Exam 3: Biology of Aging and Geriatrics

Question 1

Normal aging effects

Answer 1

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

Question 2

Lipofuscin

Answer 2

“Wear and tear” pigment

Product of perioxidation of unsaturated fatty acids

Question 3

Disease associated with aging

Answer 3

Cancer
Atherosclerosis
CVA's
T2DM
Thromboembolism
Alzheimer's/Parkinsons

Question 4

Theories of aging

Answer 4

Clock theory: programmed by aging genes

Rust theory: oxidative damage and build up

Question 5

Clock theory evidence

Answer 5

Programmed cell death of somatic cells
Happens faster (after fewer replications) with age
Shortened telomers (TTAGGG)
Progeria (10 year life span)

Question 6

Telomeric disease

Answer 6

TERT mutations: aplastic anemia
TERC mutations: bone marrow failure
Dyskerin mutations: hyperpig, oral leuko, BM failure, liver/lung fibrosis

Question 7

Progeria

Answer 7

10 year life span
Lamin A gene mutation (int. filament in nucleus)
Tethers chromosome to nuclear envelope
Mutation = genetic instability

Question 8

Mutations that increase life span in nematodes

Answer 8

Age-1 gene - slow metabolism
ILGFR - slow metabolism
Clk-1 - slow metabolism
Sir-2 - promotes gene silencing

Question 9

Oxidation theory evidence

Answer 9

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

Question 10

mTOR and aging

Answer 10

Inhibition of mTOR leads to same effects as caloric restriction

Question 11

Renal changes with aging

Answer 11

GFR decreases by 10ml/decade
Decrease ADH in response to hypovolemia
Decreased Na excretion in response to hypervolemia
Decreased excretion of drugs

Question 12

Monitoring kidney fxn in older patients

Answer 12

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

Question 13

Loss of max physiology capacity translates to what?

Answer 13

Loss of fxnal reserve and loss of ability to compensate to stress

Question 14

VO2max and walking every day

Answer 14

VO2 of 15 required to maintain walk (maintained okay)

Loss of VO2max leads to loss of functional reserve

Question 15

Sarcopenia

Answer 15

Age-related muscle loss

Question 16

Disabilities related to sarcopenia and obesity

Answer 16

Each contribute about half to odds ratio

Together = greatest risk for disability

Question 17

Top two causes of M and M in older population

Answer 17

1. Smoking

2. Physical inactivity

Question 18

Physical activity recommendation

Answer 18

5x week of cardio: 30 min walking per day

2x week of resistance training

Question 19

Compression of morbidity

Answer 19

Compress the amount of morbidity prior to mortality

Question 20

Fever with infection in older patients

Answer 20

Fever absent in 30% elderly with serious infection

Fever absent in 50% frail elderly with serious infection

Question 21

Immobility issues on inpatient treatment

Answer 21

<1hr of day spent performing activity
Lay flat most of day -> added dizziness with sat up -> increased fall risk
Loss of muscle mass

Question 22

Ways to improve mobility on inpatient

Answer 22

D/c bladder caths, IV
Encourage mobility
Order PT and confirm patient participation
“Road test” prior to d/c

Question 23

HTN management in elderly

Answer 23

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

Question 24

Activities of daily life

Answer 24

Bathing
Dressing
Transferring
Toilet
Grooming
Feeding

Question 25

Instrumental activities of daily life

Answer 25

Phone
Shopping
Cooking
Housekeeping
Finances
Take meds

Question 26

ADL and IADL investigation and treatment

Answer 26

Ask
Observe (including verification with family)
Intervene
Refer

Question 27

Get up and Go test

Answer 27

Get up from chair with out arms
Walk 10 feet, return and sit down
>10 sec = fall risk
>20 sec = referral