Introductory Concepts of Geriatrics Flashcards
Conventional age to define “seniors” or “older adults” is…
65+
Is debatable - spectrum because 65 is relatively young (increased longevity)
Seniors have an important implication on healthcare because…
$
They account for a large amount of healthcare spending
(43.6%)
Aging is a ____ process
Heterogenous
Higher age does not equal being sick
Protocols and guidelines in geriatric care are less useful compared to younger ages because…
Increased diversity of health with aging
Care must be individualized
Factors that can affect health as we age include…
Lifestyle
Genetics
Socioeconomic status
Education
Social engagements and support
Life expectancy refers to…
Proportion of maximum age a person may live
Male avg 81, Female avg 84
Health span refers to…
Number of years that are spent free from functional limitations, morbidity, and pain
Goal of most geriatric models of care is to prolong the health span
Functional capacity is an indicator of…
Ability to carry out everyday tasks
Activities of Daily Living (ADL’s) may include…
Bathing
Ambulation
Toileting
Transfers
Eating
Dressing
BATTED
Instrumental activities of daily living (IADL’s) may include…
Supportive tasks that are required to maintain independence
Shopping
Cooking/Cleaning
Using transportation/communication
Managing money/medication
SCUM
The clinical frailty scale is measured based off of…
Degree of functionality and ability to carry out ADL’s and IADL’s, with/without help
Functional reserve refers to…
When body systems have capability beyond what is needed for everyday activities
Older adults have a lower functional reserve compared to younger adults
Impairment in function relates to functional capacity in that…
An individual experiences Impairment in function when their demands exceed their functional capacity (ability to carry out everyday tasks)
Lower functional reserve in adults (ex: increase risk of decline when faced with illness/injury)
Functional decline refers to…
Reduction in ability to perform ADL’s or IADL’s due to decreased physical/cognitive function
Changes in the GI system with absorption involve…
Decreased gastric acid secretion
Slower gastric emptying + delayed intestinal transit
Decreased blood flow
The extent of absorption for some medications may be impacted due to…
Some examples of medications include…
Decrease in gastric acid secretion
Iron supplements
Calcium carbonate
Ketoconazole
Generally speaking, absorption in geriatrics is impacted by…
A decrease in rate of drug absorption
No change in extent of drug absorption (does have some exceptions)
Percutaneous absorption is impacted in geriatrics via…
Drier, lower lipid content - decrease rate of percutaneous absorption of lipophilic medications (extent is the same)
Fentanyl
Testosterone
Estradiol
Distribution of drugs associated with body composition changes with aging because of…
increase in body fat (lipophilic drugs), and decrease in muscle mass/body water (hydrophilic)
Highly lipophilic drugs are impacted by aging via…
Some examples include…?
Distributing out into fat tissues - longer half-life, more re-distribution needed to eliminate
Diazepam, amiodarone
Highly hydrophilic drugs are impacted by aging via…
Some examples include…
Less lean body tissue = more drug in bloodstream, increased concentration of drug
Lithium, aminoglycoside antibiotics
Metabolizing enzymes that are affected with aging include…
Some reduction in Phase 1 (CYP mediated) - longer half-lives, decreased dose requirements or increase in dosing interval
Phase 2 is NOT affected
Heterogenous - can vary via individual
Protein-binding is impacted with aging via…
Some medication examples include…
Decreased albumin levels in frail/malnourished older adults - decreased protein binding of highly bound medications
Phenytoin, warfarin, VPA
Overtime, increased metabolism/elimination compensates for increased free drug
Start low, go slow
Elimination in older adults is primarily affected by…
Decrease in renal size, blood flow, GFR and tubular secretion - elimination is slower and may require decreased dosages to avoid toxicity.
First-pass extraction in older adults is affected by…
Some examples include…
Decrease in liver size and blood flow; drugs with high first-pass extraction will have increased bioavailability
Metoprolol, morphine, amitriptyline
Start low, go slow
Using serum creatinine alone to estimate kidney function is…
Not reliable - muscle mass tends to decrease with age, so SCr may be falsely low
Also does not account for effect of age on kidney function
The equation that drug-dosing recommendations are generally based on for estimating renal function is…
Cockcroft-Gault - incorporates SCr, age, gender, and weight to estimate CrCl
Pharmacodynamic changes refer to…
Changes in medication response associated with aging
Pharmacodynamic changes may be due to…
Changes in receptor sensitivity or altered homeostatic mechanisms
Pharmacodynamic changes related to the CV system involve…
(4)
Decreased BP lowering response to beta-blockers
Decreased arterial compliance and decreased baroreceptor reflex (predisposition to orthostatic hypotension)
Increased stiffness of large blood vessels (isolated systolic hypertension)
Increased susceptibility to QT prolongation
Pharmacodynamic changes related to CNS involve…
Increased permeability of BBB - increased susceptibility to CNS adverse effects
Decreased dopaminergic neurons in substantia nigra - increaed susceptibility to EPS of dopamine-blocking medications
Pharmacodynamic changes associated with fluid and electrolyte homeostasis involve…
Decreased thirst response, GFR, response to ADH, and aldosterone
More susceptible to dehydration, hyponatremia, SIADH, hyperkalemia
Older adults have a lower hematopoietic reserve, which means…
Increased risk of hematological toxicities associated with chemotherapeutic drugs
Older adults have an ____ response to antiepiletic drugs at lower serum concentration, which…
Increased response - increases susceptibility to adverse effects
Immunosenescence changes with aging, because…
Reduced ability to fight infection
Reduced immune response following vaccination
Increased susceptibility to malignancy
Gastric mucosa changes with aging by…
Decreasing regenerative capacity of gastric mucosa - increased risk of GI bleeds (NSAID, ASA)
Therapeutic window changes with aging by…
Narrowing the window between therapeutic response and toxic response
Hence, dosing is important to avoid AE’s
Geriatric syndromes are…
Common health conditions in older adults that have multifactorial causes, and do not fit into discrete disease categories
