Normal ageing process Flashcards
Physiological reserve
The potential capacity of a cell, tissue or organ system to function beyond its basal level in response to alterations in physiologic demands
Homeostenosis
This is the progressive reduction in an individual’s capacity to maintain homeostasis as they age
T/F aging beings in utero
True
Morbidity
a diseased state, disability, or poor health due to any cause.
In regard to australia’s aging population, it is estimated that by 2050…
the proportion of the population over 65 will increase by 25%
(8,975,000)
What percentage of Australia’s total population in 2020 were aged 65 and over?
16%.
(4.2 million)
Trends in the number of older people (65+) in any area are a function of which demographic processes:
- Fertility – the rate at which women in that area were having children 65-90 years ago.
- Mortality – the rate at which older people are lost to death.
- Migration – the extent to which older people move into or out of the area.
When did australia’s fertilitaty rate increase between 1901-2012?
1950-1960
Post war baby boom
The median age (years) for long term condition demenita
83
The median age (years) for long term condition heart disease
72
The australian burden of statistics census in 2021 found which long term health condition to have the highest proportion per total population %
Arthritis- increasing after 50
What were the top 4 disease rankings by total burden in 2022 by the australian burden of disease study?
- Coronary heart disease
- Dementia
- Back pain/problems
- COPD
Disability
is any condition that makes it more difficult for a person to do certain
activities or effectively interact with the world around them (socially or materially
In 2018, 1 in 9 (11.6%) aged 0-64 had disability. In older australias (65+ years), the prevalence of disability was…
Almost 1 in 2
The average life expectancy for indigeonous people born between 1996 and 2001 (M & F)
M- 59.4
F- 64.8
Most prevalent long-term health conditions among older Indigenous Australians in 2004–05 were?
- **eye/sight problems **(89%),
- heart and circulatory problems/diseases (61%),
- arthritis (49%)
- diabetes/high sugar levels (36%).
Normal aging within the brain and nervous system
- Decreased brain weight
- Loss of gray matter
- ventricle sizes can increase
Normal aging within the Senses
- Presbyopia (far-sightedness)
- Presbycusis (hearing loss)
Normal aging within - Vestibular function
- Loss of hair cells
- Decline in vestibular sensitivity
Normal aging for strength
- Loss of lean body mass/skeletal muscle
Males decrease bone mass with age, in women what in particular contributes to bone loss?
menopause
Conditions that contribute to a general deterioration in function:
- Vision – glaucoma; atherosclerosis
- Vestibular – drug toxicity; Meniere’s Disease
- Peripheral sensation – neuropathy (Diabetes)
Conditions causing marked changes in function:
- Alzheimer’s Disease
- Stroke
- Parkinson’s Disease
Theories on ageing:
The immune theory
Breakdown in the immune system leads to a greater risk of disease and cancer.
Theories on ageing: Progressive decline model
Longer we live = more wear and tear
Biological clock model
Aging is directed by biological time and, specifically, cell replication
Cardiovascular (CV) system: Structural changes:
- Decreased elastin, increase collagen levels = vessel membrane thickens resulting in arterial stiffness
- Decreased myocardial cells
- LV wall thickens, atria size increases = resulting in increase heart weight
What heart chamber increases in size, and which thickens during ageing?
Atria increase
left ventricle thickens
Functional changes to the heart from ageing
slightly less able to tolerate an increased workload due to the changes from aging that reduce the extra pumping ability.
Does ageing affect the brain talking to the heart?
- Decreased response to catecholamines
- Diminished cardiac output with exercise
- Decreased blood flow to brain, heart, kidney, liver.
- Slower adaptation to change in activity
- Conditioning takes longer
Whilst diastolic remains the same, systolic pressure may increase with ageing. It is thought to be due to…
thickening arterial wall.
