Older Age

Question 1

What happens to the Respiratory System as we age?

Answer 1

1. Decreased compliance: decreased TLC, FVC, FEV1 and VC.
2. Decreased elastic support of airway-> more collapsible or alveoli and terminal conducting pathway.
3. Atelectasis, PE and pneumonia more common post op.
4. Loss of elastic tissue around oropharynx-> collapse upper airways.
5. More progressive number of eps of arterial desaturation in sleep.

Question 2

How does Pharmacokinetics change as we age?

Answer 2

1. Increased sensitivity to CNS dependent drugs-> dose change (decrease).
2. Decreased hepatic and renal function means less metabolism and elimination of drugs-> dose change (decrease).

Question 3

How does the Skin change as we age?

Answer 3

Skin is thinner and the subcutaneous blood vessels are more fragile-> bruise easily and harder to secure venous access.

Question 4

How does the Cardiovascular System change as we age?

Answer 4

1. Decreased elasticity of large and medium sized vessels-> decreasing compliance.
2. Increased systemic vascular resistance and hypertension leads to LV strain and thus hypertrophy.
3. Decreased cardiac conducting cells so increased prevalence of HB, ectopic beats, arrhythmias and atrial fibrillation.
4. Atrial contraction (1/3 of EDV) reduces so CO decrease by 30%.
5. Cardiac output decrease by 3% per decade, decreasing SV and ventricular contractility.
6. Increased arm-brain circulation time for drugs: IV anaesthesia slower and decreased dose.

Question 5

How does pharmacology change as we age?

Answer 5

Patients of an older age have polypharmacy.
Decreased CO means delayed IV anaesthesia.
There is a decreased body water and increased adipose tissue so an altered Volume of Distribution.
Decreased plasma proteins means decreased protein binding so increased free drug availability.

Question 6

How does the Renal System change as we age?

Answer 6

1. Glomerular filtrate decrease by 1% every year from 20+ (decreased renal cortical glomeruli)
2. Secondary to decreased CO and atheromatous vascular disease there is decreased renal function.
3. Increased prevalence of DM common and increased chance of nephrotoxic drug damage.

Question 7

How does the Central Nervous System change as we age?

Answer 7

1. Cerebrovascular disease common in elderly due to diffuse atherosclerosis and hypertension.
2. There is a decrease in neuronal density of 30% by age 80.

Question 8

How does Endocrine and Metabolic Effects change as we age?

Answer 8

Basal metabolic rate decreases by 1% after age 30.

Decreased metabolic and muscle mass impairs thermoregulatory control.

Question 9

What is dementia?

Answer 9

A common condition that presents with impaired cognitive function.
It is important to mange both in community and hospital care.
Diagnosis is based on a comprehensive assessment: Hx, Ex, cognitive and MSE, blood tests and imaging.

Question 10

What is Malnutrition?

Answer 10

Condition caused by inbalance between what an individual eats and what the individual requires to maintain health. Can be too much or too little.
Likely to have longer hospital admissions and respond less well to treatment.

Question 11

How can you screen for malnutrition?

Answer 11

Malnutrition Universal Screen Tool (MUST).

Question 12

Why is it important to measure health?

Answer 12

1. Indication of need of healthcare.
2. Target resources where most needed.
3. Assess effectiveness of health intervention.
4. Evaluate quality of health service.
5. Value for money.