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Integration for clinical application > Lecture 2- Ageing and its effect on body system > Flashcards

Lecture 2- Ageing and its effect on body system Flashcards

1
Q

ageing and the lower airway

A
  • Lung and chest wall compliance decrease with advancing age
  • TLC, FVC, FEV1 and VC are all reduced as people age
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2
Q

why do

  • TLC, FVC, FEV1 and VC reduced as people age
A
  • These changes occur due to reduction in elastic support of the airways and leads to increased collapsibility of alveoli and terminal conducting airways
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3
Q

common post-operative complications to the lower airway in the elderly

A
  • Atelectasis, PE and pneumonia are common post-operative complications in the elderly
  • These complications are increase in smokers, pts with chronic chest disease and those undergoing abdominal and thoracic surgery
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4
Q

ageing and the upper airway

A

Loss of elastic tissue around the oropharynx

  • Can lead to collapse of the upper airway
  • Sleep or sedative states may result in partial or complete obstruction of the airway
  • Also made worse by:
    • Obesity
    • Lying flat
    • Sleep apnoea
    • Smoking
    • Opiate analgesic
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5
Q

Ageing and the skin

A
  • Reduction in elasticity
  • Thin skin and fragile subcutaneous blood vessels
  • Therefore pts bruise easily
  • Achieving and securing venous access can be difficult
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6
Q

Drugs to be careful with in elderly

A
  • Steroids- thins skins
  • Warfarin- blood thinners
  • Aspirin (platelet levels)
  • Statins
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7
Q

Ageing and the cardiovascular system

A
  • Large and medium sized vessels become less compliant with age
  • This results in raised systemic vascular resistance and hypertension, which in turn may lead to left ventricular strain and left ventricular hypertrophy
  • aortic stenosis can also causes LVH
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8
Q

ECG changes

A
  • Cardiac conducting cells decrease in number making heart block, ectopic beats, arrhythmia and AF more prevalent
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9
Q

why do patients with AF suffer a reduced CO of about 30%

A

Since atrial contraction contributes approx. one third of the volume towards normal ventricular filling

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10
Q

CO falls by

A

3% per decade which is due to reduced stroke volume and ventricular contractility

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11
Q

CVS changes and IV anaesthesia

A

Reduction in CO with age increases the arm-brain circulation time for drugs (delay between injecting person with drug and it working)and means IV anaesthesia is achieved more slowly with reduced doses of anaesthetic agents

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12
Q

ageing and the renal system

A
  • GFR decreases by 1% per year over the age of 20 years due to a progressive loss of renal cortical glomeruli
  • A reduction in renal perfusion secondary to reduced CO and atheromatous vascular disease leads to a decline in renal function
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13
Q

Other factors which effect the renal system…

A
  • Diabetes mellitus more common in elderly
  • Use of nephrotoxic drugs such as NSAIDS and ACEi are increasingly common
  • Urinary symptoms due to obstruction in males can leads to obstructive nephropathy and dehydration is common in the older patients esp during illness
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14
Q

ageing and the CNS

A
  • Cerebrovascular disease is common in the elderly secondary to diffuse atherosclerosis and hypertension
  • Neuronal density is reduced by 30% by the age of 80
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15
Q

ageing and endocrine and metabolic effects

A
  • Basal metabolic rate falls by 1% per year after the age of 30
  • Fall in metabolic activity and reduced muscle mass may cause impaired thermoregulatory control
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16
Q

Clinical relevance of normal ageing

A
  • Normal ageing has effects on all the major body systems and clinical management of older pts has to take normal ageing into account
  • This includes impact on prescribing and anaesthesia, recovery time from operations, increases rate of post off complications, susceptibility to side effects from medications, appropriate moving and handling and general care
  • Older pts are far more likely to have serious chronic conditions and co morbidities- a linear approach focussing on just one body system is not fit for purpose
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17
Q

Dementia

A
  • Increasingly common condition
  • Progressive
  • Not just related to memory loss
  • Dyspraxia
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18
Q

Diagnosis of dementia

A
  • Comprehensive assessment
    • Hx (history from pt and carer), Ex (exam), cognitive and Mini mental State Examination
    • Blood tests
      • To rule out reversible causes of confusion
    • Imaging
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19
Q

