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Geriatrics > Into to geriatrics > Flashcards

Into to geriatrics Flashcards

1
Q

what is aging?

A

A progressive and insidious decline in cellular processes after reaching sexual maturity

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2
Q

what does aging result in?

A

Decreased homeostatic balance
Decreased reaction to tissue injury
Increased vulnerability to environmental changes
↓’d organ/system reserve (if patient has good organ reserve then the patient will age healthier)
Less specific causes of disease with greater individual variation

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3
Q

what is the mutation accumulation theory

A

We are born with specific vulnerability to a late life disorder
Radiation (sun) is the most common cause of genetic mutation
Free radical theory is the most important reason for aging
Poor eating, exercising

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4
Q

what is antagonistic pleitropy

A

genes undergo role switch

from early life enhanced reproductive fitness to “diseases causing genes” later in life

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5
Q

cocoon hypothesis

A

there is a decline in natural selection forces from decreased immobility with aging
decreased environment risk
air conditioning, heating, vaccines, preventive care

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6
Q

hypomorphic mutations

A

decreased physiological process during environment stressor by conservation of energy results in decreased resting metabolic rate
food shortages results in decreased insulin

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7
Q

what is demographic transition

A

rate of population aging
shift in age distribution world-wide
factors influencing population age shifts:
decreased fertility rates and infant mortality
decreased mortality rates in the oldest of old

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8
Q

what is the most important systems that indicates decline

A

brain function

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9
Q

what happens with brain and spinal cord as we age?

A

reactive gliosis- glial cells are hyperactive and cause scarring leaving amyloid plaques
dural meningeal fibrosis
brain atrophy- occurs in someone without any memory impairment
decreased peripheral nerve conduction velocity

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10
Q

what happens to endocrine function as we age.

A

decrease hormonal secretion
decreased receptors
decreased efficacy and efficiency

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11
Q

what happens to cardiovascular system as we age

A

decreased cardiac muscle contractility
myocardial fibrosis
atherosclerosis/arteriosclerosis
conduction abnormalities

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12
Q

what happens to glucose regulation as we age

A

decreased pancreatic function

decreased counter regulatory mechanisms

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13
Q

what happens to the muscular skeletal system

A

sarcopenia- the loss of lean body mass if you lose 15% of lean body mass you’re at risk of death
decreased muscle strength and coordination
osteoporosis
osteoarthritis

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14
Q

what happens to our immune system as we age

A

decreased defense mechanism

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15
Q

what happens to out senses as we age?

A

decreased hearing, smell, vision, taste, touch and vibration

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16
Q

what happens to the respiratory system as we age

A

interstitial fibrosis

cough less effective, decreased PFT

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17
Q

what happens to the renal system as we age

A

interstitial fibrosis
glomerular sclerosis
decreased creatinine clearance and GFR 10ml/decade

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18
Q

what happens to male reproductive system as we age?

A

testicular atrophy
BPH
prostate cancer

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19
Q

what happens to female reproductive system as we age?

A

ovarian atrophy
endometrial hyperplasia
uterine fibroids

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20
Q

what happens to GI system as we age?

A

mucosal atrophy
decreased emptying, hormonal secretion and HCL acid
hyperplastic polyps
colorectal adenomas

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21
Q

what happens with cytokines and inflammatory mediators as we age

A

they increase because it may be in response to radical oxygen species and less effective anti-oxidative stress

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22
Q

who loses more lean body mass faster men or women

A

women because they start out with less

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23
Q

what is prognostic indicator of frailty?

A

grip strength

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24
Q

what happens to resting metabolic rate as we age?

A

is decreased because we no longer need a faster heart rate and can no longer respond to situations as fast

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25
Q

what happens to the brain volume as we age?

A

decreased brain volume and hippocampus

26
Q

what areas are important in brain function

A

fusiform gyrus, inferior temporal cortex, orbitofrontal these structures will decrease 50% in size in 5years

27
Q

what happens to memory impairment in men and women as they age

A

men have greater memory impairment then women its theorized that it has to do with estrogen

28
Q

skin homeostatic function

A 
environmental protection
absorption- may not be able to absorb through skin as effective
temp regulation
biochemical synthesis
immune process
sensory 
water balance
29
Q

disturbance with skin as we age

A 
atrophy
eccrine gland atrophy 
statsis dermatitis
cancer
hair loss and graying
30
Q

oxidative stress

A

decreased synthesis of antioxidants against reactive oxygen species
disrupts DNA molecule-nuclear and mitochondrial DNA-cell membrane disruption
-decreased ability to neutralize radical oxygen species
Obesity increases oxidative stress
Oxidative stress disrupts cellular growth regulation

31
Q

decreased cellular function is significant risk for?