Postural hypotension in elderly is due to…
Decreased baroreceptor sensitivity
The prevalence of baroreflex sensitivity to low blood volume & cardiac output decreases with age. If the baroreceptors are not triggered to normative blood pressure, what might an individual experienced?
dizziness, syncope, and falls.
Which added heart sounds are normal and abnormal?
S3- is abnormal in elderly, but normal in under 40. Results from increased atrial pressure leading to increased flow rates.
S4- normal in elderly. Heart relies on atrial contraction to compensate for diminished LV filling and stiffness. Can be heard
in athletes and healthy children.
Which is the most common cause of S3?
Congestive heart failure
sarcopenia
loss of muscle tissue as a natural part of aging process
Disengagement social theory on ageing
relationship between aging person and society has changed.
Decreased blood flow around the body, the first thing that is generally effected?
extremities
Within 3 minutes of standing, what happens to blood pressure?
systolic BP drop >20mm Hg
or diastolic BP drop of >10mm Hg
What condition is the most chronic cause of chronic leg edema?
Chronic venous insufficiency CVI
How can Chronic venous insufficiency (CVI) symptoms be alleviated?
support stockings, exercise, elevation of legs and good diet (reduce salt)
If a patient has acute onset of unilateral leg oedema what should you be suspicious of?
DVT
In young populations, acute MI typically presents with crushing chest pain and diaphoresis. How can acute MI in elderly patients present?
Sometimes dyspnea accompanied by anxiety and confusion
Typical structural changes to lungs with ageing
- muscle atrophy and rigidity
- thick membranes, alveoli, capillary
- alveolar duct size increases (decrease surface area)
- mucous increases (cells increase)
- cilia activity decreases (decline in cilia)
Aging affects on the functions of the respiratory system
- compliance
- lung volume
- air flow
- diffussing capacity
- other lung parameters of function
How does a decline in cilia and an increase in mucous producing cells affect the elderly?
Increased mucous obstructing airways, makes them more vulnerable to infections
A decreased ability to breath due to wall stiffness and decrease lung elastic recoil affects the ability to cough. What affect might this have on older adults?
Less aware of bronchoconstriction and are less sensitive to hypoxia. At greater risk for mortality from acute respiratory problems
Oesophagus changes
Upper sphincter tension decreases (doesn’t have effect)
Reflux is just as prevalent as the younger population.
Drugs can cause injury; higher risk due to delayed transit
Stomach changes
modest slowing of gastric emptying
achlorhydria
Atrophic gastritis is a stomach disorder
Liver changes
reduced BF to liver, diminished capacity to regenerate cells
ability to withstand stress decreases-> substances to toxicity is more sensitive
Pancreas changes
Decrease in overall weight, duct hyperplasia, and lobular fibrosis.
Higher risk of glucose intolerance and type 2 diabetes ( less insulin secretion and insulin resistance increasing)
Intestine changes
- prevalence of diverticulosis increases (prevented with high fibre)
- less lactase from SI
- excessive growth of bacteria
- rectum enlarges somewhat
Absorption of B12 requires
- adequate amounts of gastric acid
- pepsin enzyme
- intrinsic factor
GU system changes
and size of nephrons decrease
- kidney BF decreases 10% per decade.
- number and size of nephrons decrease
- kidney looses mass.
- all changes reduce filtration rate from kidneys
What effects the ability to control urination
- Normal anatomy
- Normal Nervous System
- Recognise and respond
Prevalence of incontinence
> 60 yo 15-35%
How does incontinence affect elderly?
-Extreme activity limitation and social isolation.
-Increases fall risks due to urgency.
types of incontinence
Overflow
Stress
Urge
Overflow incontinence
Urethral blockage
bladder unable to empty properly
stress incontinence
relax pelvic floor
increased abdominal pressure
urge incontinence
bladder oversensitivty from infection
neurologic disorders
What is the most common type of incontinence in women?
Stress incontinence
Overactive bladder is another name for
Urge incontinence
Which incontinence is rare in women and more common in men?
overflow incontinence
(hx of prostate surgery/issues)
How does menopause affect bones? How to manage?
