Geriatric patients

Question 1

Major cardiovascular changes with age

Answer 1

• Decreased number of myocytes
  
  • Fibrosis of conducting pathways with increased arrhythmias
  • Decrease in ventricular and arterial compliance (increased afterload)
  • Decreased β-adrenergic responsiveness
  • Increased dependence on preload (including atrial kick)
  • Increased diastolic dysfunction
  • Increased silent ischemia

Question 2

Major respiratory changes with age

Answer 2

• Decrease in chest wall compliance
  
  • Decline in maximum inspiratory and expiratory force
  • Decrease in lung elasticity (small airway collapse)
  • Ventilation-perfusion mismatch
  • Decrease in PaO₂, no change in PaCO₂
  • Decreased FVC and FEV₁
  • Decline in ventilator responses to hypoxemia and hypercapnia
  • Decline in normal airway protective mechanisms (increased risk for aspiration)

Question 3

Major renal changes with age

Answer 3

Decrease in the number of functional nephrons
* Decrease in the number of tubular cells
* Decreased renal blood flow
* Decreased glomerular filtration rate
* Decline in creatinine clearance despite normal serum creatinine level
* Decline in tubular function (loss of concentrating ability)
* Increase susceptibility to dehydration
* Decrease clearance of certain drugs
* Increase in lower urinary tract dysfunction and infection

Question 4

Major hepatobiliary changes with age

Answer 4

• Decrease in the number of hepatocytes
  
  • Decrease in hepatic blood flow
  • Synthetic capacity remains unchanged
  • Increased sensitivity to and decreased clearance of certain drugs
  • Increased incidence of gallstones and gallstone-related diseases

Question 5

Major changes in immune function with age

Answer 5

Involution of the thymus gland
* Decrease in production and differentiation of naïve T cells
* Decrease in T cell mitogenic activity
* Increase in inflammatory cytokines
* Increase in autoantibodies

Question 6

Risk factors for postoperative delirium

Answer 6

• Age greater than 65 years
  
  • Cognitive impairment
  • Severe illness or comorbidity burden
  • Hearing or vision impairment
  • Current hip fracture
  • Presence of infection
  • Inadequately controlled pain
  • Depression
  • Alcohol use
  • Sleep deprivation or disturbance
  • Renal insufficiency
  • Anemia
  • Hypoxia or hypercarbia
  • Poor nutrition
  • Dehydration
  • Electrolyte abnormalities (hypernatremia or hyponatremia)
  • Poor functional status
  • Immobilization or limited mobility
  • Polypharmacy and use of psychotropic medications (benzodiazepines, anticholinergics, antihistamines, antipsychotics)
  • Risk of urinary retention or constipation
  • Presence of urinary catheter
  • Aortic procedures

Question 7

Формула Кокрофта-Голта

Answer 7

Клиренс креатинина = ((140 - {Возраст})*Вес (кг) *72)/Креатинин сыворотки (мг/дл)