Intro to Geriatrics Flashcards
Overview: Geriatric medicine
- prevelence
- longeviti v expectancy
Geriatrics: older people are living longer!; need to develop the art to caring for them; helping their quality of life
- approach from a complex, mulitmodal view with pt. interests and values at the core of care
Life expectancy
- how long one can expect to live, dependent of demographics, year born, etc.
- US 2021: 76 years (dip from COVID)
Longevity: how long an indivdual actuall lives past the average
art of agins: functional ability, autonomy, independence, security and safety of our pts.
Older Population tends to….
- increase prevelence of disase: older age, more likely
- multi-morbidites: confoudning disease states
- geriatric syndromes dx. and outcomes that are common for geriatrics
- they rely heavily on social supports! less independence
- atypically present: psychologic changes and muted presentations
- they respond differently to treatments (risk=benefit ratio)
There is a difference between normal aging changes in physiolgic processes and disease!! example: dementia is not :normal
General Trends of Physiologic Changes in Eldery
relation to frality
which systems affected most? least?
Physiologic Rhythms altered
- muted patterns of hormone release thus, the “patterns” of normal life are different
Lost complexity
- decrease variablity, response to stressors and other extremes
Homeostenosis
- dimished ability to alter to complexities results in less able to meet challeneges of homeostatic deman
end result is frality; smaller “blows” have larger impact on this population
Affected MOST
- endocrine & reporoductive are biggest changes
Affected LEAST
- GI and MSK
How does body structure and composition change with aging
Muscle Mass Decreases
- quantity of muscles decreases by up to 1/2
- quality of muscles decrease: more fat and connective tissue
- Sarcopenia: age-related loss of muscle mass & strength by 2 Standard Deviations than the younge helathy adult
- this decreases tehir strength : higher fall risk & easily fatigued
Adipose Tissue Increases
- this increases their risk for metabolic disease (DM, etc.)
- volume of distirbution for medications changes (fat soluable hang here more, water soluable higher concentration in the water)
Bone Mass Decrease
- decline in osteoblast (building) activity but no change in the osteoclastic activity (so more breakdown)
- this increases their risk for fractures and they have slower healing of these fractures
Cardiovascular Changes with aging
weaker, slower and stiffer heart
Decreased Elasticity
- more stiff arteries: makes the heart owrk harder to pump against stiffness
- hypertrophy of LV
- sytolic BP increase
- risk of HF increases
Electrical Conductivity Decreases
- decreased in intrinsic HR due to decrease in the pacemaker cells (SA node)
- amplified with medications which decrease HR also
Decreased Responsiveness to stimulatsion (inotropy)
- decreased exercise tolerance & cardiac output
- baroreceptors and adregneric stimulants arent as “stimulating”
Respiratory Changes with Aging
Decreased Elasticity
- stiffer chest wall: difficult for the lungs to expand and contract properly for air flow
- decreased muscle mass already!!
- decrease cough vigor, exercsie tolerancea and functional reserve
Decreased Bronchial Clearance
- cant clear secretions as well
- risk of PNA
Decreases surface of Gas Exchange in Alveoli
- decrease air flow and gas exchange
GI Changes with Aging
least changed
Decrease Taste and Smell Receptors
- things dont taste as good; less likely to eat
Muscles Decreased Effort
- swallowing is difficult; aspiration risk & weak gag reflex to protect self
Decreased Sphincter Contractions
- leaky sphinters! so reflex of stomach to esophagus
Decrease Elasticity
- stomach cant hold as much; full quicker
Declayed INtestinal Transient
- reduced perstalsis
- stuff sits there longer: more time for water to resorb into body
- INCREASED CONSTIPATION
Genitourinary Changes with Aging
Lost Renal Parynchma
- loss of nephrons; less able to clear (dec. CrCL)
- impaired ability to concentrate urine - more dilute: dehydrated
- more vulnerable to nephrotoxic agents
Increase Prostate size
- bladder pressure: obstructive urinary incontience
- noturia, incomplete emptying
Decrease Detrusor Muscle activity
- cant hold as much = increased frequency
- decreased contraction of msucle: increase post-void residual = increased need to go
- urinary incontinence
CNS and Nervous System Changes
Neuronal Loss
- brain atrophy in size: increased room for movement and injruy
Decreased Cognitive Function
- working memory and executive functioning impacted with age normally
- (skills, ability and knowledge remain stable)
Endocrine Changes in Aging
Decreased DHEA: precursor to sex hormones
Decreased estrogen, testosterone
Decreased GH and Thyroid hormone
- increased insulin resistance
- increased risk of metabolic disease
cortisol released in same amounts but different times : early to wake!
every other hormone decreases in amount from the pituitary therefore imaptcing lots of aspects of the body and homeostasis
Integumentary Changes in Aging
Thinning of the Epidermis
- fragility of skin; easy tearing
- redued ability to heal (blunted immune function too)
- decreased vasculature strength too easily brusing and bleeding
Decreased Surface Area in the Dermo-Epidermal Junction
- more water loss = dry
- compromised barrier
Decrease subQ fat
- reduced thermal regulation
Ocular Changes with Aging
Lacrimal Gland Decreased Function
- less tears = dry eye
- increase infection and injury
Iris gets smaller
- difficult night vision & transition to darker rooms
Retina Thinning
- retinal detachment
- macular degeneration
- flashing and floaters
Lens thickens and protein accumulation
- thickening = presbyopia (harder to see things close up)
Auditory Changes with Aging
External Ear
- increased and dry wax
Inner ear
- vestibular changes: loss of hair and salts
- Endolymph decreased production
results in balance issues and localization of sound
- Cholear changes: lost hairs
- basilar membrane less bouncy
hearing acuity decreases (cant hear higher frequencies = presbycusis
Immune Function Changes with Aging
Decrease Immune Reaction
- infections become severe quciker
- harder to tell: they dont moutn the same respnse (may not have a fever, for example)
Decreased Inflammatory Response
- vaccinations need higher doses
- infections take longer to fight off
immunosesnscence
Phenotypes of Aging
- increase succeptibiltiy to diseases
- multipel co-morbidities
- imparied stress response
- alltered repsonse to medications and treatments
- higher risk of disability
- loss of personal autonomy and independence
- geriatric syndromes
- Frailty
