Geriatrics

Question 1

Current life expectancy (2013)

Answer 1

82 for women vs. 77 for men

Average is 80

Question 2

Aging statistics

Answer 2

Currently 13% of US population is > age 65

20% by 2030

Question 3

Human life-span

Answer 3

~ 110 years

Oldest recorded age is 122

Question 4

Changes in the brain with aging

Answer 4

Brain volume decreases by 10% from age 35 to 60 due to loss of white matter

Question 5

Lipofuscin

Answer 5

“Wear and tear pigment” - the product of peroxidation of unsaturated fatty acids; accumulates in heart and liver with age

Question 6

Diseases associated with aging

Answer 6

Cancer
Atherosclerosis
Cerebrovascular disease
Diabetes
Thromboembolism
Alzheimer's and Parkinson's Disease

Question 7

Clock theory of aging - Basic idea

Answer 7

Somatic cells are “programmed” to die due to inevitable shortening of telomeres, which limits the number of mitotic divisions each cell can undergo

Telomeres decrease in length by 50 bp/year such that by age 100 they are only 1/2 of their original length

Question 8

Telomeres

Answer 8

Long tandem TTAGGG repeats at the ends of chromosomes

Question 9

Telomerase

Answer 9

Regenerates TTAGGG telomere repeats at the ends of chromosomes; found in stem cells only (not somatic cells)

Question 10

Telomerase mutations

Answer 10

Individuals with mutations in any component of the telomerase complex (TERT, TERC, DSC1) develop early bone marrow failure, skin disease, and organ fibrosis

Question 11

Dyskeratosis Congenita

Answer 11

Due to mutation of DSC1 enzyme of telomerase complex

Mucucutaneous triad of nail dystrophy + skin hyper/hypopigmentation, leukoplakia

Question 12

Progeria

Answer 12

Dominant mutation in Laminin A gene, an intermediate filament important for maintaining chromatin stability

Presents with accelerated aging; death usually occurs by 10 years due to cardiac / cerebrovascular disease

Question 13

Werner Syndrome

Answer 13

Caused by mutation in DNA helicase resulting in faulty DNA replication / damage repair

Presents with early onset cataracts, aging changes in skin and hair, DM, osteoporosis, cancer, ASCVD; death by ~ 50 years

Question 14

age-1

Answer 14

Inactivation of age-1 gene in nematodes increases life span by 30% by “slowing down” metabolism

IGF receptor gene mutations may have a similar effect

Supports Rust Theory

Question 15

SIR-2

Answer 15

Histone deacetylase that functions in chromatin remodeling / stabilization; also suppresses BAX and apoptosis

Expression of Sir-2 is induced by caloric restriction, and over-expression of Sir2 increases life-span up to 30%

Question 16

mTOR

Answer 16

mTOR coordinates growth and survival to the availability of nutrients

Treatment of mice with rapamycin (mTOR inhibitor) increases life span; mTOR is also inhibited by caloric restriction

Question 17

Rust Theory of Aging - Basic Idea

Answer 17

Aging occurs as a result of the accumulation of somatic mutations and oxidative damage in cellular macromolecules over time

Evidence: Increased percentage of oxidized protein with age, accumulation of somatic mutations in mtDNA leading to decreased capacity for oxidative phosphorylation in somatic cells with age

Question 18

Sarcopenia

Answer 18

Progressive decrease in fat-free mass (bone and muscle) with age; increased percentage of adipose

Question 19

What are the two most important causes of morbidity related to secondary aging?

Answer 19

Tobacco

Physical inactivity

Question 20

Exercise recommendations for elderly

Answer 20

Walking 30 - 40 minutes/day (4x/week)

10 weight-bearing exercises, 10-15 reps each (2x/week)

Question 21

Renal changes related to age

Answer 21

Decreased GFR (10mL / decade)
Decreased ADH sensitivity > reduced response to hypovolemia
Decreased sodium excretion response to hypervolemia

Question 22

Cardiovascular changes with age

Answer 22

Increased arterial and ventricular stiffness > increased systolic and diastolic pressure

Decreased maximum HR and CO

Question 23

Pulmonary changes with aging

Answer 23

Declining VO2 max such that regular activity (“walking”) requires a greater percentage of total energy expenditure; i.e. “functional reserve” declines

Vital capacity, elasticity decrease
Residual capacity increases

Question 24

Metabolic changes with aging

Answer 24

Metabolic syndrome =

Insulin resistance / hyperinsulinemia
Gucose intolerance / DM
HTN
Dyslipidemia

Question 25

How is fever diagnosed in the elderly?

Answer 25

Single temp > 100
or repeated temp > 99
or rise > 2 over baseline

Question 26

ADLs

Answer 26

Bathing - usually first need for help
Dressing 
Transferring (i.e. bed to chair) 
Toileting
Grooming
Feeding

Question 27

Instrumental activities of Daily Life (IADLs)

Answer 27

Using the telephone
Shopping
Food prep
Housekeeping
Laundry

Question 28

Get Up and Go Test

Answer 28

Rise from hard chair without use of arms, walk 10 feet, turn, return, and sit back down

Time > 10 seconds = increased fall risk
Time > 20 seconds - consider therapy referral

Question 29

Depression - 2 Question screen

Answer 29

1. “During the past 2 weeks, have you felt down, depressed, or hopeless?”
2. “During the past 2 weeks have you felt little interest or pleasure in doing things?”

Question 30

Cognitive screening methods in geriatrics (2)

Answer 30

1. MMSE (30 point screen)

2. MIni-cog = 3 item re-call + clock test

Question 31

Approach to assessment of ADLs and IADLs

Answer 31

1. Ask
2. Observe - corroborate responses with patient appearance, verify accurary with family members
3. Intervene - determine and correct underlying cause of deficit
4. Refer - to case management, PT, social services, etc.