell NHL, celomic ovarian cancer

More indolent: NSCLC - adenocarcinoma, estrogen/progesterone responsive breast cancer, prostate cancer

Question 16

Treatment issues

Answer 16

Surgery is most effective for many cancers

Chemo has most SE, increased toxicity with decreased treatment effectiveness due to required dose adjustments

-major risk: Myelosuppression, mucositis, drug-specific toxicities