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Pathophysiology II > Gerontology Pathophysiology > Flashcards

Gerontology Pathophysiology Flashcards

1
Q

What is life expectancy?

A

The average age that members of a population are expected to obtain when premature causes of death are taken out

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2
Q

What is life span?

A

The average age of all those that die of natural causes , absence of disease or trauma

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3
Q

What factors have increased longevity in the 20th century?

A

Advanced public health
Nutrition
Education
Social services

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4
Q

What age group is said to be elderly?

A

Those older than 65 years old

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5
Q

What is the fastest growing segment of the population?

A

Elderly people who are greater than 90 y/o

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6
Q

What often complicates geriatric surgical procedures?

A

Infections, Organ system failure and prolonged hospitalization

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7
Q

What is senescence?

A

Progressive deterioration of physiologic functions with aging

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8
Q

What is longevity?

A

Summation of forces that avoid or retard senescence

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9
Q

What is the formal definition for aging?

A

Progressive loss of physiologic research necessary to maintain homeostasis

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10
Q

What is frailty?

A

Loss of physiologic reserve for a specific biologic system, especially in the presence of stressors

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11
Q

Why shouldn’t a patients age be solely based on a number?

A

The elderly are neither a medically nor physically homogenous patient group such that rigid chronologic definition has little value other than administrative or epidemiological applications

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12
Q

What does the term aging suggest about a patients body?

A

Degenerative changes in structure and functional reserve of organs and tissues

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13
Q

When does functional decline begin to occur in the body?

A

Anatomic and physiologic changes begin in middle line in almost every system

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14
Q

What are the three elements that contribute to damage to the elderly in the perioperative period?

A

Limited end organ reserve
Any underlying disease
Actual stress or the peri operative period

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15
Q

What components make up frailty?

A

Disease
Dependency
Disability

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16
Q

What are characteristics of frailty?

A 
Wasting 
Loss of muscle mass/strength
Decreased balance
Slow performance/inactivity
Decreased cognitive function
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17
Q

What is multidimential geriatric syndrome?

A

Characterized by a loss of physiologic reserve that causes the patient to be vulnerable to adverse events

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18
Q

What helps to identify populations at greatest risk of events in the elderly population?

A

Biologic markers of age and physiologic reserve

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19
Q

What is the general rule of thumb for loss of organ system function per year?

A

Normally organ systems lose about 1% of function per year after 30 years of age

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20
Q

What is the hallmark sign of aging?

A

The lack of functional reserve in response to stress

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21
Q

What is the best indicator for biologic age?

A

Exercise tolerance, it is an important predictor of post op outcomes in the elderly

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22
Q

How would one determine organ system functional reserve?

A

Maximum capacity - basal level of function

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23
Q

What organ reserves can be tested prior to surgery?

A

Cardiopulmonary with stress test

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24
Q

What organ systems functional reserves are assumed for surgery?

A

Renal, Hepatic, Immune and Nervous system

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25
Q

Why is it important to determine an organ systems functional reserve prior to surgery?

A

To determine safety margins

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26
Q

How does aging affect cerebral blood flow and brain mass?

A

Decreased cerebral blood flow and brain mass

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27
Q

Does age affect cerebral auto regulation?

A

No, cerebral auto regulation is preserved

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28
Q

What is thought to cause a decrease in brain weight with age?

A

6-7% decrease in brain mass thought to be due to neuronal shrinkage rather than neuronal loss

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29
Q

How is white and gray matter affected by age?

A

Gray and white matter both decrease and CSF increases

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30
Q

What is thought to contribute to parkinsons disease in the elderly?

A

Decrease in dopamine in the substantia nigra

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31
Q

What is thought to contribute to senile demential in the elderly?

A

Decreased Ach in the hypothalamus

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32
Q

What is thought to cause depression in the elderly?

A

Decrease in Norepinephrine and 5-hydroxytryptamine in the hypothalamus

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33
Q

What neurotransmitter levels seem unaffected by age?

A

Glutamate

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34
Q

What additional factor other than neurotransmitters are thought to contribute to depression and dementia in the elderly?

A

Sleep patterns altered, decreased REM sleep

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35
Q

How is memory affected by aging?

A

Impaired short term memory but long term memory may be preserved

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36
Q

What factors increase an elderly patients risk for post op delirium and cognitive dysfunction?

A

Mental confusion with difficulty in temporal and spatial orientation

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37
Q

Why are elderly patients prone to orthostatic HoTN?

A

Impaired postural control

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38
Q

Why do elderly patients often develop arrhythmias?

