Elderly Flashcards
Elderly Body Composition and Metabolism:
- Oxygen consumption ___
- Basal resting metabolic rate ___
- Heat production ___
- Decreased ___ production (protein binding)
- Decreased ability to handle ___
- decreases
- decreases
- decreases
- serum albumin
- glucose load
Body Composition and Metabolism: •In \_\_\_: –Total body lipid reservoir –Body fat –Bone mass –Intracellular water •In \_\_\_: –Body mass –Skeletal muscle –Other tissue mass –Intracellular water
women
men
Central Nervous System Function: •Brain size •Neuronal capacity –Cerebral and cerebellar cortices –Decrease in \_\_\_ –Decrease \_\_\_ and \_\_\_ time •More complex neurons –Language skills, esthetics, and personality –Comprehension, knowledge base, and long term memory well maintained in active/fit older adults.
- short term memory
- visual and auditory time
CENTRAL NERVOUS SYSTEM FUNCTION •\_\_\_ of cerebral blood flow •\_\_\_ response to hyperventilation •Neurotransmitters –Dopamine, norepi, tyrosine, serotonin •Catabolic transmitters –MAO, catechol O-methyltransferase
- Autoregulation
- Vasoconstrictor
CENTRAL NERVOUS SYSTEM FUNCTION
•Impaired cognition of uncertain etiology may be secondarly to an ___ and elevated ___.
•Aging in CNS also leads to loss of selective ___ cell loss. (can lead to removal of chronic hippocampal suppression of HPA activity and thus activation of the HPA axis)
•The increase in ___ further increases the hippocampal loss and feeds into stress/injury cycle
- HPA (hypothalamic-pituitary-adrenal) dysregulation
- cortisol levels
- hippocampal
- cortisol
PERIPHERAL NERVOUS SYSTEM FUNCTION
•Peripheral motor nerve conduction velocity ___
•Slowed conduction of ___ impulses
•Dynamic muscle strength, control and steadiness of extremities declines 20-50% by the age of ___ and produces disseminated ___ at the neuromuscular junction
- decreases
- pain
- 80 years old
- neurogenic atrophy
AUTONOMIC FUNCTION •Plasma levels of \_\_\_ higher •Plasma levels of \_\_\_ less predictable •Beta-adrenergic agonist response –Endogenous \_\_\_ •Alpha-adrenoceptor and muscarinic cholinoceptor activity has little change.
- norepinephrine
- epinephrine
- beta blockade
AUTONOMIC FUNCTION •\_\_\_ response decreased •\_\_\_ less tightly regulated –delay in \_\_\_ –wider variation from \_\_\_ –\_\_\_ dysfunction
-Baroreflex
-Autonomic regulation
restabilization
homeostasis
autonomic
CARDIOVASCULAR SYSTEM •Anatomic changes –Increased \_\_\_ wall thickness –Increased \_\_\_ –Increased \_\_\_ of \_\_\_ •Physiologic changes –Decreased \_\_\_ compliance –Decreased \_\_\_ ***Hemodynamics •\_\_\_ increases •\_\_\_ decreases
-ventricular
-myocardial fibrosis
-calcification of valves
-ventricular
-CO
~Systemic BP
~Resting HR
CARDIOVASCULAR FUNCTION •Aorta –\_\_\_ diameter/stiffness –Effect on ? •\_\_\_ elasticity (loss of elasticity) –Pulse pressures \_\_\_ with \_\_\_ –\_\_\_ pressures (reduced) •Cardiac Output/Index •Atrial kick
- Increased
- LV function
- Arterial elasticity
- increase with decreased compliance
- Diastolic
CARDIOVASCULAR SYSTEM •VOLUME \_\_\_ YET VOLUME \_\_\_ •Diastolic \_\_\_ –Decreased \_\_\_ compliance, increased \_\_\_ Can cause atrial enlargement with subsequent \_\_\_. –Not associated with \_\_\_
VOLUME DEPENDENT YET VOLUME INTOLERANT Dysfunction LV LVEDP CHF volume overload
CARDIOVASCULAR SYSTEM
- **___: LV wall thickness, LV wall tension, afterload (impedence to LV output), cardiac workload, systemic BP, peripheral vascular resistance, circulation time (longer), conduction system fibrosis, incidence of dysrhythmias, SA node cell loss, symptoms of diastolic dysfunction, vagal tone
- **___: Diastolic blood pressure (no change or slightly decreased), resting systolic function, cardiac contractility proteins, ionized calcium metabolism, excitation-contraction coupling
- **___: Cardiac reserve, CO, max CO, resting and maximal HR, LV compliance, Arterial compliance, SV, coronary blood flow, perfusion to vital organs, chronotropic and ionotropic responses, baroreceptor function, adrenergic sensitivity decreases leading to decreases in HR
- **Increased
- **No change
- **Decreased
PULMONARY FUNCTION •Structural changes in the aging lung –Loss of \_\_\_ –Altered \_\_\_ production –Increased \_\_\_ compliance –Loss of elastic elements associated with enlargement of \_\_\_ and \_\_\_ –Decreased \_\_\_ compliance –\_\_\_ chest appearance with diaphragmatic \_\_\_ –Signs of both \_\_\_ and \_\_\_ disease
- elastic recoil
- surfactant
- lung/alveolar
- respiratory bronchioles and alveolar ducts
- chest wall
- Barrel, flattening
- obstructive and restrictive
What happens to anatomic dead space, diffusion capacity, and closing capacity?
Lol this was a question on the slide
PULMONARY FUNCTION •Decline in \_\_\_ efficiency –Alveolar surface area \_\_\_ –\_\_\_ thickens –Pulmonary capillary blood volume declines –FRC/CC relationship –\_\_\_ \_\_\_ increases –Shunt –V/Q matching
- Gas exchange
- reduction
- Alveolocapillary membrane
- declines
- Dead space
Pulmonary Function
Pulmonary changes to remember in the elderly
–FRC ___
–Closing capacity ___
–Residual volume ___
–Vital capacity ___ significantly with age
–Expiratory and inspiratory reserve volumes ___
–Progressive decline in ___ by 6-8% per decade
- increases slightly
- increases
- increases
- decreases
- decrease
- FEV1
Pulmonary Changes to Remember in the Elderly continued…
-Pulmonary vascular resistance and Pulmonary artery pressures ___
–Cross sectional area of pulmonary capillary bed ___
–___ is blunted
–___ is common in the elderly
–More stimulation needed for ___—watch for risk of ???
–Protective ___ is compromised
- increase
- decreases
- Hypoxic Pulmonary Vasoconstriction (HPV)
- Sleep apnea
- Vocal cord closure…aspiration
- airway reflex
PULMONARY FUNCTION
•Considerations for intubations in the elderly
–___ more difficult in patients with no teeth
–___ mobility and ___ range of motion decreased
•These changes may lead to potentials for difficult intubations!
- Mask ventilation
- Temporomandibular joint mobility and cervical spine
PULMONARY FUNCTION •??? –More likely to experience apnea and obstruction intraoperatively •Periop prevention of \_\_\_ –Higher \_\_ concentrations –Small increments of \_\_\_ –Aggressive \_\_\_
- Periodic Apnea
- Hypoxia
- oxygen
- PEEP
- pulmonary toileting
•Respiratory depression
–Potential for increased sensitivity to respiratory depression from ___ as well as non-narcotics like ___
–Elderly have depressed response to ___ and ___
- opioids
- versed
- hypoxia and hypercapnia