Rapid loss due to oestrogen withdrawal.
Replacement therapy (doesn’t effect symptoms of menopause)
Andropause
Gradual decline in testosterone.
Features can include loss of muscle, fatigue, depression, anaemia, poor libido.
The decrease GH secretion leads to
- reduction of protein synthesis
- decrease in lean body/bone mass
- decline in immune function.
Common symptoms of menopause
hotflushes, hotskin, sweating, increase heart rate
Hot flushes can last
2 minutes to half an hour, may occur through day or several times a week
Hot flushes is preceded by a
surge in LH
Regarding the GU system, oestrogen deprivation may lead to?
dysuria, urinary frequency and incontience.
oss i
Oestrogen deprivation in postmenopausal women can cause, and why?
loss of libido (ovarin function stopping)
Somatopause
the progressive decline in GH secretion
GH hormone on peripheral tissue is mediated by
IGF-I
What happens to GH and IFG-I concentrations with ageing?
decline by 50% in healthy older adults.
Adrenopause
age-related change in adrenal cortex - decreases DHEA biosynthesis (steroid hormone) - by 80 levels are ~ 20%
Function of DHEA?
steroid hormone; acts directly as neurosteroid to cardioprotective, antidiabetic, anti obesity and enhance immune properties.
Changes to skin in elderly
thinner epidermis and flatter basement membrane.
fewer langerhans cells.
dermal blood supply diminised
decreases collagen and elastin in dermis
Hair changes
and nail changes
hair loss, coarse changes.
dry brittle nails
An patient with hair loss should be distinguished from diffuse hair loss due to?
- iron deficiency
- hypothyroidism
- chronic renal failure
- undernutrition
- certain drugs
Difference between fast bone loss and slow bone loss
Slow bone loss is normal from ageing that affects equal sexes.
fast bone loss is a transient/more rapid, occuring approx 35% of early postmenopausal women and some men who develop hypoonadism.
At what age is the average peak bone mass?
~ 30
What type of bone does menopause affect?
trabecular
Benefits for physical activity for elderly
- acrobatic activity involves motor learning
- stimulating environments
- cognitive challenges
- aerobic activity
What is the most common sensory change in older adults?
vision
What are vision changes seen in older adults/
- hardening of lens reduce ciliary body effect
- discolourated cornea lens: yellow tint to the visual field
- alterered colour perception
- decrease night vision
- decrease contrast
- light adaptation (less light into eyes)
Presbycusis
age-related , gradual, bilateral, symmetric, and predominaty high frequency hearing deficits
Changes to ear from ageing
- thinning of canal
- obstruction of canal
- thicken tympanic membrane less responsive
- cochlear function ( loss of hair stiffness, calfication, neuron loss)
- atrophic changes in the temporal auditory cortex
Changes to taste and smell from ageing is due to?
Reduction in the olfactory receptors.
Anosmia
complete loss of smell and taste
Age related deficits in nasal function can adversely affect?
affect sleep, eating, and breathing, and significantly alter patient quality of life.
- There is a decrease in the number of skin receptors, particularly free nerve
endings and Pacinian corpuscles, resulting in elevated detection thresholds and a slower stimuli-response reaction. - Other changes include physical properties of skin and PSN and CNS systems that result from reduced blood supply to neurons.
Benefits of exercise in older adults on cardiovascular?
- VO2 max and cardiac output
improves - Improves blood pressure
- Decreased risk of CAD
Benefits of exercise for Diabetes Mellitus Type 2 –
- Improves glycaemic control
- Improves insulin sensitivity
Benefits of exercise in older adults on osteoporosis
- Moderates bone density loss
- Reduces risks of falling
Benefits of exercise in older adults on Osteoarthritis
- Improves functional capacity
- Reduces pain
Benefits of exercise in older adults on Neuropsychologic health
- Improves sleep
- Improves cognitive function
