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Special Population-RCM > Geriatrics Exam 3 > Flashcards

Geriatrics Exam 3 Flashcards

1
Q

What marks the beginning of the aging process, and what are its eventual outcomes?

A
  • Begins with birth
  • Includes gradual organ impairments
  • Ends with death
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2
Q

How much has the geriatric population increased in the last 50 years?

A

Increased 300%.

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3
Q

At what age does an individual qualify as elderly?

A

65 years or older.

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4
Q

At what age do our physiological functions peak before they start to decline?

A

Peak at 30, then decline.

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5
Q

Does aging itself pose a surgical risk?

A
  • No
  • Anatomic and physiologic changes associated with aging determine patient outcomes.
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6
Q

How does aging affect tolerance to changes or restoration of homeostasis?

A
  • Makes individuals less tolerant to changes or restoration of homeostasis
  • When exposed to disease, trauma, or surgical stress.
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7
Q

What factors increase the risk of perioperative complications in the elderly?

A
  • Progressive decline of baseline functions
  • Age-related comorbidities
  • Increased ASA physical status.
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8
Q

How are patients 65 years of age or older classified?

A

As geriatric or elderly.

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9
Q

What tool is needed for measuring functional reserve in geriatric patients?

A

A bedside tool that measures metabolic equivalents (METs).

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10
Q

What is the oxygen consumption rate equivalent to one MET?

A

3.5 mL O2/kg/min.

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11
Q

What MET level is associated with increased perioperative risk?

A

Inability to achieve 4 METs.

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12
Q

Can you give examples of activities that meet the 4 METs level?

A
  • Climbing a flight of stairs without stopping
  • Raking leaves.
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13
Q

Why might METs be considered a poor predictor of postoperative morbidity and mortality?

A
  • Due to their subjective nature
  • Duke Activity Status Index (DASI) may be better for functional evaluation
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14
Q

How is frailty characterized in geriatric patients?

A
  • By decreased reserve and reduced resistance to stress
  • Leading to poorer outcomes when exposed to perioperative stressors
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15
Q

What is the most common coexisting disease in the elderly, and what are the four most common conditions?

A

Cardiac diseases

  1. Hypertension
  2. Coronary artery disease (CAD)
  3. Congestive heart failure (CHF)
  4. Myocardial ischemia
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16
Q

What are the best indicators of cardiac reserve in the elderly?

A
  1. Exercise tolerance
  2. Ability to perform daily living activities.
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17
Q

What happens to arterial compliance in the elderly?

A

Decreased

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18
Q

What happens to venous compliance in the elderly?

A

Decreased

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19
Q

How does myocardial compliance change in the elderly?

A

Decreased

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20
Q

What happens to conduction in the cardiovascular system of the elderly?

A

Decreased

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21
Q

What change occurs in myocardial mass in the elderly?

A

Increased

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22
Q

What happens to lung elastic recoil and residual volume with aging?

A
  • Reduced recoil
  • Increases residual volume (RV)
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23
Q

What is Residual Volume (RV)

A

The volume that remains in the lungs after a full exhalation

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24
Q

Why do the elderly’s small airways collapse during expiration?

A

Reduced elastic recoil.

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25
Q

When does closing capacity surpass FRC, and its effects?

A
  • At ~45 years (supine)
  • ~65 years (standing)
  • Leading to V/Q mismatch and reduced PaO2.
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26
Q

Small airway collapse during tidal breathing sets the stage for:

A
  • V/Q mismatch
  • Increased anatomic dead space
  • Reduction in PaO2
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27
Q

What factors reduce vital capacity in the elderly?

A
  • Reduced recoil
  • Increased chest stiffness
  • Weaker muscles
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28
Q

How does aging affect total lung capacity?

A
  • Remains unchanged
  • Due to increased RV balancing, reduced VC.
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29
Q

What are the Key Pulmonary changes that Increase in the elderly?

A
  • Minute ventilation
  • Lung compliance
  • FRC
  • Closing Capacity
  • Residual volume
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30
Q

What is the only pulmonary function that has no change in the elderly?

A

Total lung capacity

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31
Q

What is lung compliance?

A

Increase volume for a given increased pressure

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32
Q

What are the consequences of small airway collapse in the elderly?

A
  • Increased Dead space
  • Increased V/Q mismatch
  • A-a gradient
  • Decreased Alveolar surface area
  • Decrease PaO2
33
Q

An aged lung tissue has high compliance, but it has:

It’s easy to inflate

A

Low Elasticity

Its harder for it to return to its original shape

34
Q

How is the FRC determined?

A
  • The balance between lung elestic recoil
  • Chest wall complaince
35
Q

Why is the kidney’s function important?

A
  • Regulates intravascular volume
  • Electrolytes
  • Acid/base balance
  • Plasma drug concentrations
36
Q

What effect does a reduction in renal reserve have?

A

Well tolerated in healthy patients but risky with surgery or disease due to impaired homeostasis maintenance.

37
Q

What is the risk associated with perioperative renal failure?

A

Very high mortality.

38
Q

Why is perioperative fluid management critical?

A
  • Prevents fluid overload and dehydration
  • Due to impaired sodium handling
  • Urine concentration/dilution capacity
39
Q

How does reduced venous compliance affect the elderly?

A

Impairs venous circulation’s reservoir function.

40
Q

The Kidneys have difficulty in correcting the following in the elderly:

A
  • Correcting electrolyte imbalances
  • Titrating excess non-volatile acids
41
Q

The kidneys have the ability to regulate:

A
  • Intravascular volume
  • Electrolytes
  • Acid/base balance
  • Plasma drug concentration
42
Q

What endocrine changes lead to diabetes in the elderly?

