Elderly

Question 1

General considerations

Answer 1

Aging associated with increased mortality and morbidity 
Major adverse cardiac events
Airway and pulmonary problems
Healthcare-associated infections
Post op cognitive delirium

Question 2

Vascular changes affecting drug administration

Answer 2

Decreased elasticity

• exaggerated hypotension during induction
• exaggerated hypertension during emergence

Question 3

Polypharmacy

Answer 3

More than 10 meds-> increased mortality

• receptor up regulation (beta-blockers)
• receptor downregulation (opioids and benzos)

Question 4

Increased body fat in elderly

Answer 4

Increased % of body fat

- can overdose on drug on total body weight

Question 5

Elderly and pharmacokinetic changes

Answer 5

Decreased volume of distribution
- higher blood concentrations
Lower GFR -> prolonged elimination
Higher variability between patients

Question 6

Elderly and pharmacodynamics

Answer 6

Decreased MAC & MAC-awake

Loss of consciousness at higher BIS index

Question 7

CV changes with age

Answer 7

Decreased elasticity -> higher afterload, systolic HTN, LVH
LVH and CAD -> increased coroNary perfusion pressure
- maintain diastolic >70
Diastolic dysfunction - impaired filling
Increased incidence of arrhythmias, chf, aortic stenosis

Question 8

Pulmonary changes with age

Answer 8

Decreased compliance, residual volume
Decreased airway reflexes, muscle strength, cough -> aspiration
V/Q mismatching
Decreased carotid body functioning
Decreased response to hypoxia and hypercarbia

Question 9

Renal system changes with age

Answer 9

Decreased GFR with no change in creatinine (low muscle mass)
- prolonged half-lives
Increased contrast studies
Decreased renal concentration
Increased renal failure

Question 10

Nervous system changes with age

Answer 10

Increased carotid disease -> maintain cerebral perfusion pressure and time
Decreased neuronal density -> downregulation of opioid and GABA
Prolonged emergence
Increased risk of hypotension and respiratory depression with spinal and epidural anesthesia

Question 11

Avoiding overdose in elderly

Answer 11

Administer reduced [ ] of inhaled
Correct IV dosing for age
Allow for slower onset time
Take into account longer duration of action