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ANCC - Fitzgerald Notecards > Gerontology: Body and Metabolic Changes > Flashcards

Gerontology: Body and Metabolic Changes Flashcards

1
Q

Physiologic Changes: Skin and Hair

A
  • skin atrophies → epidermic and dermis thin, less subdermal fat and collagen (less elasticity)
  • skin is fragile and lower to heal
  • oil production is lower and skin drier (xerosis) d/t ↓ sebaceous and sweat gland activity
  • ↓ in sensitivity to touch, vibration and temperature
  • ↓ vit D synthesis
  • fewer melanocytes → graying of hair
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2
Q

Seborrheic Keratoses

A
  • soft wartlike skin lesions
  • appear “pasted on”
  • mostly seen on back and trunk
  • benign
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3
Q

Senile Purpura

A
  • bright purple-colored patches w/ well-demarcated edges
  • located on extensors surfaces of forearms and hands after a minor trauma
  • lesions eventually resolve over several weeks
  • residuals are brown appearance when hemosiderin deposits in the tissue
  • benign
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4
Q

Lentingines

A
  • aka “liver spots”
  • tan- to brown-colored macules with a “moth-eaten” border on dorsum of hands and forearms caused by sun damage
  • more common in light-skinned individuals
  • benign
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5
Q

Actinic Keratosis (Solar Keratosis)

A
  • flat or thickened plaque w/ color varying from skin-colored to red, white or yellow
  • may appear scaly or have a horny surface
  • found on sun-damaged skin
  • condition is secondary to sun exposure
  • has the potential for malignancy
  • precancerous form of squamous cell carcinoma
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6
Q

Physiologic Changes: Nails

A
  • growth slows
  • nails become brittle, yellow, and thicker
  • longitudinal ridges develop
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7
Q

Physiologic Changes: Eyes

A
  • presbyopia is caused by loss of elasticity of lenses, which makes it difficult to accommodate or focus on close objects
  • close vision is markedly affected
  • onset is during early to mid-40s
  • can be remediated w/ “reading glasses” or bifocal lenses
  • cornea is less sensitive to touch
  • arcus senilis, cataracts, glaucoma, and macular degeneration are more common
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8
Q

Arcus Senilis

A

Corneal Arcus
- opaque grayish-to-white ring w/ a sharp outer border
- indistinct central border at periphery of cornea
- typically bilateral; unilateral finding associated w/ contralateral carotid artery disease
- develops gradually, not associated w/ visual changes
- caused by deposition of lipids
- 60% of pts have evidence at age 60; nearly 100% at age 80
- in pts <40 years, can be a sign of elevated cholesterol
- chest fasting lipid profile

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9
Q

Cataracts

A
  • cloudiness and opacity of lens of the eye(s) or its envelope (posterior capsular cataract)

3 types:
- nuclear
- coprtical
- posterior capsular

  • color of lens is white to gray
  • cataracts cause gradual onset of ↓ night vision, sensitivity to glare of car lights (driving at night), halos around lights, blurry vision, and double vision
  • red reflex disappears
  • Mature cataracts appear white

Test: Red reflex (reflection os opaque gray vs. orange-red glow

  • increase sensitivity to glare of car lights (driving at night)
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10
Q

Glaucoma

A
  • normally, anterior chamber of eye is modestly pressurized, helping to maintain eye’s shape → Aging is associated w/ loss of cells that help w/ efficient drainage of anterior chamber → loss causes ↑ anterior chamber pressure secondary to bottle neck at the drainage canal

Test: Visual fields and tonometer

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11
Q

Macular Degeneration

A
  • loss of central visual fields → loss of visual acuity and contrast sensitivity
  • may fund drusen bodies

Test: Amsler grid to evaluate central-vision changes

** Most common cause of blindness in US is macular degeneration
- In developing countries, cataracts are the most common cause of blindness

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12
Q

Physiologic Changes: Ears - Presbycusis

A

Presbycusis (Sensorineural Hearing Loss)
- high-frequency hearing is lost first (e.g., a speaking voice)
- Presbycusis starts at ~50 years
- degenerative changes of ossicles, fewer auditory neurons, and atrophy of hair cells resulting in sensorineural hearing loss

