Elderly Flashcards by Bryan Groff

How does minute ventilation change in the elderly?

Minute ventilation increases

Increased Vd leads to an increased Ve (minute ventilation) to maintain normal PaCO2

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How does lung elasticity change in elderly?

Elasticity decreases which leads to collapsed small airways

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How does chest wall compliance change in the elderly?

Becomes less compliant and stiffer

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How does lung recoil change in the elderly?

Decreased

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How does A:P diameter change in the elderly?

Increased

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How does FRC change with age?

Increases

Reduced recoil leads to air trapping which increases residual volume

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At what age does closing capacity surpass FRC when supine ? What about standing?

Supine - 45

Standing - 65

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How does arterial compliance change in the elderly?

Decreases (more stiff)

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What does decreased arterial compliance lead to in the elderly? Pulse pressure, HR, BP, myocardial wall tension?

Increased in all

BP
HR
PP
Myocardial wall tension to overcome higher afterload and myocardial hypertrophy

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How does myocardial compliance change in the elderly?

Decreased compliance

Impaired relaxation

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What type of rhythms do the elderly tolerate poorly? Why?

Atrial dysrhythmias, they rely more on atrial kick

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What type of heart dysfunction are the elderly at risk for?

Diastolic dysfunction

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How does the cardiac conduction system change in the elderly?

It becomes fibrotic and increases the incidence of dysrhythmias

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Do the elderly exhibit a change in systolic function?

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How do HR, SV, and CO change in the elderly?

All decrease

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What happens to circulating catecholamines in the elderly?

The increase but have a decreased response to them

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How does thermoregulation change in the elderly?

It becomes impaired so they are at risk for hypothermia (Why old people are cold and like Florida)

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How does baroceptor response change in the elderly?

Decreases (Unable to change HR during hypotension)

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How does the adrenergic receptor density change in the elderly?

Decreases

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When does MAC change in the aging population? How much ?

MAC decreases by 6% each decade after 40

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What is the difference between postop delirium and postoperative cognitive dysfunction?

Post op delirium - early post op period

Postoperative cognitive dysfunction - weeks to months after surgery

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What is the treatment for postoperative cognitive dysfunction?

Time - most resolve after 3 months

Use rapidly metabolized drugs

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What is the treatment for Post op delirium?

Use less drugs and drugs that are metabolized fast

Treat underlying cause and use antipsychotics

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How does sensitivity to local’s change in the elderly?

Become more sensitive because of

decreased conduction velocity, decreased diameter and decreased number of myelinated nerves.

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Do elderly need a change in intrathecal or epidural anesthesia? Why?

Yes, they need less because of reduction in CSF volume and reduction in space

How does GFR change in the elderly?

Decreases by 1ml/min/year after the age of 40 *drug elimination is or may be slower

What is the most sensitive indicator of GFR in the elderly? Why?

Creatinine Clearence because Even though creatine goes up from the GFR, elderly have less muscle mass

Normal Creatinine Clearance ?

100-150 but decreases by 1 every year after 40

How does alpha 1 acid glycoprotein change with age?

It increases which is a larger reservoir for basic drugs (Decreases free fraction)

How does albumin change with age?

Decreases (smaller reservoir for acidic drugs) (Increases free fraction)

How does pseudocholinesterase change with age?

Decreases

How does circulation time change in the elderly?

It increases

How does decreased circulation time change IV and Inhaled anesthetics?

IV - slower induction Inhaled - faster induction

How does lean body mass change with age?

Decreases which causes decreased - blood volume - Total body water -Basal metabolic rate -Plasma volume -Vd

What is a MET equal to?

One MET is equal to 3.5mL//kg/min

Most significant risk factor for cancer?

Old age

For every MET achieved, mortality decreases by how much?

11%

Frailty is characterized by a combination of what 2 things?

Decreased reserve and reduced resistance to stress

In the elderly, does MV increase or decrease?

increases

In the elderly, does lung compliance increase or decrease?

Increases (this is how easy to inflate the lungs)

In the elderly, does lung elasticity increase or decrease?

Decreases (this is the recoil of the lungs)

In the elderly, does chest wall compliance increase or decrease?

Decreases

In the elderly, does dead space increase or decrease?

increase

In the elderly, does V/Q mismatch increase or decrease?

Increase

In the elderly, does A-a gradient increase or decrease?

Increase

In the elderly, does alveolar surface area increase or decrease?

Decrease

In the elderly, does PaO2 increase or decrease?

Decrease

In the elderly, does calcification of joints increase or decrease?

increase

In the elderly, does diaphragmatic flattening increase or decrease?

Increase

In the elderly, how does the response change to hypercarbia and hypoxia?

Chemoreceptors are less responsive

In the elderly, does upper airway tone change?

Decreased respiratory strength

What age does closing capacity surpass FRC when supine? Standing?

Supine - 45 Standing - 65

In the elderly, does Residual volume increase or decrease?

Increases

In the elderly, does TV increase or decrease?

No change

In the elderly, does ERV increase or decrease?

Decrease

In the elderly, does IRV increase or decrease?

Decrease

In the elderly, does FRC increase or decrease?

Increase

In the elderly, does IC increase or decrease?

Decrease

In the elderly, does CC increase or decrease?

Increase

In the elderly, does VC increase or decrease?

Decrease

In the elderly, does TLC increase or decrease?

No change

What 3 volumes are increased in the elderly?

FRC CC RV

In the elderly, which lung volume does not change

TLC

In the elderly, does FEV and FEV1 increase or decrease?

Decrease

How does arterial compliance change in the elderly?

Goes down

How does SVR and Pulse pressure change in the elderly?

Increases due to reduced arterial compliance

How does the left ventricle change in the elderly?

Increases in thickness due to pumping against stiff arteries

How does venous compliance change in the elderly? How does this change the blood volume?

Compliance decreases which allows for less blood

What does the elderly heart rely on?

Atrial kick

What type of heart disease develops in the elderly ?

Diastolic dysfunction

How does the cardiac conduction change in the elderly?

Becomes fibrotic which increases dysrhythmias like afib, 1st degree HB and 2nd degree HB and sick syndrome

What three things increases the risk of venous emboli ?

Venous stasis Hypercoagulability Endothelial dysfunction

How does HR and CO change in the elderly?

Decreases

Increased or decreased catecholamines circulating? Responsiveness to them?

Increased catecholamines Decreased responsiveness

Increased or decreased SNS and PNS?

Increased SNS tone Decreases PNS

ANS tone in the elderly ?

Decreases

By what percentage does MAC decrease for each decade after 40?

How does brain mass, peripheral nerves, and neurotransmitter in the brain change with age?

All decrease

Postoperative delirium or postoperative cognitive dysfunction, which develops weeks to months after surgery ?

PCD

Postoperative delirium or postoperative cognitive dysfunction, which has no treatment other than time?

PCD

Postoperative delirium or postoperative cognitive dysfunction, which is treated by treating the underlying cause, giving antipsychotics, and minimizing polypharmacy

Postop delirium

How does kidney function change in the elderly?

Everything decreases

What is the most sensitive indicator for renal function?

Creatinine clearance

Are more nephrons lost in the medulla or cortex ?