Introduction to geriatric medicine Flashcards
What is the normal change in kidney function as you age?
Kidney function peaks at 25-20 years old
Renal/Volume regulation
Decreased GFR (variable but averages 10ml decrease/decade)
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 can you determine kidney function in the elderly?
Serum creatinine alone does not provide adequate information regarding renal function
Formulas for estimating GFR in older adults:
Modification of Diet in Renal Disease (MDRD)
Cockcroft-Gault (CG) – more conservative, preferred in older pts, more comorbid dz, frail
Normal cardiovascular changes associated with aging
Increased left ventricle and arterial stiffness
Decreased beta-adrenergic receptor responsiveness
Decreased maximum HR and CO
Increased systolic and pulse pressure
Diastolic stiffness (increased reliance on atrial kick)
Increased risk postural hypotension
Normal pulmonary changes associated with aging
Decreased elasticity (compliance)
Increased residual capacity
Decreased vital capacity
Decreased closing pressure
Increased Atelectasis
What Happens When You Lose Maximal Physiological Capacity with aging?
You Lose Functional Reserve
The Ability to Compensate in the Face of Stress
Sarcopenia
muscle atrophy due to disuse and disease
What contributes to the major loss of function over lifespan?
Usually NOT aging alone.
It’s the adiposity and inactivity (sarcopenia) that gets you into trouble
What is the second most common cause of morbidity and mortality (after smoking)?
Inactivity
What are the effects of exercising on aging?
even for very old, frail!
Increased funx/ decreased falls/decreased disability
Dz prevent/tx: DM, CV Dz, DJD, HTN, OP
Better Psychological health: sleep, depr, cognition
What is the “prescription” for exercise for the elderly?
Resistance (weight) training 2x/ week
Walk 30-40 min somewhat hard 4x/week
How has the population changed in terms of age?
More elderly people now compared to before.
Age stratification used to look like a pyramid with the elderly on top being smaller than the young, working population (larger).
Now age stratification almost looks like a rectangle with same elderly as young.
We will need to take care of the elderly and keep them not just alive but with low morbidity!