A
  • Decreased pancreatic beta cell number/function
  • Decreased insulin secretion
  • Insulin resistance
  • Increased hepatic glucose release
  • Impaired fat/protein breakdown
43
Q

How does diabetes affect perioperative and postoperative risks?

A

Increases risks due to complications like:

  • Microvascular disease
  • Hypertension
  • Cardiovascular disease
  • Especially in patients with a history of diabetes for 10+ years
44
Q

What cognitive issues are associated with diabetes?

A
  • Development of cognition issues
  • Alzheimer’s dementia
45
Q

What factors should be assessed in diabetic patients preoperatively?

A
  • HGB A1C
  • Length of disease
  • Medications
  • Complications from diabetes
46
Q

How does MAC change with age?

A

Decreases by 6% per decade after age 40.

47
Q

What happens to neurotransmitter activity in the brain with aging?

A

Decreased.

48
Q

How does aging affect brain mass?

A

Decreased.

49
Q

What changes occur in peripheral nerves with aging?

A

Quantity and function decrease.

50
Q

What is the most common perioperative CNS complication in the elderly?

A

Postoperative delirium.

51
Q

When does postoperative delirium and cognitive dysfunction typically occur?

A
  • Delirium: early postoperative period
  • Cognitive dysfunction: weeks to months after surgery
52
Q

How is postoperative delirium treated?

A
  • Reversing underlying cause
  • Antipsychotics
  • Minimizing polypharmacy
53
Q

Is there a specific treatment for postoperative cognitive dysfunction (POCD)?

A
  • No specific treatment
  • Most cases are mild and tend to resolve after about 3 months.
54
Q

What causes a decreased basal metabolic rate in the elderly?

A
  • Decreased physical activity
  • Decreases in testosterone levels
  • Decrease growth hormone levels
55
Q

By age 80, what percentage of skeletal mass is lost?

A
  • 50%
  • Causing significant loss of body protein
  • Alterations in carrier proteins
56
Q

What increases the elderly’s susceptibility to skin tears and nerve injuries?

A

Loss of collagen and elastin.

57
Q

Where does body fat increase in the elderly?

A
  • In the viscera
  • Subcutaneous abdominal area
  • Intramuscular area
  • Hepatic areas
58
Q

What happens to total body water and blood volume by age 75?

A
  • Decrease in total body water
  • Blood volume decreases 20%-30%
  • Increasing the risk of hypotension
  • poor compensation for postural changes
59
Q

What body composition changes affect thermoregulation in the elderly?

A
  • Loss of lean body mass
  • Increased total body fat
  • Decreased metabolic rate
  • Decreased total body water
60
Q

How do age-related changes make the elderly vulnerable?

A
  • They become more vulnerable to hypotension and postural changes
  • With a reduction in blood volume of 20%-30%.
61
Q

What contributes to impaired thermoregulation in the elderly?

A
  • Decreased function of the hypothalamus
  • Leading to more pronounced and longer-lasting hypothermia
  • Lower basal metabolic rate
  • High ratio of surface area to body mass
  • Less effective peripheral vasoconstriction in response to cold
62
Q

How does hypothermia affect anesthetic elimination?

A

Slows anesthetic elimination.

63
Q

What is the impact of hypothermia on recovery from anesthesia?

A

Prolongs recovery.

64
Q

How does hypothermia affect coagulation?

A

Impairs coagulation.

65
Q

What does hypothermia increase the chance of in patients?

A

Increases the chance the patient will shiver.

66
Q

How does shivering affect the body, and what are its consequences?

A
  • Increases oxygen consumption by 400%
  • Leading to hypoxia
  • Acidosis
  • Cardiac compromise
67
Q

What are the Key Cardiovascular Changes in the Elderly?

A
  • Decreased Arterial Compliance
  • Decreased Venous compliance
  • Decreased Myocardial compliance
  • Decreased Conduction
  • Increased Myocardial mass
68
Q

A stiffer chest wall reduces the tendency of the chest to:

A

Expand

69
Q

Why is Vital Capacity Decreased with the Elderly?

A
  • Increase chest wall stiffness
  • Decrease elastic recoil
  • Decrease muscle strenght
70
Q

Factors that predispose a patient to fluid overload/Dehydration:

A
  • Impairment of Na+
  • Ability to concentrate urine
  • Capacity to dilute urine
71
Q
A
72
Q

Venous capacity is reduced in the elderly and affects the ability of:

A

Venous circulation to function as a Reservoir

73
Q

How much does Renal Blood Flow decreases per decade?

A

10%

74
Q

How is the serum creatine affected in the elderly?

A

Does NOT change!

GFR decreases with age!

75
Q

Is Serum creatine an indicator of renal function in the elderly?

A

NO, its a poor indicator

76
Q

What is the most sensitive indicator of renal function in the elderly?

A

Creatinine Clearance

77
Q

What is the GFR rate in the adult male?

A

~ 125 mL/min

78
Q

How much does GFR decreases after age of 40?

A

Decreases 1 mL/min/year

79
Q

What are the consequences of a decrease GFR?

A
  • Increased risk for fluid overload
  • Decrease elimination of hydrophilic drugs
  • Decrease elimination of hydrophilic metabolites of lipophillic drugs

Consider dose adjustment if > 60 Yr.

Special Population-RCM (8 decks)

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