geriatric medicine

Question 1

geriatric use of health care services

Answer 1

65+ year olds 12.5% of population but consume over 25% medications. Account for over 44% hospital bed days.

Question 2

renal changes with normal aging

Answer 2

decreased GFR, decreased ADH/ renal response to hypovolemia, decreased sodium excretion response to hypervolemia, decreased renal excretion of drugs, decreased ability to compensate for volume depletion and overload states

Question 3

how to estimate renal function in elderly

Answer 3

Serum creatinine alone does NOT provide adequate info. Estimate GFR using Modification of Diet in Renal Disease (MDRD) or Cockcroft-Gault (CG) – more conservative, preferred in older pts, more comorbid dz, frail

Question 4

cardiovascular changes with normal aging

Answer 4

Increased left ventricle and arterial stiffness, systolic/ pulse pressure, and risk of postural hypotension. Decreased B-adrenergic receptor responsiveness, maximum HR and CO. Also diastolic stiffness with increased reliance on atrial kick

Question 5

Pulmonary changes with normal aging

Answer 5

decreased elasticity (compliance), vital capacity, and closing pressure. Increased residual capacity and atelectasis

Question 6

compare ventilatory response to hypoxia in older vs younger patients

Answer 6

younger patients will increase ventilation in response to hypoxia. Older patients increase ventilation to a lesser degree

Question 7

VO2 max changes with age

Answer 7

decreases over time, but people who train at high and moderate intensity start with higher VO2 max

Question 8

Sarcopenia

Answer 8

the loss of lean body mass that occurs with age

Question 9

Metabolic Syndrome

Answer 9

obesity leading to insulin resistance, glucose intolerance/ type 2 DM, HTN, dyslipidemia, abnormal fibrinolysis

Question 10

primary vs secondary aging

Answer 10

primary: unavoidable, happens to everyone. Secondary: modifiable factors such as activity, dz,

Question 11

which 3 dz states have been shown to benefit from exercise

Answer 11

diabetes (both aerobic and resistance), cardiovascular dz (cardio)and falls (strength training)

Question 12

function vs physiology

Answer 12

functional status doesn’t change much from high to normal to beginning of low physiologic function. But a precipice effect occurs at low physiologic function where functional status drops off rapidly