Geriatrics Flashcards
What are the cardiovascular changes in the geriatric population?
- Decrease in elasticity of arteries
- Elevated afterload and SBP
- Left ventricular hypertrophy
- Adrenergic activity decreases
- Decreased HR, both rest and max
- Decreased baroreceptor response
How much does the HR decline per year?
Decreases 1 beat/minute/year over the age of 50
Is there an increase or decreased risk of arrhythmias?
Increased, conduction system fibroses and loss of SA node cells increases the risk
What does atrial enlargement put geriatrics at risk for?
SVT and a-fib
Which type of hypertrophy has increased volume?
Eccentric
Which type of hypertrophy has increased wall thickness?
Concentric
Is inhalation or IV induction faster in the elderly?
Inhalation because circulation time is slow
What are the 2 cardiovascular responses that are altered to blunted B-receptor response?
Decreased maximal HR and decreased peak ejection fraction
How do elderly patients increase their CO?
Increase in end-diastolic volume as opposed to HR
What are the respiratory changes in the geriatric population?
Decrease in elasticity of lungs Decrease in alveolar surface area Increased residual volume Vent/Perfusion mismatch Increased chest wall rigidity Decreased cough Blunted response to hypercapnea and hypoxia Decreased max breathing capacity Increased closing capacity and closing volume
T/F: There is a collapse of small airways
True
Are elderly at an increased risk for aspiration?
Yes r/t decrease in airway reflexes
What happens to the FRC?
Increases slightly
What happens to the vital capacity?
Significantly decreases 25 ml/year starting at 20
What happens to residual volume and dead space?
Increases
What happens to total lung capacity?
Decreases with age
Does Vd/Vt ratio increase or decrease with age? And which equation do you use to find out?
Increases because dead space increases Bohr equation (Vd=dead space, Vt=tidal volume)
What happens to the gastric pH and emptying?
pH rises and gastric emptying slows
What happens to heat production?
Decreases
T/F: heat loss decreases
False, increases
What are the 3 things that put the elderly population at risk regarding normothermia?
Decreased metabolic rate, decreased heat production, deficient thermostat control
What happens to blood flow and GFR?
Decreases
What happens to the mass of the kidney?
Decreases
What happens to the concentration and dilution?
Both decreased
When they need to concentrate they can’t, when their body needs to dilute, they can’t
Is drug excretion increased or decreased?
Decreased
What happens to the renin-aldosterone response?
Decreased
What is the renal cortex replaced with?
Fat and fibrotic tissue
Is serum creatinine increased or decreased?
The same r/t decrease in muscle mass and decreased production of creatinine
Does BUN increase or decrease?
Increases 0.2% mg/dl/year
Do the elderly have increased or decreased risk for renal failure?
Increased risk d/t decreased blood flow to the kidneys
What is the most specific test of renal failure?
24 hour serum creatinine clearance to assess GFR
What happens to the cerebral blood flow and brain mass?
Both decrease
What shows to preserve cognitive function?
Physical activity
What leads to muscle atrophy?
Degeneration of peripheral nerves slows conduction and reactions
Which thresholds increase in regards to the nervous system?
Touch Temperature Pain Proprioception Hearing Vision
Are the dosages for locals and GAs increased or decreased?
Reduced
What happens when you give the elderly an epidural?
Anesthetic tends to have a more cephalad spread
Which type of drugs are the elderly very sensitive to?
Anticholinergics like scopolamine and atropine
Relationship between drug dose and plasma concentrations
Pharmacokinetics
Relationship between plasma concentrations and clinical effect
Pharmacodynamics
There is a decrease in muscle mass and increase in body fat (more in women on body fat) so this leads to what?
Decreases total body water (effects water soluble drugs)
Reduced volume for water soluble drugs can lead to higher plasma concentrations
Conversely fat soluble drugs-with increased volume of distribution, can lower the plasma concentrations
What happens to the MAC for the elderly?
Decrease 4% per decade after age 40
Why does it take longer for the elderly to wake up?
Increased body fat
Decreased hepatic function
Decreased pulmonary gas exchange
Most plasma proteins are unchanged, albumin slightly decreases, but what happens to alpha-1 glycoprotein?
AAG increases, this one binds with local anesthetics and opioids
What is Progeria?
Hutchinson-Gilford syndrome
Premature aging
When is progeria apparent?
After 6 months
What types of s/s do patients with progeria show?
Ischemic heart disease HTN Cerebrovascular disease OA DM
What is the avg life expectancy of progeria?
13 years
What are the airway difficulties with Progeria?
Mandibular hypoplasia (underdevelopment)
Micrognathis (small mandible)
Narrow glottis opening