Care plan for dementia

A
  • Advance care planning
  • Palliative care services
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20
Q

Which part of the brain involved in recognising objects

A
  • Optic nerve
  • Occipital- visual processing
  • Temporal lobe- memory
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21
Q

Malnutrition in older age

A

At risk of being malnourished or already malnourished

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22
Q

issue with malnourishment

A
  • Malnourished pts are likely to have longer hospital admission
  • They respond less well to treatment and are 3 times more likely to develop complications after surgery and have higher mortality rates
  • Over 40% of pts malnourished on admission to hospital and nutritional risk increases during their stay
23
Q

tool used to diagnose malnutrition

A

MUST Tool

24
Q

MUST tool

A
  • Malnutrition universal screening tool
  • 5 steps
  • This tool can be used in hospital and community settings
25
Q

older people and pharmacokinetics: metabolisma nd excretion

A
  • Metabolism and excretion of many drugs decrease, requiring that doses of some drugs be decreased.
    • Toxicity may develop slowly because concentrations of chronically used drugs increase for 5 to 6 half-lives, until a steady state is achieved.

For example, certain benzodiazepines (diazepam, flurazepam, chlordiazepoxide), or their active metabolites, have half-lives of up to 96 h in older patients; signs of toxicity may not appear until days or weeks after therapy is started

26
Q

Older people and pharmacokinetics: Volume of distribution

A
  • With age, body fat generally increases and total body water decreases. Increased fat increases the volume of distribution for highly lipophilic drugs (eg, diazepam, chlordiazepoxide) and may increase their elimination half-lives.
  • Serum albumin decreases glycoprotein increases with age, but the clinical effect of these changes on serum drug binding varies with different drugs.
27
Q

Older people and pharmacokinetics: Hepatic metabolism

A
  • Metabolism via P450 decreases with age- older adults may have higher circulating drug in plasma
28
Q

Older people and pharmacokinetics: Renal elimination

A
  • GFR decreases with age
  • So does clearance
29
Q

Dementia is a brain condition that affects

A

memory, thinking and daily function.

30
Q

types of dementia

A
  • Alzheimer’s disease
  • Vascular dementia
  • Lewy body dementia
  • Fronto-temporal dementia.
  • These have differing features, but mostly the similarities are more important than the differences.
31
Q

Dementia is characterised by :

A
  • Progressive loss of memory plus changes in at least one other area of cognitive function, including
    • Aphasia
      • Disorder of language including understanding or comprehension and expression
    • Agnosia
      • Inability to recognise objects or people
    • Apraxia
      • Inability to perform purposeful activity in the absence of motor or sensory loss
    • Executive function
      • about planning, judgement and making decisions
      • includes initiation and maintenance of activity and responding to changing circumstance (frontal lobe functions)
  • This leads to impairments in judgement, thinking, planning, reasoning and the processing of information.
32
Q

Mild Memory Loss:

A

Mild memory loss is sufficient to interfere with everyday activities but does not prevent independent living

33
Q

Moderate Memory Loss:

A

Moderate memory loss can be a serious handicap to everyday living. Only very familiar material is retained. New information may be retained only occasionally or briefly. There is an inability to recall basic information on local geography, recent activities and even the names of familiar people.

34
Q

Severe Memory Loss:

A

Severe memory loss means the complete inability to learn new information. Only fragments of previously learned information remain. People with severe memory loss in dementia can’t recognise even close relatives.

35
Q

Alzheimer’s disease Background

A

most common dementia

  • A chronic, irreversible and degenerative brain disorder of unknown aetiology
  • Most common in people over 65
  • Not a natural part of ageing
  • Difficult to diagnose since progressive
36
Q

Alz RFs

A
  • head trauma
  • age
  • family history
  • high BP
  • gender – women more likely
  • down syndromes
  • excessive alcohol consumption
37
Q

Signs and symptoms of Alz

A
  • Confusion, disorientation, getting lost in familiar places
  • Difficulty planning or making decisions
  • Problems with speech and language
  • Problems with moving around and performing self care tasks
  • Personality changes e.g. becoming aggressive, demanding. And suspicious
  • Hallucinations
  • Low mood or anxiety
38
Q

