geriatrics Flashcards
sub optimal aging
feeling deleterious effects of normal physiological aging bc you aren’t engaging in preventative health care
MSK changes w/ age
- sarcopenia: age-related loss of ability of muscles to regenerate, progressive loss of m mass and strength
- number of motor units decrease - each motor neuron must innervate larger number of muscle fibers, result in motor unit hypertrophy
- increase in fat mass, decrease in lean body mass - predictor of mobility restriction
- decreased bone mass and density - greater resorption than deposition, esp after 40s
- less water in articular cartilage - arthritis, decreased water in disks
- less extensible fascia, ligaments, tendons -> decreased ROM and flexibility
- type IIb fibers denervated and remaining motor unit hypertrophy
- 10% strength decline per decade, esp 60s and 70s
- decreased CSA of type II muscle fibers
- increased collagen stiffness d/t cross linkage btw fibers
frailty syndrome
older adults
- unintentional weight loss
- muscle weakness
- slow gait speed
- exhaustion
- low physical activty
NM changes with age
- decreased brain volume and conduction velocity
- increased ventricular size
- decreased periph nerve conduction velocity: decr ability to sense pain, decr joint proprioception and coordination, decr somatosensory input, impaired balance, increased gait instability
- decreased reaction speed
CV changes with age
- CO decreases - less tolerance to exercise s/t decreased perfusion of peripheral tissues
- CO decr d/t decr venous return, arteriosclerosis effectign afterload esp in aorta, fibrotic changes in myocardium, decreased response to cardiac hormones
- increased BP, increased risk postural hypotension, decreased RHR, cardiac dysrhthmias
- increase myocyte volume in ventricles - encroaches on myocardium vasculature, increases risk for MI (decreased myocyte density but increased myocyte volume)
- greater risk for stroke, CAD, CHF
- decreased SA node pacemaker cells
- decreased sensitivity to beta-adrenergic stimulation
- increased calcification and fibrosis of heart. vales
- incr vascular tone -> incr BP
- decreased FEV1
- greater than 50% of all adults have some heart diseaes
if SV can be maintained w/ exercise, CO can be sustained despite low MHR
pulm system changes with age
- stiffer chest wall, incr thoracic kyphosis
- diminished MSK pump - decreased VC of lungs and residvual volume incr
- decreased number and zie of alveoli, decreased expiratory flow rates, ciliary function in upper airways (more pneumonia)
- decreased strength/effectiveness of coughing
integ changes with age
- decr dermal layer thickness, loss of elastin fibers
- loss of collagen - more prone to damage from shear forces
- pressure ulcers more common - vasc changes delay healing
- BV reduction in dermis - less thermoregulation
- decreased fever response
- decreased autonomic regulation of thermoreg responses
- decreased vasc, thickness, and elasticity of dermis
- increased pain threshold
- decreased subcutaneous adipose tissue
- decr sensory perception
metabolic and endocrine changes with age
- basal metabolic rate decr with age
- changes in acid=base balance
- general decrease in hormone production and function
- higher blood glucose s/t reduction in beta cells in pancreas and peripheral resistance to insulin
- decreased insulin sensitivity
- decr hepatic insulin release control
- decr sensitivity to beta-adrenergic stimulation
GI changes with age
- decr taste and smell - affect desire to eat
- loss of alveolar bone and dental issues - difficulty w mastication
- decr salivation
- loss of motility (peristalsis) - constipation and diverticulosis
- loss of control with sphincters
- decr E metabolism
- decr drug metabolism
- increased risk adverse side effects of meds
- decreased gastric acid production
GU changes with age
- kidneys less effective s/t anatomic and physiologic changs like decr blood to kidneys, fewer nephrons, overalld ecrease in kidney size
- GFR decreases
- more difficult regulation of sodium levels in blood and clearance of some meds from body
- urinary frequency and nocturia
- prostate enlargement
- increased incontinence
- decr kidney function and filtration rate
- decr bladder capacity
presbycusis
hearing loss in older adults
tinnitus also common with older adults
working memory
- remembering info in middle of an activity
- items on grocery list
episodic memory
personally experience events
semantic memory
knowledge or facts
procedural memory
performance of skills
types of attention that decline with age
- dual tasking, switching attention
- no decline with age: sustained attention, selective attention
intelligence and age
- declines but difficult to quantify d/t generational differences
- crystallized intelligence: accumulation of knowledge and skills, maintains or improves with age
- fluid intelligence: speed and ability to reason and problem solve, declines with age
mild cognitive impairment
MCI
- lower than expected cog performance when compared to others in age group
- does not interfere with ADLS
- does not = eventual dementia
4 parameters of pharmacokinetics
- absorption
- distribution
- metabolism
- excretion
what happens to drug once inside body
pharmacokinetics and age
- decreased acidity in stomach, slower emptying times, decr motility alters absorption
- some drugs become more concentrated in blood stream and intensify effects
- slower metab d/t liver changes
- excretion slower d/t kidney functions
pharmacodynamics
- how a drug exerts therapeutic effects on body at cellular or organ level
3 drugs most responsible for adverse drug reactions (ADRs)
digoxin
warfarin
insulin
advance directives
documents completed by pt prior to illness to dictate end-of-life care
- power of attorney and livign will
do not rescuscitate
- medical order for pt wishes to not have cardiopulmonary resuscitation (CPR) if they stop breathing or heart stops
- does not apply to meds or HC treatements
hospice
form of palliative care for terminally ill who have limited life expectancy
living will
- document where pt dictates desires and preferences for health care treatment
palliative care
- usually with serious illness
- aims to relieve pain and suffering
