Clinical aspects of aging

Question 1

homeostenosis

Answer 1

reduced physiologic reserve to maintain homeostasis during periods of stress

Question 2

vision

Answer 2

dec dynamic visual acuity, detection of lateral motion, depth percetion
dec contrast sensitivity
inc glare sens

can’t night drive, fall risk, med issues

Question 3

Presbycusis

Answer 3

high frequency hearing loss first

bilateral, symmetric, slow progressive

Question 4

Presbystasis

Answer 4

vestibular degeneration

diagnosis of exclusion

Question 5

Taste and smell

Answer 5

50% increased taste threshold by 80
15% red of smell
inc use of salt shaker

Question 6

GI

Answer 6

reduced relaxation of gastric fundus, early antral filling
dec gastric emptying
dec in dynorphins- eating drive
dec physical activity and altered metabolism

Question 7

Esophageal

Answer 7

reduced swallowing coordination
presbyoesophagus- decrease of contractile amplitude
inc microaspiration risk

Question 8

Gastric

Answer 8

dec Hcl
reduced intrinsic factor
inc risk of peptic ulcer disease

Question 9

Intestinal- small bowel

Answer 9

red absorption of iron, zinc, b12, folic acid, lactose
red vit d receptors in gut- calcium absorption impaired
bacterial overgrowth

Question 10

intestinal- colon/rectum

Answer 10

inc rectal compliance + dec rectal sensation

diverticulosis

Question 11

liver/gallbladder/pancreas

Answer 11

reduced blood flow to liver- impaired hepatic oxidative pathways
dec synthesis of vit K dependent clotting

Question 12

CV

Answer 12

LV compliance and diastolic filling dec 
LV thickness inc
LV relaxation dec
Max CO dec
Systemic vascular resistance inc 

inc afterload, leads to LVH , reducing ventricular compliance and diastolic filling

atrial fibrillation common

Question 13

sym stimulation

Answer 13

reduced cardiac inotropic and chronotropic responses
prolonged recovery
cardiac output at rest no change

Question 14

vascular

Answer 14

thickened arterial intima- calcium, altered collagen and elastin

inc systolic pressure- afterload

AMI, HF

inc fall risk
orthostatic hypotension

Question 15

pulmonary

Answer 15

reduced chest wall compliance- cartilage calcification
inc risk for atelectasis, reduced clearance, pneumonia
inc residual volume

upper lung better ventilated, lower lung better perfused- vq mismatch

dec PaO2, normal PCO2

reduced sensitivity to hypoxia- less likely to report dyspnea

Question 16

Renal

Answer 16

dec in functioning glomeruli- 30% reduction
renal glucose threshold lower
Inability to maximally conserve water in response to water deprived or hyperosmolar conditions

dec renin response to volume depletion, ANP levels increase, dec body water reserves, reduced thirst

Question 17

Endocrine changes

Answer 17

DMT2 risk
TSH elevations
Drop GH

Question 18

Immune system

Answer 18

Red immune response
INc mortality from pneumonia and flu
TB and Hz reactivation

reduce development of SLE, MS

Question 19

MSK

Answer 19

height loss of 2 inches by 80
Grip strength down 60%
Muscle mass to body weight reduced 30-40% (sarcopenia)
inc risk of falls- red muscle strength, inc fall related fracture risk

Question 20

Neuro

Answer 20

slower reaction times
reduced proprioceptive info 
dec or absent ankle jerk 
dec in brain weight and dec cerebral blood flow 
mild forgetfulness