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Pathophys II > Geriatric considerations > Flashcards

Geriatric considerations Flashcards

1
Q

Elderly patients disproportionately utilize

A

more medical care

40% of surgery/procedures performed on elderly

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2
Q

Describe oxidative damage*

A

free radicals (reactive oxygen species) that are byproducts of oxygen use/metabolism that can damage chromosomal DNA–> impair gene function, damage mitochondrial DNA & damage telomeres

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3
Q

Describe DNA damage & repair**

A

age related increases in somatic mutations & other DNA damage occur–> permanent alterations in DNA sequences & function

  • centenarians who have good health have higher levels of PARP-1
  • telomere length related to mortality
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4
Q

Describe environmental factors in the biology of aging:

A

lower calorie diet leads to longer lifespan

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5
Q

Describe malfunction of proteins in the biology of aging:

A

damaged, misfolded or malfunctioning proteins accumulate over time; seen in Parkinson’s disease, Alzheimer’s disease, & senile cataracts

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6
Q

Describe mitochondrial senescence as it relates to the biology of aging

A

increased incidence of mutated mitochondrial DNA noted in aging brain tissue, muscle cells, and gut epithelium

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7
Q

Physiologic effects of aging affect the

A

CNS, CV, respiratory, renal system, fluids & electrolytes, GI, immune, endocrine, body composition, and frailty

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8
Q

___________ in the brain undergo structural changes

A

all major cell types*****

neuronal death, synaptic loss, glial cell reactivity

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9
Q

With aging, there is a _____ in neuronal regenerative capacity

A

reduction

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10
Q

Mass of brain ____ 15% with aging with ____ in CSF volume

A

decreases; increases

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11
Q

Neural plasticity

A

decreases

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12
Q

_______ in nerve conduction velocity

A

decrease

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13
Q

Elderly patients have an increased risk of

A

postoperative delirium or cognitive dysfunction

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14
Q

There is a ________number of myelinated fibers

A

decreased

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15
Q

In the CNS, there are decreased

A

alpha 2 agonist receptors

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16
Q

_____ signaling becomes impaired in the eldelry

A

Cholinergic & dopamine

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17
Q

In the CNS for elderly patients, there are decreased

A

neurotransmitter activity- decreased glutamate & GABA binding sites
decreased cerebral blood flow
decreased cerebral metabolic rate

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18
Q

Elderly patients have an increase in susceptibility to

A

metabolic stress

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19
Q

Intellectual functioning, attention, memory, & psychomotor function ______ with age

A

decline

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20
Q

Describe the anesthetic considerations for elderly patients:

A

increased sensitivity to drugs

  • Decreased number of receptors
  • BBB more permeable
  • Exaggerated response to CNS-depressant drugs
  • Decrease induction agents 50%**
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21
Q

With neuraxial anesthesia in the elderly:

A

decreased myelinated nerve fibers causes a risk for neural damage
volume of CSF decreases
Enhanced spread of LAs
DECREASE dose of LA’s for spinal/epidural block
difficulty with placement due to anatomic changes

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22
Q

Describe the two major structural effects in blood vessels in the elderly patient:

A

stiffening & atherosclerosis**

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23
Q

With the CV system in elderly patients, they will have

A

decreased tissue elasticity/less compliance
-increased stiffness in tissues
will see stiffening & atherosclerosis of blood vessels
INCREASED afterload due to stiffer arteries

24
Q

Describe changes to the left ventricle with aging:

A

LVH develops*

myocardium prone to ischemia*

25
Q

Describe how blood pressure changes in the elderly individual.

A

systolic blood pressure increases 5 mmHg per decade until age 60, & then increases 10 mmHg per decade
systolic function is abnormal

26
Q

Elderly individuals have mismatch

A

between supply & demand

27
Q

Describe increases you may see for CV in the elderly.

A

incidence of heart failure increases
increase in ventricular septal thickness
increase in LA size
increased incidence of aortic sclerosis & stenosis

28
Q

Describe the electrical system of the heart in the elderly.

A

Electrical system of heart DECLINEs with age
-pacemaker cells reduced
prolongation of PR, QRS, & QT intervals
INCREASED incidence of dysrhythmias**
resting heart rate slows
increased incidence of pacemakers and/or AICD
increased heart rate variability
decrease in maximum heart rate in response to exercise

29
Q

The most common complication and leading cause of death in the postoperative period for elderly patients is______

A

myocardial infarction****

30
Q

Describe the anesthetic implications of the CV system.

