Medicine for the Elderly Flashcards
what are the implications of an increasing elderly population ?
higher healthcare costs due to increased cancer, dementia, stroke, diabetes
home care costs
what are the consequences of ageing ?
reduced income, reduced social status, loss of family and friends, loss of privacy
what are the 4 personality types of elderly people ?
integrated - active, satisfied, flexible, functioning
armoured - fights ageing, preoccupied with loss
passive - dependent, low level of satisfaction
angry - low activity, low life satisfaction, bitter
what are the physiological changes of ageing ?
skin - wrinkles, dry, Cambell de Morgan spots, seborrhoeic keratosis
what are the effects of ageing in the mouth ?
decrease in saliva production, impaired muscles of mastication, tooth loss, decrease in tastebuds, reduced sense of smell, enlarged tongue
what other changes are caused by ageing ?
reduced hepatic drug metabolism, decline in GFR, enlarged prostate, decreased bladder capacity, bone loss, thickened valves, dilation of large elastic arteries, increased systolic BP, reduction in SV and CO, decline in cardiovascular response to stress, fall in FVC and FEV1, reduced brain weight, presbyacusis, hardening got lens, flatter cornea, reduction in lean body mass, increase in fat mass, impaired ability to maintain body temperature, reduced oestrogen levels, increased immune deficiency
what effect does ageing have on IQ ?
cross section studies show decline, longitudinal studies show maintained, verbal scores preserved, speed of response deteriorates
what are the specific feature of disease presentation in the elderly ?
non specific presentation, atypical presentation, multiple pathology, symptoms attributed to old age, single illness leading to catastrophic outcome
what is non specific presentation ?
intellectual failure, incontinence, immobility, instability
what is atypical presentation ?
MI without chest pain, infection without increased WCC or temperature, silent perforation
what is multiple pathology ?
increase in age related incident of common illnesses, increased likelihood that illness in one system will affect another, immobility leading to pressure sores or DVT
what symptoms are erroneously attributed to old age ?
hypothyroidism, anaemia, bowel problems, urinary problems, shortness of breath, forgetfulness
which illnesses can lead to catastrophic consequences ?
pneumonia, delirium, postural instability, fall, fracture neck of femur, immobility, DVT/PE
how is pharmacology altered with ageing ?
renal drug clearance diminished, changes to hepatic drug metabolism, changes to volume of distribution
what causes changes to volume of distribution ?
ratio of fat to lean muscle increases,
lipid soluble drugs have an increased volume of distribution leading to more prolonged effects e.g. diazepam,
water soluble drugs have a smaller volume of distribution leading to a more rapid peak e.g. digoxin