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13
Q

Physiologic Changes: Heart

A
  • Elongation and tortuosity (twisting) of the arteries occurs
  • thickened intimal layer of arteries and arteriosclerosis → ↑ SBP d/t ↑ vascular resistance (isolated systolic HTN)
  • MV and AV may contain calcium deposits
  • baroreceptors are less sensitive ot change sin position
  • ↓ sensitivity of autonomic nervous system
  • BP response is blunted
  • Maximum HR ↓
  • higher risk of orthostatic hypotension
  • S4 heart sound is a normal finding in elderly if not associated w/ heart disease
  • LVH w/ aging (up to 10% increase in thickeness)
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14
Q

Physiologic Changes: Lungs

A
  • TLC remains relatively the same w/ aging
  • FVC ↓ w/ aging
  • FEV1 ↓ w/ aging
  • Residual volume (air left in lungs at end of expiration) ↑ w/ age d/t ↓ in lung and chest wall compliance
  • chest wall become stiffer
  • diaphragm is flatter and less efficient
  • Mucociliary clearance (fewer cilia) and coughing are less efficient
  • smaller airways collapse sooner during expiration
  • responses to hypoxia and hypercapnia ↓
  • ↓ breath sounds and crackles are commonly found in lung bases o9f elderly pts w/out presence of disease

Instruct pts to “cough” several times to inflat ethe lung bases (the benign crackles will disappear)
- ↑ anterior-posterior (AP) diameter r/t normal body changes

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15
Q

Physiologic Changes: Liver

A
  • liver size and mass ↓ d/t atrophy (20-40%)
  • liver blood flow and perfusion ↓ (up to 50% in some elders)
  • fat (lipofuscin) deposition in liver is more common
  • live function test result (ALT, AST, alkaline phosphatase) not significantly changed
  • metabolic clearance of drugs is slowed by 20-40% d/t cytochrome P450 (CYP450) enzyme system is less efficient
  • LDL and cholesterol levels ↑ w/ aging
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16
Q

Physiologic Changes: Renal System

A
  • renal size and mass ↓ by 25-30%
  • steepest decline in renal mass occurs after age 50
  • starting at age 40, GFR starts to ↓
  • by age 70, up to 30% renal function is lost
  • renal clearance of drugs, concentrating and diluting ability, and response to sodium is less effective
  • serum creatinine is a less reliable indicator of renal function in elderly d/t ↓ muscle mass, creatine production, and creatinine clearance
  • serum creatinine can be in the normal range, even if renal function is markedly reduced
  • risk of kidney damage from NSAIDs is much higher
  • renin and angiotensin II levels are lower in elderly
17
Q

Physiologic Changes: Genitourinary System

A
  • capacity of the bladder ↓ w/a ge
  • both compliance of bladder and rate of urine flow ↓
    → these factors contribute to ↑ amount of urine that remains in bladder after urination (residual urine)
  • normally, bladder holds approx 300-400 mL
  • prostatic hypertrophy occurs w/ age for men
  • in postmenopausal women, the urethra becomes thinner and shortens; ability of urinary sphincter to close tightly ↓ (because of declining estrogen)
  • urinary incontinence is 2-3x more common in women
  • ED affects approx 40% of men aged 40 years and 70% of men aged 70
18
Q

Physiologic Changes: Musculoskeletal System

A
  • muscle strength and power ↓ w/ age → can contribute to morbidity in elderly
  • deterioration of articular cartilage is common after age 40
  • stiffness in the morning that improves w/ activity is a common sx of osteoarthritis (degenerative joint disease [DJD])
  • Bone resorption is more rapid than bone deposition in women compared w/ men (4:1)
  • fractures heal more slowly d/t ↓ # of osteoblasts
19
Q

