Exam #1: Altered Homeostasis

Question 1

What is altered homeostasis in geriatrics?

Answer 1

Process of change that happens with age

*****Our reserve generally goes down with age

Question 2

What are the implications of altered homeostasis as related to the cardiac system?

Answer 2

• Decreased CO
• Decreased maximal HR w/ stress & exercise*****
• Greater difficulty maintaining cardiac output in a. fib.

Question 3

What are the changes occur in the cardiac system w/ age?

Answer 3

1) Decreased diastolic function i.e. slower/less filling of the left ventricle
2) Decreased response to SNS
3) More reliance on atrial kick

Question 4

What are the changes occur in the pulmonary system w/ age?

Answer 4

1) Decreased collagen & elastin
2) Collapse of small airways with no change in total lung capacity
3) Ventilation/perfusion imbalance

Question 5

What are the implications of altered homeostasis as related to the pulmonary system?

Answer 5

Decreased lung elasticity, arterial saturation, & maximal oxygen uptake

*E.g. hip fracture–>hypoxia following the stress

Question 6

What are the changes occur in the GI system w/ age?

Answer 6

1) Slowed colonic transit time

2) Slower metabolism of alcohol

Question 7

What are the implications of altered homeostasis as related to the GI system?

Answer 7

• Constipation
• Decreased tolerance

*****Note that diarrhea in the elderly can be the result of seepage around a fecal impaction

Question 8

What are the changes occur in the CNS w/ age?

Answer 8

1) Cerebral atrophy i.e. loss of volume that is “normal & universal”
2) Decreased blood flow to the brain

Question 9

What are the implications of altered homeostasis as related to the CNS system?

Answer 9

• Cognitive decline
• Limited/ loss of reserve

**Note that neuroimaging when there is cognitive decline is really only done to R/O a more organic pathology i.e. tumor, bleed…etc.

Question 10

Where are new neurons produced on a daily basis? What causes these neurons to survive?

Answer 10

1) Memory center (hippocampus)
2) Olfactory

*****Only survive with exercise & learning new things

Question 11

What are the changes occur in the ocular system w/ age?

Answer 11

1) Increased rigidity of iris
2) Accumulation of yellow substance in the lens
3) Decreased size of the anterior chamber
4) Decreased elasticity of the lens

Question 12

What are the implications of altered homeostasis as related to the ocular system?

Answer 12

• Decreased size of the pupil
• Alteration of perception
• Impaired vision in darkness
• Challenges going from near to far vision

**Challenges for the elderly with driving

Question 13

What are the implications of altered homeostasis as related to the auditory system?

Answer 13

• Hearing loss for pure tones

- Higher frequencies are effected more than lower frequencies

Question 14

What are the changes occur in the auditory system w/ age?

Answer 14

1) Loss of cochlear neurons
2) Tinnitus (ringing or constant noise in the ears)
- Brain compensation for loss of neurons

Question 15

What are the changes occur in the skin w/ age?

Answer 15

1) Decreased vascularity of the dermis
2) Altered epidermal turnover time
3) Decreased melanocytes
4) Low dermis density and eccrine function

Question 16

What are the implications of altered homeostasis as related to the skin?

Answer 16

• Dry skin
• Decreased sweating response
• Prolonged wound healing b/c of altered epidermal turnover time
• Poor insulation (need to monitor temperature changes)
• Uneven tanning

Question 17

How do you care for dry skin?

Answer 17

• Wet
• Lock in w/ lotion

*****Note that in the elderly, you need to keep wounds moist & covered for best healing

Question 18

What are the changes occur in the MSK system w/ age?

Answer 18

1) Decreased bone mass, muscle mass, lead body mass, & repair of microfracture
2) Flattening of the arch of the feet

Question 19

What are the implications of altered homeostasis as related to the MSK system?

Answer 19

• Osteoporosis
• Decreased muscle strength
• Loss of height
• Increased curvature of the spine
• Decrease muscle strength for breathing
• Gait impairment

Question 20

What are the changes occur in the renal system w/ age?

Answer 20

1) Decreased renal mass
2) Decreased GFR
3) Decreased renal tubular secretion & concentrating ability
4) Decreased bladder capacity

Question 21

What are the implications of altered homeostasis as related to the renal system?

Answer 21

• Decreased drug clearance
• Facilitation of incontinence
• Decreased creatinine clearance
• Higher risk of dehydration due to decreased concentrating ability

*****Note that liver & renal clearance need to be taken into account when prescribing medications

Question 22

What are the changes occur in the endocrine system w/ age?

Answer 22

1) increased NE, vasopressin, insulin, ANP, parathyroid hormone

Question 23

What are the implications of altered homeostasis as related to the endocrine system?

Answer 23

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Question 24

What are the changes occur in the immune system w/ age?

Answer 24

Globally, there is a decrease in function of the immune system

Question 25

What are the consequences of the altered changes in the immune system?

Answer 25

Increased risk of infection

Question 26

What are they keys to healthy aging?

Answer 26

1) Socialization
2) Exercise
3) Stress reduction
4) Use of talents for self & others
5) Avoidance of accidents on the road & in the home
6) Nothing in excess
7) Rest one day per week
8) Healthcare
9) maximize spiritual life