Exam 3: Biology of Aging and Geriatrics Flashcards
Normal aging effects
Decline in function after 20's Velocity of nerve conduction Brain -> loss of myelin, 10% volume Glomerular filtration decrease, loss of nephrons Cardiac contractility Atrophy of spleen, thymus, bone marrow Vital capacity
Lipofuscin
“Wear and tear” pigment
Product of perioxidation of unsaturated fatty acids
Disease associated with aging
Cancer Atherosclerosis CVA's T2DM Thromboembolism Alzheimer's/Parkinsons
Theories of aging
Clock theory: programmed by aging genes
Rust theory: oxidative damage and build up
Clock theory evidence
Programmed cell death of somatic cells
Happens faster (after fewer replications) with age
Shortened telomers (TTAGGG)
Progeria (10 year life span)
Telomeric disease
TERT mutations: aplastic anemia
TERC mutations: bone marrow failure
Dyskerin mutations: hyperpig, oral leuko, BM failure, liver/lung fibrosis
Progeria
10 year life span
Lamin A gene mutation (int. filament in nucleus)
Tethers chromosome to nuclear envelope
Mutation = genetic instability
Mutations that increase life span in nematodes
Age-1 gene - slow metabolism
ILGFR - slow metabolism
Clk-1 - slow metabolism
Sir-2 - promotes gene silencing
Oxidation theory evidence
High lipofucin, cross-linked collagen, and oxidized DNA/protein in older
Transgenic strains with SOD overproduction live longer
Caloric restriction can lead to longer life
MtDNA hit harder by ox mutation -> more inefficient ox/phos
mTOR and aging
Inhibition of mTOR leads to same effects as caloric restriction
Renal changes with aging
GFR decreases by 10ml/decade
Decrease ADH in response to hypovolemia
Decreased Na excretion in response to hypervolemia
Decreased excretion of drugs
Monitoring kidney fxn in older patients
Can’t use Cr due to both clearance changes and much less muscle mass -> less Cr (therefore high values may appear in normal range)
Cockcroft Gault equation: most conservative estimate
Loss of max physiology capacity translates to what?
Loss of fxnal reserve and loss of ability to compensate to stress
VO2max and walking every day
VO2 of 15 required to maintain walk (maintained okay)
Loss of VO2max leads to loss of functional reserve
Sarcopenia
Age-related muscle loss
Disabilities related to sarcopenia and obesity
Each contribute about half to odds ratio
Together = greatest risk for disability
Top two causes of M and M in older population
- Smoking
2. Physical inactivity
Physical activity recommendation
5x week of cardio: 30 min walking per day
2x week of resistance training
Compression of morbidity
Compress the amount of morbidity prior to mortality
Fever with infection in older patients
Fever absent in 30% elderly with serious infection
Fever absent in 50% frail elderly with serious infection
Immobility issues on inpatient treatment
<1hr of day spent performing activity
Lay flat most of day -> added dizziness with sat up -> increased fall risk
Loss of muscle mass
Ways to improve mobility on inpatient
D/c bladder caths, IV
Encourage mobility
Order PT and confirm patient participation
“Road test” prior to d/c
HTN management in elderly
Guidelines are not strict rules
Studies rarely include elderly, comorbidities
More active/fxnal patients = treat
Less active/more frail = consider, may need HTN to fxn
Activities of daily life
Bathing Dressing Transferring Toilet Grooming Feeding
Instrumental activities of daily life
Phone Shopping Cooking Housekeeping Finances Take meds
ADL and IADL investigation and treatment
Ask
Observe (including verification with family)
Intervene
Refer
Get up and Go test
Get up from chair with out arms
Walk 10 feet, return and sit down
>10 sec = fall risk
>20 sec = referral