Pathogenesis of Alz

A
  • Deterioration of the hippocampus and later areas in the cerebral cortex responsible for language, reasoning and social behaviour
  • Progressive accumulation of beta-amyloid in the brain triggers a cascade ending in neuronal cell death, loss of neuronal synapses and progressive NT deficits
39
Q

Treatment of Alz

A
  • No cure
  • Some medications can slow progressing
    • Acetylcholinesterase inhibitors an
    • Non pharmacological coping strategies e.g. calming oils
40
Q

Vascular dementia background

A

second most common dementia

  • Changing in thinking skills occurs suddenly after a stroke- due to inadequate oxygen supply to cells
  • Often multiple minor strokes meaning mild changes get gradually worse
  • Linked to other dementia inc Alz and Lewy body
41
Q

Symptoms of vascular dementia

A
  • Confusion
  • Disorientation
  • Trouble speaking or understanding speech
  • Physical stroke symptoms, such as a sudden headache
  • Difficulty walking
  • Poor balance
  • Numbness or paralysis on one side of the face or the body
42
Q

Risk factors of VD

A
  • CVS disease
  • Smoking
  • High blood pressure, cholesterol and blood sugar
  • Poor diet
  • Lack of exercise
  • Alcohol
  • High BMI
43
Q

Treatment of VD

A
  • No cure- just prevent worsening
  • Involves controlling risk factors
  • E.g. controlling BP and reducing cholesterol
44
Q

Frontotemporal dementia background

A
  • Progressive nerve cell loss in the brains frontal and temporal lobes- lobes shrink
  • Onset younger 40-60s
  • Not life threating- but can lead to increased risk of other illnesses e.g. pneumonia
45
Q

Pathophysiology of frontotemporal dementia

A

The two most prominent are

1) a group of brain disorders involving the protein tau and
2) a group of brain disorders involving the protein called TDP43.

46
Q

Risk factor of frontotemporal D

A

family history

47
Q

Signs and symptoms of frontotemporal D

A

Less linked to memory loss in early disease

  • Behavior and/or dramatic personality changes, such as swearing, stealing, increased interest in sex, or a deterioration in personal hygiene habits
  • Socially inappropriate, impulsive, or repetitive behaviors
  • Impaired judgment
  • Apathy
  • Lack of empathy
  • Decreased self awareness
  • Loss of interest in normal daily activities
  • Emotional withdrawal from others
  • Loss of energy and motivation
  • Inability to use or understand language; this may include difficulty naming objects, expressing words, or understanding the meanings of words
  • Hesitation when speaking
  • Less frequent speech
  • Distractibility
  • Trouble planning and organizing
  • Frequent mood changes
  • Agitation
  • Increasing dependence
48
Q

frontotemporal D treatment

A
  • No cure or treatment to slow progression
  • Antidepressants may help treat anxiety an control obsessive- compulsive behaviours
  • Prescription sleeping aids
49
Q

lewy body dementia background

A

third most common dementia

  • Lewy body dementia and Parkinson’s may be linked
50
Q

lewy body D pathophysiology

A

a disease associated with abnormal deposits of a protein called alpha-synuclein in the brain.

These deposits, called Lewy bodies, affect chemicals in the brain whose changes, in turn, can lead to problems with thinking, movement, behavior, and mood

51
Q

Risk factors of LBD

A

none

52
Q

Symptoms of LBD

A
  • Memory loss less prominent in early lewy compared to Alz
  • Changes in thinking and reasoning.
  • Confusion and alertness that varies significantly from one time of day to another or from one day to the next.
  • Slowness, gait imbalance and other parkinsonian movement features.
  • Well-formed visual hallucinations.
  • Delusions.
  • Trouble interpreting visual information.
  • Sleep disturbances.
  • Malfunctions of the “automatic” (autonomic) nervous system.
  • Memory loss that may be significant but less prominent than in Alzheimer’s.
53
Q

Treatment of LBD

A
  • No treatments that can slow or stop brain cell damage caused by lewy body dementia
  • Focus on helping symptoms
54
Q
A

Integration for clinical application (13 decks)

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