Nornal Ageing, Dementia, Nutrition

Question 1

When does care for the elderly begin

Answer 1

~70 but not consistent

Question 2

Descrbe changes to lung compliance eith age

Answer 2

Lung and chest wall compliance decrease with advancing age. Total lung capacity (TLC), Forced Vital Capacity (FVC), Forced Expiratory Volume in 1 second (FEV1) and Vital Capacity are all reduced as people age.
These changes occur as a result of reduction in elastic support of the airways and leads to increased collapsibility of alveoli and terminal conducting airways.

Question 3

What are teh clinicalconsequences of the ageing of the respiratory system

Answer 3

Atelectasis, pulmonary emboli and pneumonia are common post-operative complications in the elderly.
• These complications are increased in smokers, patients with chronic chest disease and those undergoing abdominal or thoracic surgery.
Melnutrition and immunodeficiency can exacerbate this

Question 4

What are the changes to he oropharynx with age

Answer 4

• With advancing age, 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
• A progressive increase in the number of episodes of arterial desaturation during sleep occurs with advancing age.
If treating what opiate - depress cns function - older patients will be more prone to worse arterial desaturation at night,, they may not be monitored at night and at home

Question 5

Descrive ageing and pk

Answer 5

Elderly patients have an increased sensitivity to CNS depressant drugs and so drug doses need to be modified accordingly.
Patients have reduced hepatic and renal function leading to slower metabolism and elimination of drugs.
Takes longer for drug to take effect, takes longer for it to be eliminated. Do not give elderly same dosage as younger adult. Wait for the response before you give more

Question 6

Desribe skin changes in the elderly

Answer 6

Elderly patients tend to have thin skin and fragile subcutaneous blood vessels and therefore patients tend to bruise easily. Achieving and securing venous access can be difficult
Most older patients have fragile skin prone to bruising. Harder to insert cannula. Dermis reduced. Iv fluid can leak around site of cannula causeing pain swelling and infection

Question 7

Describe changes to blood vessels n the elderly

Answer 7

• Large and medium sized vessels become less elastic and therefore 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
Less compliance of large and medium sized vessels
LV has to pump against resistance
Hypertrophy

Question 8

Describe ageing of the conducting cells

Answer 8

• Cardiac conducting cells decrease in number making heart block, ectopic beats, arrhythmias and atrial fibrillation more prevalent.
• Since atrial contraction contributes approximately one third of the volume towards normal ventricular filling, patients with atrial fibrillation suffer a reduction in cardiac output of about 30%.

Question 9

Describe changes to tone in periods of stress

Answer 9

Change tone in periods of activity - vessels are redistributing flow to areas that need it most. Eed vascular tone to keep by stable when stand up. In older patients - coziness and falls. Or in activity or stress - cannot redirect blood flow as easily as someone who si younger

Question 10

What are the changes to co with age

Answer 10

Cardiac output falls by 3% per decade which is due to reduced stroke volume and ventricular contractility.
The reduction in cardiac output with age increases the arm-brain circulation time for drugs and means intravenous anaesthesia is achieved more slowly and with reduced doses of anaesthetic agent.
Elderly people - mroe friar. Less finely tune peripheral vascular response. Drop co by 1/3. They may collapse.

Question 11

Desribe pharmacology in the elderly

Answer 11

Reduced cardiac output results in delayed onset of intravenous anaesthesia.
Reduced total body water and increased adipose tissue leads to an altered volume of distribution of some drugs.
Plasma proteins are reduced resulting in decreased protein binding and increased free drug availability.

Question 12

What are changes to gfr in the elderly

Answer 12

• Glomerular filtration rate is thought to decrease 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 cardiac output and atheromatous vascular disease leads to a decline in renal function.

Question 13

What other factors in the elderly could lead to effects to the renalsystem

Answer 13

• In addition diabetes mellitus is increasingly common, as is the use of nephrotoxic drugs such as non-steroidal anti-inflammatory drugs (NSAID’s) and angiotensin converting enzyme inhibitors (ACE inhibitors).
• Prostatism in males can lead to obstructive nephropathy and dehydration is common in the elderly especially during illness

Question 14

Describe changes to cvs in the elderly

Answer 14

Many conditions can exacerbate the progress but will happen with age anyway
• Cerebrovascular disease is common in the elderly secondary to diffuse atherosclerosis and hypertension.
• Neuronal density is reduced by 30% by the age of 80 years.

Question 15

Describe endocrine and metabolic effects of ageing

Answer 15

The 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.

Question 16

Descirb polypharmacy in the elderly

Answer 16

Many patients take multiple medications on a regular basis and the effects of these medications on the individual’s physiology must be taken into account.

Question 17

What is dementia

Answer 17

Dementia is an increasingly common condition. In the UK, at least one quarter of acute hospital beds are occupied by patients with dementia, with admissions spread across a broad range of specialties
Dementia care in the community is equally important, given that the majority of people with dementia live at home with their care primarily under the auspices of general practice

Question 18

What can dementia be diagnosed by

Answer 18

Diagnosis based on comprehensive assessment
• • •
- Hx, Ex, cognitive and MSE - Maintaining ability to make decisions . Need to think. Do they have mental capacity to make these decdiosn
- Blood tests
- Imaging

Question 19

How is dementia managed

Answer 19

•Chronic disease management
• Containment
• Medication
Can slow down progression but not cure
Medication may slow down particular types
Thinking about the patient, their functioning
•Advance care planning •Palliative care services

Question 20

Give an overview o the natuianal dementia strategy sq

Answer 20

S

Question 21

What is malnutrition

Answer 21

Malnutrition is any condition caused by an in-balance between what an individual eats
and what that individual requires to maintain health.
This can result from eating too little (under- nutrition) or too much (over-nutrition) and may also be caused by an incorrect balance of nutrients.

Question 22

What are the effects of malnutrition in the elderly

Answer 22

• Malnourished patients are likely to have longer hospital admissions
• They respond less well to treatment, are 3 times more likely to develop complications after surgery and have higher mortality rates.
• It is recognised that over 40% of patients are malnourished on admission to hospital and nutritional risk increases during their stay.

Question 23

What tools are available to screen for amlnutiion

Answer 23

Different tools are available to screen for malnutrition. Most are not evidence based and the only recognised evidence based tool is the Malnutrition Universal Screening Tool (MUST). This is used in the University Hospitals of Leicester NHS trust.