geriatrics Flashcards
Characteristics that protect you when you are young may not protect you when you are past your reproductive years
(antagonistic pleiotropy)
theories of aging
mutation acculumation (loss of proofreading), mitochondrial dysfunction (extra free radicals from oxidation), telomere shortening, dysregulation of cell cycle (loss of cell cycling and uncontrolled cycling)
reduced ability to maintain homeostasis
Homeostenosisis
physiologic changes in CV system of aging
o Basement membranes thicken around capillaries→ impaired diffusion
o Decreased compliance of aorta=HTN, increased pulse pressure and SVR
o Decreased sensitivity of baroreceptors
o Decreased CO and EF→ decrease coronary flow
o Decreased efficacy of Frank-Starling mechanism
physiologic changes in respiratory system of aging
o Decreased elastin and elastic recoil, early airway closure, can’t get air=obstruction
o Enlargement of alveoli →increased residual volume, decreased vital capacity
o Increased mucus, decreased cilia→ pneumonia
o More V/Q (vent/perfusion) mismatch→ slightly increased Pc02 and lowerd pH
physiologic changes in electrolyte system of aging
o Decreased GFR and can’t concentrate as well=peeing in middle of night
o Decreased thirst drive→ dehydration
o Decreased renal excretion of magnesium and increased laxatives causes hypermagnesemia→ too much membrane stabilization→ dysrhythmias, hypotension, drowsiness, decreased breathing, muscle weakness, constipation, polyuria
physiologic changes in renal system of aging
o Decreased GFR from atrophy of neurons d/t decreased blood flow→ overmedicated
o Decreased tubular reabsorption→ more urine→ nocturia
o Decreased drinking and decreased innervation of bladder→ incontinence
oral heaalth changes in aging
o Loss of enamel→ tooth loss
o Decreased saliva→ dry mouth and bad breath
o Decreased taste buds→ decreased taste, less eating → malnutrition
GI changes in aging
o Decreased replication of cells that secrete digestive enzymes, decreased mucosal cells→ decreased absorption
o Loss of muscle tone→ difficulty swallowing, delayed emptying, constipation, fecal incontinence
liver changes in aging
o Decreased enzymes→ decreased drug metabolism
o Alcohol dependency→ decreased liver function
metabolism changes in aging
o Less ability to burn glucose and secrete insulin→ DM
o Decreased Basal metabolic rate
o Decreased ability to sweat and thermoregulate
immune changes in aging
o Decreased T cell function→ increased infections
neuro changes in aging
o Decreased cerebral blood flow→ brain atrophy
o Decreased # of neurons→ decreased reaction time and decreased muscular coordination
o Decreased neurotransmitters→ tremor
o Altered sleep→ insomnia
special senses changes in aging
o Decreased high pitched hearing
o Decreased smell and taste
o decreased lens accommodation→ presbyopia and dryness
pain changes in aging
o More disease process→ more pain
skeletal system changes in aging
o Decreased deposition and increased resorption→ osteoporosis
o Dehydration of intervertebral discs→ decreased stature
o Erosion of cartilage→ joint pain, osteoarthritis
muscle changes in aging
o Atrophy→ decreased strength and endurance
sex changes in aging
o Don’t assume they aren’t interested!
o Prostate enlargement
o ED
o Vaginal dryness
factors affecting driving in older aduls
- Poor visual acuity and contrast sensitivity
- Dementia
- Impaired neck and trunk rotation
- Limitations of shoulders, hips, ankles
- Foot abnormalities
- Poor motor coordination and speed of movement
- Medications and alcohol that affect alertness
important aspects of social hx in older adults
support system, caregiver burden, economic well being, mistreatment, advance directives, spirituality, home safety
3 components of why people fall
biomechanical, neuromotor, sensory (sensation, vestibular, visual)
3 components of sensory component of why people fall
vision, sensation, vestibular
evolution of falls
history: circumstances, meds, fear of falling, comorbidities
PE: orthostatic BPs, eval of sensory systems–vision, sensation, vest., neuro assessment, cognitive assessment, timed up and go test
cut off for “falls risk” with timed up and go test
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