A

Impaired autonomic regulation of CV function

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39
Q

Why is it easier to achieve a higher level of anesthesia with a lower volume of LA in the elderly?

A

There is a decrease in area of the epidural space

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40
Q

What nervous system is affected more by age?

A

CNS is more effected than the peripheral nervous system

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41
Q

Why are reflexes slower in the elderly patient?

A

Loss of myelin in PNS and

Decreased number of motor neuron in the spinal cord

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42
Q

What causes an increase in size of the heart in elderly patients?

A

Concentric ventricular hypertrophy (increase in wall thickness)

43
Q

What causes concentric ventricular hypertrophy in the elderly?

A

Response to increase LV after load due to decrease in arterial distensibility
Cardiac myocytes hypertrophy but are less in number

44
Q

How is cardiac connective tissue affected by age?

A

Increase in cardiac connective tissue leading to fragmented elastin replaced by collagen and increase wall stiffness and reduces diastolic compliance

45
Q

What do the elderly depend on for preload?

A

Markedly dependent on atrial kick for preload

46
Q

What is the most common supra ventricular rhythm in patients greater than 65y/o?

A

A-fib

47
Q

What can precipitate congestive heart failure in the elderly?

A

Preoperative increase in blood volume or a decrease in contractility

48
Q

How is heart rate altered with age?

A

No alterations of resting heart rate with age, maximum heart rate achievable decreases from 200–>160 b/m

49
Q

What causes an increase in susceptibility to supraventricular arrhythmias and ventricular ectopy with age?

A

Fibrous infiltration of SA node with loss of pacemaker cells

50
Q

Which parts of the heart are unchanged by age?

A

A-V node and bundle of his

51
Q

Why is there a decreased responsiveness to cardiac beta adrenergic agonists with age?

A

Reduced receptor numbers or affinity and there is a decrease in generation of cyclic adenosine monophosphate after beta receptor activation

52
Q

How are baroreceptors affected by age?

A

Response to decreased arterial pressure attenuated
May cause postural HoTN
HoTN with PPV, especially if patient is dehydrated

53
Q

What vessel changes lead to an increased incidence of aortic aneurysms in the elderly?

A

Less distensible vessels from thickened intimate and media

54
Q

What is thought to contribute to HTN in the elderly?

A

Large vessels become tortuous, elongated and dilated

55
Q

What causes a change in pulse wave of an a-line on an elderly patient?

A

Normal cushioning effects is impaired, reflected back from peripheral circulation and augments systolic pressure

56
Q

What is the importance of endothelium?

A

Important regulator od vasomotor response, coagulation, fibrinolysis, immunomodulation, vascular growth and proliferation

57
Q

How does aging affect the endothelium?

A

Aging alters endothelial structure even in absence of disease

58
Q

What accelerates endothelial function?

A

Smoking, DM, HTN and hyperlipidemia

59
Q

What are characteristics of endothelial dysfunction?

A

Decreased ability to dilate blood vessels in response to physiologic or pharmacologic stimuli
Decrease NO in all vascular beds
Reduced vasodilating response
Diminished B2 and alpha responses

60
Q

What mechanism is relied on in the elderly to increase SV?

A

Frank starling mechanism

61
Q

What respiratory changes are seen in the elderly?

A

Decreased lung volumes and Reduced efficiency of gas exchange

62
Q

Why do the elderly exhibit signs similar to that of emphysema?

A

Alveolar septa lost and decreased surface area

63
Q

Why us lung recoil decreased with age?

A

Loss of lung elasticity

64
Q

How is the residual volume affected by age?

A

Increased ratio of residual volume to total lung capacity

65
Q

How are closing volumes affected by age?

A

Increased closing volume leading to small airway closure at larger lung volumes (tidal volume occurs below closing volume)

66
Q

What is a common pulmonary problem when inducing the elderly with anesthesia?

A

V/Q mismatching from anesthetic induced depression of active hypoxia pulmonary casoconstriction

67
Q

What is the primary cause of decreased lung volumes in the elderly?

A

Restrictive functional impairment, increased thoracic cage rigidity restricts chest expansion

68
Q

What compensatory mechanisms are used when the chest wall becomes restrictive in the elderly?

A

Diaphragm and abdominal muscles compensate

69
Q

What is the maximum breathing capacity of that of a 20y/o compared to an elderly patient?

A

20y/o = 100L/min

Elderly: 30-40L/min

70
Q

What is the only lung capacity unaffected by age?

A

TLC remains relatively constant

71
Q

How is the VC affected by age?

