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Lifespan > Elderly > Flashcards

Elderly Flashcards

1
Q

How does minute ventilation change in the elderly?

A

Minute ventilation increases

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

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2
Q

How does lung elasticity change in elderly?

A

Elasticity decreases which leads to collapsed small airways

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3
Q

How does chest wall compliance change in the elderly?

A

Becomes less compliant and stiffer

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4
Q

How does lung recoil change in the elderly?

A

Decreased

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5
Q

How does A:P diameter change in the elderly?

A

Increased

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6
Q

How does FRC change with age?

A

Increases

Reduced recoil leads to air trapping which increases residual volume

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7
Q

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

A

Supine - 45

Standing - 65

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8
Q

How does arterial compliance change in the elderly?

A

Decreases (more stiff)

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9
Q

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

A

Increased in all

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

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10
Q

How does myocardial compliance change in the elderly?

A

Decreased compliance

Impaired relaxation

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11
Q

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

A

Atrial dysrhythmias, they rely more on atrial kick

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12
Q

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

A

Diastolic dysfunction

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13
Q

How does the cardiac conduction system change in the elderly?

A

It becomes fibrotic and increases the incidence of dysrhythmias

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14
Q

Do the elderly exhibit a change in systolic function?

A

No

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15
Q

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

A

All decrease

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16
Q

What happens to circulating catecholamines in the elderly?

A

The increase but have a decreased response to them

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17
Q

How does thermoregulation change in the elderly?

A

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

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18
Q

How does baroceptor response change in the elderly?

A

Decreases (Unable to change HR during hypotension)

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19
Q

How does the adrenergic receptor density change in the elderly?

A

Decreases

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20
Q

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

A

MAC decreases by 6% each decade after 40

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21
Q

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

A

Post op delirium - early post op period

Postoperative cognitive dysfunction - weeks to months after surgery

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22
Q

What is the treatment for postoperative cognitive dysfunction?

A

Time - most resolve after 3 months

Use rapidly metabolized drugs

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23
Q

What is the treatment for Post op delirium?

A

Use less drugs and drugs that are metabolized fast

Treat underlying cause and use antipsychotics

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24
Q

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

A

Become more sensitive because of

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

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25
Q

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

A

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

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26
Q

How does GFR change in the elderly?

A

Decreases by 1ml/min/year after the age of 40

*drug elimination is or may be slower

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27
Q

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

A

Creatinine Clearence because

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

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28
Q

Normal Creatinine Clearance ?

A

100-150

but decreases by 1 every year after 40

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29
Q

How does alpha 1 acid glycoprotein change with age?

A

It increases which is a larger reservoir for basic drugs

(Decreases free fraction)

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30
Q

How does albumin change with age?

A

Decreases (smaller reservoir for acidic drugs)

(Increases free fraction)

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31
Q

How does pseudocholinesterase change with age?

A

Decreases

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32
Q

How does circulation time change in the elderly?

A

It increases

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33
Q

How does decreased circulation time change IV and Inhaled anesthetics?

A

IV - slower induction

Inhaled - faster induction

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34
Q

How does lean body mass change with age?

A

Decreases which causes decreased

  • blood volume
  • Total body water
    -Basal metabolic rate
    -Plasma volume
    -Vd
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35
Q

What is a MET equal to?

A

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

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36
Q

Most significant risk factor for cancer?

A

Old age

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37
Q

For every MET achieved, mortality decreases by how much?

A

11%

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38
Q

Frailty is characterized by a combination of what 2 things?

A

Decreased reserve

and

reduced resistance to stress

39
Q

In the elderly, does MV increase or decrease?

40
Q

In the elderly, does lung compliance increase or decrease?

A

Increases

(this is how easy to inflate the lungs)

41
Q

In the elderly, does lung elasticity increase or decrease?

A

Decreases

(this is the recoil of the lungs)

42
Q

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

43
Q

In the elderly, does dead space increase or decrease?

44
Q

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

45
Q

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

46
Q

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

47
Q

In the elderly, does PaO2 increase or decrease?

48
Q

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

49
Q

In the elderly, does diaphragmatic flattening increase or decrease?

50
Q

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

A

Chemoreceptors are less responsive

51
Q

In the elderly, does upper airway tone change?

A

Decreased respiratory strength

52
Q

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

A

Supine - 45

Standing - 65

53
Q

In the elderly, does Residual volume increase or decrease?

54
Q

In the elderly, does TV increase or decrease?

55
Q

In the elderly, does ERV increase or decrease?

56
Q

In the elderly, does IRV increase or decrease?

57
Q

In the elderly, does FRC increase or decrease?

58
Q

In the elderly, does IC increase or decrease?

59
Q

In the elderly, does CC increase or decrease?

60
Q

In the elderly, does VC increase or decrease?

61
Q

In the elderly, does TLC increase or decrease?

62
Q

What 3 volumes are increased in the elderly?

63
Q

In the elderly, which lung volume does not change

64
Q

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

65
Q

How does arterial compliance change in the elderly?

66
Q

How does SVR and Pulse pressure change in the elderly?

A

Increases due to reduced arterial compliance

67
Q

How does the left ventricle change in the elderly?

A

Increases in thickness due to pumping against stiff arteries

68
Q

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

A

Compliance decreases which allows for less blood

69
Q

What does the elderly heart rely on?

A

Atrial kick

70
Q

What type of heart disease develops in the elderly ?

A

Diastolic dysfunction

71
Q

How does the cardiac conduction change in the elderly?

A

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

72
Q

What three things increases the risk of venous emboli ?

A

Venous stasis

Hypercoagulability

Endothelial dysfunction

73
Q

How does HR and CO change in the elderly?

74
Q

Increased or decreased catecholamines circulating? Responsiveness to them?

A

Increased catecholamines

Decreased responsiveness

75
Q

Increased or decreased SNS and PNS?

A

Increased SNS tone

Decreases PNS

76
Q

ANS tone in the elderly ?

77
Q

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

78
Q

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

A

All decrease

79
Q

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

80
Q

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

81
Q

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

A

Postop delirium

82
Q

How does kidney function change in the elderly?

A

Everything decreases

83
Q

What is the most sensitive indicator for renal function?

A

Creatinine clearance

84
Q

Are more nephrons lost in the medulla or cortex ?

A

More in the cortex

86
Q

How much does renal blood flow decrease by?

A

10% by decade

87
Q

Which liver protein is increased with age?

A

Alpha 1 acid glycoprotein

88
Q

Do phase 1 or phase 2 reactions have a change in the elderly?

A

Phase 1 reactions are decreased

Phase 2 have no change

89
Q

Does hepatocellular function change with age?

90
Q

Does liver blood flow and mass change with age?

A

Yes - decreases

91
Q

Elderly have increased or decreased circulation time?

A

INCREASED CIRC TIME. TAKES LONGER FOR DRUGS

92
Q

Slower or faster inhaled and iv onset?

A

Inhaled - faster

IV - slower

93
Q

Free fraction of drugs bound to albumin? acid or basic?

A

Increased free fraction of drugs to albumin. This means more drug is available

Acidic drugs

94
Q

Free fraction of drugs bound to alpha 1 acid glycoprotein? acid or basic?

A

Binds to basic drugs

Less free fraction of drugs so need more of the drug

Lifespan (11 decks)

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