Physiologic Changes: Gastrointestinal System

A
  • receding gums and dry mouth are common
  • ↓ sensitivity of taste buds results in ↓ appetite
  • ↓ efficiency in absorbing some vitamins (e.g., folic acid, vit B12), and minerals (e.g., calcium) by the small intestines
  • delayed gastric emptying occurs
  • higher risk of gastritis and GI damage from ↓ production of prostaglandins
  • ↑ risk of colon cancer (age >50 years is strongest risk factor)
  • Diverticuli are common
  • Large bowel (colon) transit time is slower
  • constipation is more common
  • fecal impaction may lead to small amount of runny, soft stools
  • laxative abuse is more common
  • fecal incontinence may occur d/t loss of muscle mass and weakness of external anal sphincter, drug side effects, underly disease, neurogenic disorders, or a combination of these factors
20
Q

Physiologic Changes: Endocrine System

A
  • minor atrophy of the pancreas occurs
  • ↑ levels of insulin are seen along w/ mild peripheral insulin resistance
  • changes or disorders of the circadian rhythm hormonal secretion (growth hormone, melatonin,a nd other hormones) can cause changes in sleep patterns
21
Q

Physiologic Changes: Sex Hormones

A
  • Testes are active for the entire life cycle
  • Dehydroepiandrosterone (DHEA) and testosterone production ↓ markedly w/ age
  • estrogen and progesterone production ↓ significantly in women d/t ovarian failure (menopause)
  • higher serum testosterone concentration in some postmenopausal women may cause frontal balding on the head and excess hair growth on mustache area and/or on chin
  • adipose tissue is able to synthesize small amounts of estrogen and has been tied to gynecomastia in elderly men
  • In US, up to 3% of those aged 65-74 are sexually active, and some studies have shown that older adults in their 80s can remain sexually active
  • Some studies have shown that older adults in their 80s can remain sexually active
  • by 70 years, ~70% of male shave ED
  • Refer pt to urologist for treatment of ED that is not responding to usual doses of phosphodiesterase (PDE) inhibitors (sildenafil/Viagra, tadalafil/Cialis, vardenafil/Levitra, avanafil/Stendra) or have medical contraindications
  • Advise pt to use condoms w/ new sexual partners to protect from STD and HIV infection
22
Q

Physiologic Changes: Immune System

A
  • older adults are less likely to present w/ fever during infections
  • typical body temp is slightly lower
  • ↓ antibody response to vaccines
  • immune system is less active; there is higher risk of infection
  • cellular immunity is affected more by aging than humoral immunity
    -0 cellular or cell-mediated immunity involves activity of T-lymphocytes, macrophages, and cytokines
  • Humoral immunity is associated w/ B-lymphocytes and antibody (immunoglobulins or IgG) production
23
Q

Physiologic Changes: Hematologic System

A
  • no changes in RBC life span, the blood volume, or total number of circulation leukocytes
  • higher risk of thrombi and emboli d/t ↑ platelet responsiveness
  • ↑ risk of iron and folate-deficiency anemia d/t ↓ efficiency of GI tract to absorb vit B12 and folate
24
Q

Physiologic Changes: Neurologic System

A
  • hallmark of aging is slowed reaction times, ↓ proprioception, and ↑ risk of falls
  • cognitive function remains stable if no underlying dementia, but ability to solve problems is affected by reaction time
  • cranial nerve testing may show differences in ability to differentiate color, pupillary response, and ↓ corneal reflex
  • gag reflex ↓
  • DTR may be brisk or absent
  • neurologic testing may be impaired by medications, causing slower reaction times
  • benign essential tremor is more common
25
Q

Physiologic Changes: Pharmocologic Issues

A
  • drug clearance is affected by renal impairment, less efficient liver CYP450 enzyme system, slow gastric emptying, ↑ gastric pH, ↓ serum albumin, and relatively higher ratio of fat:muscle tissue (extends fat-soluble drugs)
  • older adults have ↑ sensitivity to benzodiazepines and anticholinergic drugs such as hypnotics, tricyclic antidepressants (TCAs), antihistamines, and antipsychotics

** Anticholinergic drugs causes:
- constipation
- urinary retention (esp men w/ BPH)
- blurred vision
- dry mouth
- orthostatic hypotension

American Geriatrics Society has made a list of inappropriate meds for the elderly: Beers Criteria

ANCC - Fitzgerald Notecards (27 decks)

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