A

decreased end-organ adrenergic responsiveness
prolonged circulation time
widened pulse pressure
decreased sensitivity to baroreceptors in aortic arch in response to BP changes
decreased CO & SV
decreased sensitivity to beta-adrenergic modulation**

31
Q

Changes in cardiovascular physiology include:

A

decrease in peak heart rate & CO
slower resting heart rate
decreased ability to increase CO by change in HR
decreased ability to withstand stress

32
Q

Describe chest wall compliance in the elderly.

A

decreased chest wall compliance due to calcifications
decreased intercostal muscle mass
further decreasing chest wall compliance due to flattening of diaphragm & loss of intervertebral disc height

33
Q

Describe the relationship between FRC & closing volume.

A

Residual volume, closing volume and FRC increase** with age
TLC remains the same
Closing volume exceeds FRC in supine position at age 45 & exceeds FRC in upright position at 65

34
Q

Describe mechanical changes of the respiratory system in the elderly.

A

progressive decrease in elasticity changes respiratory mechanics & alveolar architecture

  • chest wall compliance & vital capacity decrease
  • lung compliance, work of breathing, and residual volume increase
  • decreased endurance of respiratory muscles
35
Q

Elderly individuals are more prone to

A

respiratory failure**

36
Q

Describe changes in gas exchange of the respiratory system of the elderly.

A

Reduced oxygen exchange at alveolar level*******
reduced functional alveolar surface area for gas exchange
reduction in arterial oxygen tension
reduced elastic tissue in lung
increased intrapulmonary shunting
increase in V/Q mismatch

37
Q

PaO2 decreases at a rate of

A

0.35 mmHg per year

38
Q

Elderly individuals have an increased tendency for airways

A

to close
closing volume exceeds FRC
More prone to atelectasis****

39
Q

Decreased how residual volume & FVC & Fev1 change in gas exchange.

A

residual volume increases

FVC & FEV1 are decreased

40
Q

Describe changes in the respiratory sensing mechanism of the elderly.

A

decreased ability to clear secretions
increased risk of aspiration**
reduced respiratory drive in response to hypoxia, hypercarbia, & resistive load
increased airway reactivity

41
Q

Describe changes in the renal system of the elderly.

A

decreased function with normal aging
decreased renal blood flow
decreased renal mass
reduced clearance of hydrophilic agents & hydrophilic metabolites

42
Q

The renal system is unable to

A

self-regulate due to renal vascular dysautonomy- attenuated autonomic renal vascular reflexes that protect from hypo/hypertensive events

43
Q

The renal system in the elderly has

A

tubular dysfunction
medullary hypotonicity
tubular frailty

44
Q

The aging kidney is more susceptible to

A

injury***

45
Q

The renal system has a decreased ability to

A

accommodate hemodynamic changes
-decreased renin & aldosterone production
decreased GFR & decreased ability to excrete free water

46
Q

Describe thirst response and volume sensitivity in the elderly.

A

diminished thirst response

decreased sensitivity to volume & osmoreceptors

47
Q

The best indicator of drug clearance is

A

creatinine clearance

48
Q

Patients with renal impairment, may be at increased risk for:

A
  1. fluid overload
  2. accumulation of metabolites & drugs
  3. decreased drug elimination
  4. prolonged effects of anesthetic drugs & adjuncts
  5. electrolyte imbalances
  6. arrhythmias
49
Q

Describe the hepatic function of the elderly.

A 
liver mass decreases
decreased blood flow
decreased functional hepatic reserve in elderly
decreased drug metabolism
prolonged half-life
50
Q

Describe phase 1 & phase 2 drug metabolism in the elderly.

A

phase 1 drug metabolism is variable

phase 2 drug metabolism is not significantly altered

51
Q

Describe serum albumin & alpha-1 acid in the elderly

A

serum albumin decreases

and alph-1 acid glycoprotein increases

52
Q

Describe the GI system of the elderly.

A

decreased motility of upper esophageal
decreased colonic function
decreased GI immunity
decreased GI drug metabolism

53
Q

Describe the immune system of the elderly.

A

reduced activity of immune cells
increased levels of cytokines & chemokines
decreased T & B cell function
reduced ability to fight infection & control cancers

54
Q

Describe the endocrine system of the elderly.

A

reduce hormone production
impaired endocrine function
impaired glucose homeostasis
deficiencies of insulin, thyroxine, GH, renin, aldosterone & testosterone

55
Q

Resting metabolic rate decreases

A

1%/year after 30

decreased lean body mass

56
Q

_____ is a major risk factor for CV disease.

A

Diabetes****

57
Q

Describe what happens to the pancreas in the elderly.

A

decline in number and function of pancreatic islet beta cells
-decreased insulin secretion
-increased hepatic production of glucose
-impaired production of fats/proteins
increased incidence of glucose tolerance or diabetes

Pathophys II (43 decks)

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