Into to geriatrics Flashcards
what is aging?
A progressive and insidious decline in cellular processes after reaching sexual maturity
what does aging result in?
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
what is the mutation accumulation theory
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
what is antagonistic pleitropy
genes undergo role switch
from early life enhanced reproductive fitness to “diseases causing genes” later in life
cocoon hypothesis
there is a decline in natural selection forces from decreased immobility with aging
decreased environment risk
air conditioning, heating, vaccines, preventive care
hypomorphic mutations
decreased physiological process during environment stressor by conservation of energy results in decreased resting metabolic rate
food shortages results in decreased insulin
what is demographic transition
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
what is the most important systems that indicates decline
brain function
what happens with brain and spinal cord as we age?
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
what happens to endocrine function as we age.
decrease hormonal secretion
decreased receptors
decreased efficacy and efficiency
what happens to cardiovascular system as we age
decreased cardiac muscle contractility
myocardial fibrosis
atherosclerosis/arteriosclerosis
conduction abnormalities
what happens to glucose regulation as we age
decreased pancreatic function
decreased counter regulatory mechanisms
what happens to the muscular skeletal system
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
what happens to our immune system as we age
decreased defense mechanism
what happens to out senses as we age?
decreased hearing, smell, vision, taste, touch and vibration
what happens to the respiratory system as we age
interstitial fibrosis
cough less effective, decreased PFT
what happens to the renal system as we age
interstitial fibrosis
glomerular sclerosis
decreased creatinine clearance and GFR 10ml/decade
what happens to male reproductive system as we age?
testicular atrophy
BPH
prostate cancer
what happens to female reproductive system as we age?
ovarian atrophy
endometrial hyperplasia
uterine fibroids
what happens to GI system as we age?
mucosal atrophy
decreased emptying, hormonal secretion and HCL acid
hyperplastic polyps
colorectal adenomas
what happens with cytokines and inflammatory mediators as we age
they increase because it may be in response to radical oxygen species and less effective anti-oxidative stress
who loses more lean body mass faster men or women
women because they start out with less
what is prognostic indicator of frailty?
grip strength
what happens to resting metabolic rate as we age?
is decreased because we no longer need a faster heart rate and can no longer respond to situations as fast
what happens to the brain volume as we age?
decreased brain volume and hippocampus
what areas are important in brain function
fusiform gyrus, inferior temporal cortex, orbitofrontal these structures will decrease 50% in size in 5years
what happens to memory impairment in men and women as they age
men have greater memory impairment then women its theorized that it has to do with estrogen
skin homeostatic function
environmental protection absorption- may not be able to absorb through skin as effective temp regulation biochemical synthesis immune process sensory water balance
disturbance with skin as we age
atrophy eccrine gland atrophy statsis dermatitis cancer hair loss and graying
oxidative stress
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
decreased cellular function is significant risk for?
Immunosenescence- decreased ability to respond to antigen and threat and launch immune responsive, decreased immune memory
what happens to co-mordibities as we age
they increase
what is the aging phenotype
4 functional physiological domains are the basis of the approach and assessment the older person
what are the 4 aging phenotypes
body composition changes
Energy Reserve
Neurologic Integrity
Homeostasis
body composition phenotype
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
energy reserve phenotype
availability vs. demand
measure cardiac, pulmonary function
neurological integrity phenotype
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
homeostasis phenotype
hormonal, nutritional, inflammatory
decreased testosterone=decreased lean body mass
decreased temp regulation
have lower body temp even in infection
what is the definition of frailty?
when there is > 1 disruption in physiological domain
Example: decreased wt, LBM, fatigue, impaired grip strength, physical activity, gait impairment
frailty and attendant co-morbidities
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
frailty can result in
multiple multiple morbidities need polypharmacological approach physical disability geriatric syndromes vulnerable to hospitalization decreased tx options complicated dug therapy
disability and impaired recovery from acute illness
females>males because of less body mass increased with age cognitive and physical impairment are important biomedical measures that predicts institutionalization healthcare utilization mortality
what are geriatric syndromes
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
geriatric syndromes
urinary incontinence delirium/dementia falls pressure ulcers sleep disorders
persistent pain results in
poor sleep depression increased fatigue decreased motor function delirium social isolation increased risk of ADR
what is the #1 cause of persistent pain
other causes
MSK
ischemia and neuropathic
what is the treatment according to WHO
Tx does not completely alleviated but made tolerable!!!
always start with acetaminophen
pt, splints, exercise
heat, glucocorticoids injections
urinary incontinence
involuntary voiding
females>males
50% females will have some type of UI over a lifetime
increased physical functional and psychological morbidity
RF for urinary incontinence
Childbirth, increased age, white race, obesity, UTI, co-morbidities
stress incontinence
sphinceter failure with increased abdominal pressure=females
decreased pelvic floor strenght
prostate surgery
urge incontinence
sudden sensation of need to urinate
detrusor muscle over activity
lack of neurological inhibition
local irritation, inflammation
overactive bladder
incomplete bladder emptying
urine dribbling after micturation or constantly
impaired detrusor contractility usually d/t denervation
bladder outlet obstruction
BPH
Cystocele/uterine prolapse
pathophysiology as related to aging phenotypes in UI
body composition atrophy of bladder and pelvic floor neurodegeneration CNS (conscious control) PNS (denervation)
UI treatment
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
under nutrition and anorexia
there is a overall decrease in appetite d/t decreased energy demand
poor mirconutrient intake
increased mortality
under-nutrition and anorexia tx
regular weight monitoring nutritionist nutritional supplements life dietaty restrictions these Rx increase fat not muscle
what is the most common type of ADL that is supported in the elderly
81%Meds
least was eating 12%
what increased potential to promote healthier aging
exercise and good nutrition
screening in primary care setting
influenza yearly BMD > 65 year old women yearly BP DM A1C>40yrs old lipid every 5 yrs
future directions in disease precention for elder
dietary restrictions without malnutrition
decrease weight over lifetime
