Introduction to Geriatric Medicine Flashcards
When do boomers come into the demographics of geriatrics?
2010
In the real world, when does geriatrics start?
75 yrs old
Which age group is the fastest growing?
> 85 years old “old”
How is our Population curve changing?
It is becoming more rectangular (more people live really long and then straight drop off)
Geriatrics account for over ___ of hospital bed daysand the vast majority of ___ ____ bed days
44% and majority of nursing home bed days
Did we add # of 65 year olds, or did we add years to 65 year olds?
@ 65 bought you 4-5 more years, but mostly saved people in infancy and got more to age 65
At what age do women have about 10 years of life left?
At 80 years
How do we best compress the morbidity curve?
Identify disease in the subclinical stage
Everything peaks physiologically between what ages?
25-30
Physiological Decline with Aging
- Variability of the elderly
- Aging vs. Disease vs. Disuse
- Concept of homeostasis –> homeostenosis
- Physiologic aging results in diminished reserve (can’t compensate as well)
Physiologic changes with “normal aging” of your kidney
- 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
How great is the serum creatinine for geriatric patients?
Terrible. It does not help you, you need to calculate GFR with Cockcroft-Gault
Aging changes to the heart
- 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
Aging changes to lungs
- Elasticity (compliance)
- Residual capacity
- Vital capacity
- Closing pressure
- Atelectasis
Not enough reserve to respond to hypoxia
VO2 Max changes with age and physical activity… how?
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!
What happens when y ou lose maximal physiological capacity?
You lose functional reserve and the ability to compensate in the face of stress
Body composition changes to avoid aging effects
Avoid central adiposity.. Not only do we generally have more fat mass, but we have less fat-free (lean body mass)
Sarcopenia
sarx (flesh) + penia (loss)
Disuse and disease caused loss of muscle.
What is the general prevalence of sarcopenia in > 80 y/o?
Over 50%
Functional significance of sarcopenia
Less muscle mass = less quality = less strength = less function
Does everyone get an apple body?
Yep - happens for women at menopause. Men are always apples.
Obesity is a key factor in…
- Insulin resistance
- Glucose intolerance and T2DM
- HTN
- Dyslipidemia
- Abnormal fibrinolysis
How do you take someone from untrained to trained?
Resistance training 2-3 days a week, aerobic training 5 days/wk
How much do you buy someone age wise by training them?
10-15 years
Benefits of regular physical activity for even the old and frail
Increased function, decreased falls, decreased disability.
Prevent DM, CVD, DJD, HTN, OP
Increased psychological health –> sleep, depression, and cognition
Are we prescribing exercise?
Yes!
Modality: strength, balance, aerobic, flexibility
Dose: intensity, frequency, duration
What is the lowest increment of exercise that’s useful?
10 minutes
How do you retain muscle mass as you age
Lift weights: 10 exercises (10-15 reps) for 2 days per week
Muscle mass helps burn more so you prevent weight gain
The precipice effect
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.
