Introduction to Geriatric Medicine

Question 1

When do boomers come into the demographics of geriatrics?

Answer 1

2010

Question 2

In the real world, when does geriatrics start?

Answer 2

75 yrs old

Question 3

Which age group is the fastest growing?

Answer 3

> 85 years old “old”

Question 4

How is our Population curve changing?

Answer 4

It is becoming more rectangular (more people live really long and then straight drop off)

Question 5

Geriatrics account for over ___ of hospital bed daysand the vast majority of ___ ____ bed days

Answer 5

44% and majority of nursing home bed days

Question 6

Did we add # of 65 year olds, or did we add years to 65 year olds?

Answer 6

@ 65 bought you 4-5 more years, but mostly saved people in infancy and got more to age 65

Question 7

At what age do women have about 10 years of life left?

Answer 7

At 80 years

Question 8

How do we best compress the morbidity curve?

Answer 8

Identify disease in the subclinical stage

Question 9

Everything peaks physiologically between what ages?

Answer 9

25-30

Question 10

Physiological Decline with Aging

Answer 10

1. Variability of the elderly
2. Aging vs. Disease vs. Disuse
3. Concept of homeostasis –> homeostenosis
4. Physiologic aging results in diminished reserve (can’t compensate as well)

Question 11

Physiologic changes with “normal aging” of your kidney

Answer 11

• Lose 1 ml / year for GFR
• Decreased ADH/renal response to hypovolemia
• Decreased sodium excretion response to hypervolemia
• Decreased renal excretion of drugs
• Decreased ability to compensate for volume depletion and volume overload states

Question 12

How great is the serum creatinine for geriatric patients?

Answer 12

Terrible. It does not help you, you need to calculate GFR with Cockcroft-Gault

Question 13

Aging changes to the heart

Answer 13

• Increased LV and arterial stiffness; increased blood pressure
• Decreased beta-adrenergic receptor responsiveness
• Decreased maximum HR and CO
• Increased systolic and pulse pressure
• Diastolic stiffness (increase reliance on atrial kick)
• Increased risk of postural hypotension

Question 14

Aging changes to lungs

Answer 14

• Elasticity (compliance)
• Residual capacity
• Vital capacity
• Closing pressure
• Atelectasis

Not enough reserve to respond to hypoxia

Question 15

VO2 Max changes with age and physical activity… how?

Answer 15

Untrained people have no reserve and decline from a lower baseline

Any kind of activity is better. Low intensity will have a steep drop off of VO2 Max.

Best is to be high or moderate intensity!

Question 16

What happens when y ou lose maximal physiological capacity?

Answer 16

You lose functional reserve and the ability to compensate in the face of stress

Question 17

Body composition changes to avoid aging effects

Answer 17

Avoid central adiposity.. Not only do we generally have more fat mass, but we have less fat-free (lean body mass)

Question 18

Sarcopenia

Answer 18

sarx (flesh) + penia (loss)

Disuse and disease caused loss of muscle.

Question 19

What is the general prevalence of sarcopenia in > 80 y/o?

Answer 19

Over 50%

Question 20

Functional significance of sarcopenia

Answer 20

Less muscle mass = less quality = less strength = less function

Question 21

Does everyone get an apple body?

Answer 21

Yep - happens for women at menopause. Men are always apples.

Question 22

Obesity is a key factor in…

Answer 22

1. Insulin resistance
2. Glucose intolerance and T2DM
3. HTN
4. Dyslipidemia
5. Abnormal fibrinolysis

Question 23

How do you take someone from untrained to trained?

Answer 23

Resistance training 2-3 days a week, aerobic training 5 days/wk

Question 24

How much do you buy someone age wise by training them?

Answer 24

10-15 years

Question 25

Benefits of regular physical activity for even the old and frail

Answer 25

Increased function, decreased falls, decreased disability.

Prevent DM, CVD, DJD, HTN, OP

Increased psychological health –> sleep, depression, and cognition

Question 26

Are we prescribing exercise?

Answer 26

Yes!

Modality: strength, balance, aerobic, flexibility
Dose: intensity, frequency, duration

Question 27

What is the lowest increment of exercise that’s useful?

Answer 27

10 minutes

Question 28

How do you retain muscle mass as you age

Answer 28

Lift weights: 10 exercises (10-15 reps) for 2 days per week

Muscle mass helps burn more so you prevent weight gain

Question 29

The precipice effect

Answer 29

You have less reserve, so when you get sick, you end up in a major functional decline because you live so close to the edge.