Geriatric conditions Flashcards
`Disability
dependency or difficulty in carrying out ADLs
Frailty
physiologic state of increased vulnerability to stressors
results from decreased physiologic reserves and dysregulation of multiple physiologic systems
syndrome where at least 3 of the ff are present:
- unintentional weight loss of at least 10 lbs over the past year
- self reported exhaustion
- weakness
- slow walking speed
- low physical activity
Comorbidity
concurrent presence of two or more disease processes in the same individual
——– aggravates —–
while ——— predict ———–
disability exacerbates frailty and comorbidities
frailty and comorbidities predict disability
primary aging
the normal aging without disability or environmental factors
universal changes that occur with aging independent of disease or environmental effects
secondary aging
lifestyle and environmental consequences and disease associated with aging
successful aging
aging without decrease in organ system function
usual aging
progressive but significant declines in physiologic functions
physiology for normal aging
decreased:
- ability to adapt to stress
- ability to adapt to environment
- internal homeostatic control
- reserve capacity of organ systems
steep decline of vo2 max after the age of
70
vo2 max
amount of oxygen a person is able to inhale when doing maximal exercise
an indication of aerobic endurance
—% decline in max breathing capcity
60
—% decline in NCV
15
Functional implications of organ system aging: hematologic
Anemia (<10.5 g/dL)
- usually due to iron deficiency which may be caused by cancer, polymyalgia rheumatica, B12 deficiency, GI blood loss, infection
may result to orthostatic hypotension, dec tolerance to rehab exercise programs, fatigue, confusion
Functional implications of organ system aging: GI system
presbyoesophagus
Distal GI system affected
- decreased force of smooth muscle contraction
- impaired rectal perception of feces
- constipation, fecal incontinence, diarrhea
signs of presbyoesophagus
decreased peristalsis
decreased esophageal emptying
incomplete sphincter relaxation
Functional implications of organ system aging: hepatic system
decreased liver size by 5-15%
decreased hepatic blood flow
- leads to decline in drug elimination, prone to adverse drug reactions
Functional implications of organ system aging: renal system
decreased renal mass
decreased number of functioning glomeruli & tubules
decreased renal blood flow
decreased glomerular filtration rate
decreased creatinine clearance of 7.5-10 mL
decreased renal function by about 1% per year
Impaired ability to concentrate & dilate urine, sodium conservation, ability to excrete acid load
due to decreases in renal function, older adults are more prone to the ff metabolic conditions
hyponatremia (d/t water intoxication)
hyperkalemia
Functional implications of organ system aging: pulmonary system
Decline in the ff
- max voluntary ventilation
- vital capacity
- expiratory flow rate
- forced expiratory ventilation
- VO2 max
Increased Residual volume & FRC
VQ imbalance
- decline in PO2 (lower in supine)
- unchanged PCO2, pH
- O2 sat is normal or slightly reduced
- prone to hypoxia
Remains unchanged in the pulmonary system
total lung capacity
changes in pulmonary system are attributed to
normal effect of aging on musculoskeletal system
- stiffening of ribcage
- weakening of intercostals and abdominals
- increased airflow resistance d/t decreased elasticity of the respiratory organs
For VO2 max: caused by cardiac and peripheral muscles (especially LE) deconditioning
Functional implications of organ system aging: CV system
HRmax decreased
Decreased myocardial contractility, ejection fraction, early diastolic filling, baroreceptor activity
Decreased inotropic response to adrenergic stimulus
- decreased reflex tachycardia upon standing
- coughing and micturition syncope syndrome; excretion of fluids = decrease in BP
Increased risk of CHF, atrial tachycardia, or fibrillation
Functional implications of organ system aging: immunologic system
decrease in total no of lymphocytes by 15%
decrease lymphocyte proliferation and antibody production –> decreased ability to fight infections
decrease in antibody production: causes apprehension in terms of their response to vaccines
Elderly are less or more symptomatic during infection
less
because active leukocytosis and total WBC is not increased
Functional implications of organ system aging: endocrine system
decreased glucose tolerance; higher insulin resistance
decreased serum testosterone levels in men
postmenopausal declines in estrogen
UNCHANGED FBS
Untreated hyperglycemia may result to coma or ketoacidosis
Functional implications of organ system aging: thermoregulatory system
hypohydrosis: diminished sweating
may result to heat strokes and heat exhaustion
vulnerable to both hypothermia and hyperthermia
Functional implications of organ system aging: sensory system
deterioration of vision:
- presbyopia
- miosis
cataracts in 95% of adults greater than the age of 65
glaucoma is common
loss of visual acuity, decline in dark adaptation, higher minimal threshold for light perception –> high incidence of falls at night
presbycusis
conductive hearing loss
presbyopia
inability to increase curvature and thickness of the lens to focus on an object
miosis
excessive constriction of pupil
cataract affects —- vision
central vision
may be a sequelae of DM
glaucoma
optic nerve damaged d/t high pressure in eye
causes blindness in elderlies
affects peripheral
may be sequelae of DM
presbycusis
gradual loss of hearing
Functional implications of organ system aging: neurologic system
decline in STM
loss of speed of motor activities
changes in posture, proprioception, and gait
decline in cognitive functioning
increased reaction time
RETENTION OF immediate & primary memory
Functional implications of organ system aging: musculoskeletal system
progressive loss of muscle strength
- decrease in muscle cross sectional area and muscle mass
14-16%/decade for LE
12% (M) and 2% (F) for UE muscles
Gains in muscle strength noted in older adults with high intensity resistance exercise program: can prescribe in the absence of serious illnesses
osteoporosis and DJD common
Functional implications of organ system aging: Genitourinary system (urinary)
benign prostatic hyperplasia common in M >60 yrs (prostate gland enlargement)
incontinence caused by underlying diseases, NOT AGING
decreased bladder capacity, ability to postpone voiding, detrusor contractility, & urinary flow rate
- frequent urination
- decreased urine retention
- decreased force by detrusor muscle –> incomplete emptying
post void residual volumes increased –> increased frequency of urination later in the day
