Elderly Flashcards
What % of pop is pensionable?
18%
What is fastest growing age segment?
Over 80s
How often do over 80s attend hospital?
once per week
By 2036, what % change in 60-75yr olds?
50% increase
By 2036, what % change in 75+yr olds?
75% increase
By 2036, what % change in 15-44yr olds?
8% decrease
How many years can a 60yr old male / female expect to live?
Male = 19 more years Female = 23 more years
What are the 4 personality types of the elderly?
- Integrated - active, satisfied, flexible, functioning, ok with aging
- Armoured - fights aging, preoccupied with loss, eg celebrities
- Passive - dependent, low life satisfaction, ‘I’m old, so others will have to do things for me’.
4, Angry - low activity, low life satisfaction, bitter, Mr Meldrew!
What physiological changes happen to skin when aging? (x4)
- Wrinkles
- Dry
- Cambell de Morgan spots (red elevated areas)
- Seborrhoeic Keratosis (thickening of skin, esp on face)
All of above are normal
What changes occur in the mouth with aging? (x6)
- reduced saliva production
- decrease in taste buds
- reduced sense of smell
- impaired muscles of mastication
- tongue enlargement
- tooth loss
What changes occur to the body with aging? (x20)
- decline in hepatic drug metabolism (liver)
- decline in GFR (glomerular filtration rate) by 50% (kidneys)
- prostate enlargement
- decreased bladder capacity
- bone loss
- thickening of heart valves
- dilatation / dilation of large elastic arteries
- increased systolic BP
- reduced CO
- reduced cardiovascular response to stress
- fall in FVC and FEV1 (forced vital capacity / forced expiratory volume in 1 sec)
- reduced brain weight
- presbyacusis (hearing loss)
- hardening of lens (impaired near vision)
- flatter cornea (astigmatism)
- reduced lean body mass
- increase in fat mass
- reduced ability to control body temp
- reduced oestrogen levels
- poor immune system
What happens to IQ with aging?
Cross sectional studies - IQ declines
Longitudinal studies - IQ preserved
Verbal abilities are preserved, but speed of response reduces
What are the non specific features of disease presentation in the elderly?
The 4 Is:
- Intellectual failure
- Incontinence (due to pressure, tumours, brain issues)
- Immobility
- Instability
May not be due to age! Look for other diseases
Name atypical presentations of disease in the elderly
ie diseases present differently in the old.
MI - without chest pain (still gets dyspnoea (hard to breath), confusion, hypotension)
Infection without increase in white blood cells / temp.
Silent perforation (eg stomach ulcers perforate, but no pain - painful in young ppl)
What symptoms are often mistaken for old age? (mistaken = erroneous)
Hypothyroidism - reduced energy Anaemia - reduced energy Bowel issues - could be cancer Urinary problems Shortness of breath Forgetfulness
What single illnesses / event can lead to catastrophic consequences in the elderly? x9
Pneumonia Delirium / confusion Postural instability Fall Fracture neck of femur (50% die within 2 yrs!) Immobility DVT / PE
What are the physical signs of age?
Small irregular pupils
Reduced vibration sensation
Displaced apex - kyphoscoliosis (outward and lateral curvature of the spine)
Absent ankle reflexes
What % of hospital admissions are caused by adverse drug reactions?
5-15%
What % have adverse drug reactions in hospital?
6-17%
Risk of adverse drug reactions increases with age and no. of drugs prescribed
How does drug metabolism change in elderly?
reduced renal drug clearance
changes to hepatic drug metabolism
changes in volume of distribution
What type of dosage should you use on elderly?
child dose
How is the volume of distribution affected in drug pharmacology? Give drug examples
Increase in fat, decrease in lean muscle
- lipid soluble drugs have an increased vol of distribution (can cross cell mem) and a prolonged effect eg diazepam
- water soluble drugs have a reduced vol of distribution and a more rapid peak eg digoxin
What % of drug - drug interactions result in an adverse effect?
10%
NB use BNF - predictable and preventable
What % don’t comply with their prescriptions?
40-75%
esp if 3+ drug types (25% of elderly)
What % of elderly are on 3+ drugs?
25%
How many drugs is a typical elderly pt on in hospital?
8 drugs
What % of elderly take prescription drugs meant for others?
10%
esp in nursing home / partners tablets
What % take drugs not prescribed by physician?
20%
Why are elderly at increase risk of drug reaction?
bodies reduce in size
capacity to metabolise drugs in liver / excrete drugs in kidney