A

Immunosenescence- decreased ability to respond to antigen and threat and launch immune responsive, decreased immune memory

32
Q

what happens to co-mordibities as we age

A

they increase

33
Q

what is the aging phenotype

A

4 functional physiological domains are the basis of the approach and assessment the older person

34
Q

what are the 4 aging phenotypes

A

body composition changes
Energy Reserve
Neurologic Integrity
Homeostasis

35
Q

body composition phenotype

A 
decreased lean body mass, BMI, waist circumference, muscle strength testing
decreased insulin sensitivity
decreased functional capacity
decreased metabolic rate
correlated with mortality,illness
adipokine= decreased cognitive function
36
Q

energy reserve phenotype

A

availability vs. demand

measure cardiac, pulmonary function

37
Q

neurological integrity phenotype

A

CNS,PNS
pre-frontal and hippocampus atrophy
amyloid plaques and neurofibrillatory tangles seen in normal and demented patients
decreased autonomic system regulation
CNS degeneration: decreased hypothalamic hormonal regulation and sympa/parasympathetic NS fnx

38
Q

homeostasis phenotype

A

hormonal, nutritional, inflammatory
decreased testosterone=decreased lean body mass
decreased temp regulation
have lower body temp even in infection

39
Q

what is the definition of frailty?

A

when there is > 1 disruption in physiological domain

Example: decreased wt, LBM, fatigue, impaired grip strength, physical activity, gait impairment

40
Q

frailty and attendant co-morbidities

A

they complicate diagnosis
example Fe+ and B12 together result in a normocytic anemia
this result in a prolonged illness
slow recovery
overlapping relationship between disease and frailty

41
Q

frailty can result in

A 
multiple multiple morbidities need polypharmacological approach 
physical disability
geriatric syndromes
vulnerable to hospitalization
decreased tx options
complicated dug therapy
42
Q

disability and impaired recovery from acute illness

A 
females>males because of less body mass
increased with age
cognitive and physical impairment are important biomedical measures that predicts 
institutionalization
healthcare utilization
mortality
43
Q

what are geriatric syndromes

A

reflect the complex interplay physiologic vulnerabilities and exposure to stressors
increases risk for morbidity and mortality
decrease quality of life
presents with atypical symptoms and signs due to multiple functional pathology d/t frailty and disease

44
Q

geriatric syndromes

A 
urinary incontinence
delirium/dementia
falls
pressure ulcers
sleep disorders
45
Q

persistent pain results in

A 
poor sleep
depression
increased fatigue
decreased motor function
delirium
social isolation
increased risk of ADR
46
Q

what is the #1 cause of persistent pain

other causes

A

MSK

ischemia and neuropathic

47
Q

what is the treatment according to WHO

A

Tx does not completely alleviated but made tolerable!!!
always start with acetaminophen
pt, splints, exercise
heat, glucocorticoids injections

48
Q

urinary incontinence

A

involuntary voiding
females>males
50% females will have some type of UI over a lifetime
increased physical functional and psychological morbidity

49
Q

RF for urinary incontinence

A

Childbirth, increased age, white race, obesity, UTI, co-morbidities

50
Q

stress incontinence

A

sphinceter failure with increased abdominal pressure=females
decreased pelvic floor strenght
prostate surgery

51
Q

urge incontinence

A

sudden sensation of need to urinate
detrusor muscle over activity
lack of neurological inhibition
local irritation, inflammation

52
Q

overactive bladder

A

incomplete bladder emptying
urine dribbling after micturation or constantly
impaired detrusor contractility usually d/t denervation
bladder outlet obstruction
BPH
Cystocele/uterine prolapse

53
Q

pathophysiology as related to aging phenotypes in UI

A 
body composition 
atrophy of bladder and pelvic floor
neurodegeneration
CNS (conscious control)
PNS (denervation)
54
Q

UI treatment

A 
life modification
-weight loss, avoid drinking before bed, limit alcohol, caffeine/tea, tobacco
Behavior modifications
Kegel exercises 
bladder training
biofeedback
Tx UTI
antimuscarinics oxybutinin
surgery
55
Q

under nutrition and anorexia

A

there is a overall decrease in appetite d/t decreased energy demand
poor mirconutrient intake
increased mortality

56
Q

under-nutrition and anorexia tx

A 
regular weight monitoring
nutritionist
nutritional supplements
life dietaty restrictions
these Rx increase fat not muscle
57
Q

what is the most common type of ADL that is supported in the elderly

A

81%Meds

least was eating 12%

58
Q

what increased potential to promote healthier aging

A

exercise and good nutrition

59
Q

screening in primary care setting

A 
influenza yearly
BMD > 65 year old women
yearly BP
DM A1C>40yrs old
lipid every 5 yrs
60
Q

future directions in disease precention for elder

A

dietary restrictions without malnutrition

decrease weight over lifetime

Geriatrics (9 decks)

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