Geriatrics Flashcards
leading causes of death >65 y/o
coronary heart disease 31% cancer 20% CVA COPD pneumonia/flu
leading cause of disability >65 y/o
arthritis HTN hearing impairments heart impairments catcalls and chronic sinusitis orthopedic impairments diabetes and visual impairments
aging changes: cell, tissue, organ
cellular changes:
- increase in size
- decrease in cell capacity to divide and reproduce
- arrest of DNA synthesis and division
tissue changes:
- accumulation of pigmented materials, lipofuscins
- accumulation of lipids and fat
- CT changes: decreased elastin, degradation of collagen
Organ changes:
- decrease in functional capacity
- decrease in homeostatic efficiency
primary regulators of aging:
hypothalamus, pituitary gland, adrenal gland
muscular changes of aging
**may be due more to decreased activity levels (hypokinesis) and disuse than from aging process
loss of muscle strength
- peaks at age 30-50
- accelerating loss (20-40% by 65 in non-exercising adult)
loss of power (force/unit time)
-significant losses in speed of contraction, changes in nerve conduction and synaptic transmission
loss of skeletal muscle mass (atrophy)
- both size and # of muscle fibers decrease
- by age 70 loss of 33% muscle mass
changes in muscle fiber composition
- selective loss of fast twitch fibers
- increase proportion of slow twitch
changes in muscular endurance
- decreased muscle tissue oxidative capacity
- decreased peripheral blood flow, oxygen delivery to muscles
- altered chemical composition; decreased ATPase, glycoproteins and contractile protein
- collagen changes: denser, irregular, loss of water content and elasticity- affects bone, tendons, cartilage
skeletal changes of aging
cartilage changes:
- decreased water content, becomes stiffer, fragments and erodes
- by age 60 >60% have degenerative joint changes, cartilage abnormalities
loss of bone mass and density::
- peak bone mass at age 40
- between 45-70, bone mass decreased (in women by 25%, 15% in men)
- loss of calcium and bone strength, especially trabecular bone
- decreased bone marrow RBC production
intervertebral discs:
-flatten, less resilient due to loss of water content (30% loss by age 65) and loss of collagen elasticity; trunk length, overall heigh decreases
senile postural changes: -FHP - kyphosis of thoracic spine flattening of lumbar spine with prolonged sitting, tendency to develop hip and knee flexion contractures
Neurological changes with age
atrophy of nerve cells in cerebral cortex
- overall loss of cerebral mass/brain weight of 6-11% between 20-90
- accelerated loss after age 70
changes in brain morphology
- gyral atrophy
- ventricular dilation
- generalized cell loss in cerebral cortex
- presence of lipofuscins, senile or neuritic plaques, and neurofibrillary tangles: significant accumulations associated with pathology (alzheimer’s)
- more selective cell loss in BG (substantia nigra and putamen), cerebellum, hippocampus, locus coeruleus
decreased cerebral blood flow and energy metabolism
changes in synaptic transmission
- decreased synthesis and metabolism of major neurotransmitters (ACh, dopamine)
- slowing of many neural processes, especially in polysynaptic pathways
changes in SC/peripheral nerves
- neuronal loss and atrophy: 30-50% loss of AHC, 30% loss of posterior roots by age 90
- loss of motoneurons results in increase in size of remaining motor units
- slowed nerve conduction velocity: sensory> motor
- loss of sympathetic fibers: may account for diminished, autonomic stability, increased incidence of postural hypotension in older adults
age related tremors (essential tremor)
- isolated symptoms- hands, head, voice
- exaggerated by movement and emotion
sensory changes with age
Vision:
Hearing:
Vestibular/balance control
somatosensory
taste and smell
-gradual decrease in taste sensitivity
-decreased smell sensitivity
(smokers, chronic allergies, respiratory infections, dentures, CVA -hypoglassal involvement)
vision changes with age
decline in visual acuity, accommodation, color discrimination, cornea reflex
Additional vision loss with pathology:
- cataracts
- glaucoma
- senile macular degeneration
- diabetic retinopathy
- CVA- hemianopsia
meds: impaired or fuzzy vision may result with antihistamines, tranquilizers, antidepressants, steroids
hearing changes with age
Outer ear:
-build up of cerumen (earwax) results in conductive hearing loss- common in older men
Middle ear:
-min degenerative changes of bony joints
Inner ear:
-significant changes in sound sensitivity, understanding of speech, and maintenance of equilibrium may result with degeneration and atrophy of cochlea and vestibular structures, loss of neurons
Types of hearing loss
- conducting hearing loss
- sensorineural hearing loss
- presbycusis hearing loss
Hearing loss with pathology:
- Otosclerosis: immobility of staples results in profound conductive hearing loss
- Paget’s disease
- Hypothyroidism
Vestibular/balance changes with aging
- degenerative changes in otoconia of utricle and saccule
- loss of vestibular hair-cell receptors
- decreased # of vestibular neurons
- VOR gain decreases
begins at age 30, accelerated decline 55-60
- diminished acuity, delayed reaction times, longer response times
- reduced function of VOR; affects retinal image stability with head movements, produces blurred vision
- altered sensory organization: older adults more dependent on somatosensory inputs for balance
- less able to resolve sensory conflicts when presented with inappropriate visual or proprioceptive inputs due to vestibular losses
- postural response patterns for balance are disorganized: characterized by diminished ankle torque, increased hip torque, increased postural sway
Additional loss of vestibular sensitivity with pathology:
- Meniere’s disease
- BPPV
- meds
- CVA
- cerebellar dysfunction
- migraine
- cardiac disease
Somatosensory changes with age
decreased sensitivity of touch associated with decline of peripheral receptors, atrophy of afferent fibers; LEs more affected than UE
proprioceptive losses, increased thresholds in vibratory sensibility (beginning around age 50); greater in LEs than UE
loss of joint receptor sensitivity; losses in LE, cervical joints may contribute to LOB
cutaneous pain thresholds increased: greater changes in upper body areas (UEs, face) than in LEs
Additional loss of sensation with pathology:
- diabetes, peripheral neuropathy
- CVA, central sensory losses
- peripheral vascular disease, peripheral ischemia
cataracts
opacity, clouding of lens d/t changes in lens proteins; results in gradual loss of vision- central first than peripheral
- increased problems with glare
- general darkening of vision
- loss of acuity
- distortion
glaucoma
increased intraocular pressure, with degeneration of optic disc
- atrophy of optic nerve
- results in early loss of peripheral vision (tunnel vision)
- progresses to total blindness
senile macular degeneration
loss of central vision associated with age related degeneration of the macula, compromised by decreased blood supply or abnormal growth of blood vessels under the retina
- initially patients retain peripheral vision
- may progress to total blindness
diabetic retinopathy
damage to retinal capillaries
- growth of abnormal blood vessels and hemorrhage leads to retinal scarring and finally retinal detachment
- central vision impairment
- complete blindness is rare
homonymous hemianopsia
loss of half of the visual field in each eye
- nasal half of one eye and temporal half of other eye
- -produces an inability to receive info from R or L side
- corresponds to side of sensorimotor deficit
impaired or fuzzy vision may result with which common meds?
antihistamines
tranquilizers
antidepressants
steroids
conductive hearing loss
mechanical hearing loss from damage to external auditory canal, tympanic membrane, or middle ear ossicles
results in hearing loss (all frequencies), tinnitus, may be present
sensorineural hearing loss
central or neural hearing loss from multiple factors
- noise damage
- trauma
- disease
- drugs
- arteriosclerosis