A

Progressive loss of VC

72
Q

How is RV and FRC affected by age?

A

Progressive increase

73
Q

What is considered to be a normal PO2 in elderly patients greater than 60y/o?

A

81 mean, 71-90mmHg

74
Q

Why do the elderly experience a markedly attenuated increase in HR and minute ventilation in response to increases in PaCO2 or decrease in PaO2?

A

Decreased peripheral chemoreceptor sensitivity
Reduced respiratory muscle activity
Decreased respiratory mechanical efficiency
General respiratory deconditioning

75
Q

What anesthetic agents further attenuate the response to hypercarbia and hypoxia in the elderly?

A

Opioids, sedatives and volatile agents

76
Q

Why do the elderly have a reduced cough effectiveness?

A

Desensitization of airway epithelial cough receptors and impaired muscle function

77
Q

When is the highest prevalence of snoring in the elderly?

A

Highest in the 7th decade, associated with increased risk of stroke

78
Q

How are the kidneys affected by age?

A

Renal blood flow and GFR decline

79
Q

What is thought to cause a decrease in renal mass with age?

A

Decreased number of functional renal glomeruli, disproportionate loss of cortical nephrons and medullary nephrons relatively preserved

80
Q

How does the decrease in tubular excretion affect the elderly?

A

Impaired sodium handeling
Decreased ability to concentrate
Decreased drug excretion and
Impaired fluid handeling

81
Q

Why does Creatinine remain normal in elderly patients even if pathology is present?

A

Decline in skeletal muscle mass

82
Q

Why do elderly patients have a decreased volume of distribution?

A

They have an increase percent of body fat and decrease intracellular water content

83
Q

What sex has less synthesis of plasma cholinesterase in the elderly population?

A

Males

84
Q

How are enzyme activities of the liver affected by age?

A

Appears to be preserved

85
Q

Why is there an increased incidence in glucose intolerance and DM in patients older than 70?

A

Due to decreased pancreatic function

86
Q

What changes occur with decreased renin production in the elderly?

A

May lead to decreased plasma aldosterone production

87
Q

Why is thermoregulation impaired in the elderly?

A

Thermal stress poorly tolerated
Age related decrease in muscle mass
Unable to efficiently conserve heat

88
Q

What an appropriate focus in the pre operative period for the geriatric patient?

A

Evaluation of physical status and identification of age related disease rather than aging itself

89
Q

What are the components of Friedman’s model and how many places a patient at risk?

A 
Weight loss
Exhaustion
Weak grip strength 
Slow walking speed
Low physical activity 
Three or more of these place a patient at risk and are considered frail
90
Q

Why do minor insults in the elderly population often result in large changes?

A

When a complex system fails, it fails with higher order functions first

91
Q

What is the primary determinants of hospital mortality?

A

Age
Pre operative disease
The site of surgery

92
Q

What should be thoroughly assess prior to airway manipulation in the elderly patient?

A

Extension and rotation of the head: mental status changes could reflect vertebrobasiliar arterial insufficiency or the patient could have cervical arthritis
Cervical arthritis may be present

93
Q

Why is HoTN often seen in the elderly during induction?

A

Diuretic use
Decreased thirst
Age related decrease in renal capacity to conserve water and sodium

94
Q

Why are the elderly sensitive to fluid overload?

A

Decreased left ventricle compliance

95
Q

How is pharmacokinetics affected by age?

A

Overall reduced drug clearance from decreased renal and hepatic function

96
Q

Why does Reglan in the elderly prolong the effects of succyncholine and remifentanyl?

A

Interferes with the action of plasma cholinesterase

97
Q

How is the dose of hypnotics altered with age?

A

Decrease with age

98
Q

How should opioid doses be altered in the elderly?

A

Decreased the initial dose by 25-50% to achieve desirable serum levels and compensate for reduced rate of clearance

99
Q

Which non depolarizers are unaffected by age?

A

Atracurium and Cisatracurium (Hofmann elimination)

100
Q

How should the anesthetic provider dose reversal for the elderly?

A

Reversal agent dosages are not modified in the elderly

101
Q

How much does the MAC change with age?

A

MAC decreases 6.7% per decade of life

102
Q

What types of surgeries are associated with post op delirium in the elderly?

A

Ophthalmologic, cardiac and hip surgeries

103
Q

When does interval delirium occur in the elderly?

A

POD 1 or 2

104
Q

What are the four factors of surgical risk and outcome in the elderly?

A

Age
Patient physiologic status and coexisting disease
Surgery elective or urgent
Type of procedure

Pathophysiology II (6 decks)

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