P - Geriatrics Flashcards
Postoperative cognitive dysfunction is most commonly associated with
advanced age
Progressive deterioration in overall functional connectivity of the brain and the effects of anesthetic agents in the face of those changes may explain the increased incidence of postoperative cognitive dysfunction in the elderly.
Select the two most prominent effects of aging on the pulmonary system.
Increased stiffness of the chest wall
Decreased stiffness of the parenchyma
The two most prominent effects of increased age on the pulmonary system are a decrease in the stiffness of the lung parenchyma and an increase in the stiffness of the chest wall.
What surgical procedure has the highest risk for postoperative delirium in elderly patients?
Orthopedic surgery
Although postoperative delirium can occur following any type of surgical procedure, it is most common in orthopedic surgery. Up to 35% of elderly patients undergoing orthopedic surgery experience delirium.
With age, renal cortical mass decreases by as much as
25 %
The mass of the renal cortex lowers by 20-25 percent with age. Also, by age 80 approximately half of the glomeruli are lost.
Which of the following tests of renal function would you expect to be unchanged by advanced age?
Creatinine
Due primarily to fibrotic changes and decreased mass in the renal cortex, glomerular filtration rate and creatinine clearance decrease with age. Even though creatinine clearance decreases, the reduced muscle mass and creatinine production associated with increased age result in an unchanged serum creatinine level.
What primarily explains the prolonged duration of midazolam in an elderly patient?
decreased hepatic perfusion
The duration of action of midazolam is increased in the elderly. The clearance of the drug is reduced by as much as 30 percent due to a decrease in hepatic mass and perfusion. The recommended dose for a 90 year-old should be reduced by 75 percent from that acceptable for a 20 year-old.
Elderly patients have
A. decreased sympathetic activity at rest
B. a decreased systolic blood pressure
C. a diminished cardiac response to beta-receptor stimulation
D. an increase in the number of sinus node pacemaker cells
a diminished cardiac response to beta-receptor stimulation
Elderly patients have a diminished cardiac response to beta-receptor stimulation and increased sympathetic activity at rest. The number of sinus node cells decreases with age.
Select the two most dramatic changes in lung volumes seen with increased age.
Increase in closing volume
Increase in closing capacity
Although decreases in total lung capacity and increases in the functional residual capacity are associated with aging, the most significant changes are the increases in both closing volume and closing capacity.
Which agent would be appropriate for the treatment of delirium and agitation in a patient in the intensive care unit?
Haloperidol
Haloperidol is an antipsychotic agent that doesn’t exhibit any significant alpha-adrenergic activity. The principal use of haloperidol is the treatment of delirium and agitation in the intensive care unit.
You are concerned about the postoperative fluid status of an elderly patient with a history of congestive heart failure. On what postoperative day would you expect third space fluid to mobilize into the vascular system?
2
Third-space fluid begins to mobilize into the vascular space on postoperative day two. It is important to evaluate the elderly patient for signs of fluid volume excess such as rales, crackles, tachypnea, and orthopnea.
Most of the decrease in hepatic blood flow associated with aging is due to
Decreased liver mass
Liver mass decreases with age and accounts for most of the 20-40% decrease in hepatic blood flow with age.
Match the physiologic characteristic with the manner in which it changes with age. Increases decreases stays the same Insulin resistance CNS activity Total lung capacity
stays the same - TLC
increases - insulin resistance
decreases CNS activity
CNS activity decreases with age. Serum albumin decreases slightly with age. Although residual volume increase and vital capacity decreases, the total lung capacity remains unchanged. Elderly patients exhibit a lower insulin response to glucose loads as well as increased insulin resistance in skeletal muscle.
Which of the following tests is diagnostic of Alzheimer’s disease?
Postmortem analysis of the brain
Although computed tomography may demonstrate ventricular dilation and cortical atrophy and positive emission tomography may exhibit areas of decreased cerebral blood flow, only postmortem examination of the brain tissue is definitively diagnostic of Alzheimer’s.
A drug with a high hepatic extraction ratio may exhibit a prolonged elimination half-life in an elderly patient because:
Hepatic blood flow diminishes with age
Hepatic transaminase levels and hepatic enzyme activity do not normally change with increased age. Hepatic mass does decrease with age, but the clearance of drugs with a high hepatic extraction ratio relies on hepatic blood flow not hepatic mass. Hepatic blood flow decreases by as much as 40% by 80 years of age.
Which of the following drugs would not exhibit a smaller volume of distribution in the geriatric patient?
Diazepam
In the elderly patient, total body water decreases while total body fat increases. Thus, the volume of distribution for water-soluble drugs such as glycopyrrolate, succinylcholine, and gentamicin decreases while the volume of distribution for lipid-soluble drugs such as barbiturates, benzodiazepines, and volatile anesthetics increases.
Which of the following does not decrease significantly with age?
Baseline hepatic function
By age 80, the number of functioning nephrons has decreased by 50 percent. Lean muscle mass decreases with age. Bone density decreases significantly with age, increasing the risk for fractures. Although hepatic mass decreases significantly, baseline hepatic function remains well preserved with age.
All of the lung parameters below increase with age except for
Total lung capacity
The total lung capacity doesn’t change significantly due to age alone. Functional residual capacity increases due to an increase in residual volume. The closing volume and closing capacity eventually increase to such an extent, however, that they exceed functional residual capacity.
Which of the following increases as a result of the aging process?
Catecholamine levels
As a result of aging, the response to beta-receptor stimulation and parasympathetic activity decrease. Serum catecholamine levels increase as a result of aging. Efficacy of blood pressure control by the baroreflex decreases with age.
Which of the following drugs would be least appropriate for use in a patient with advanced Alzheimer’s disease?
Atropine
Alzheimer’s is associated with a progressive and selective decrease in cholinergic neurons in the brain. For this reason, centrally acting anticholinergics such as atropine and scopolamine are not recommended for use.
Which of the following responses to induction would you expect to occur in the elderly?
Slower intravenous induction
The elderly exhibit a prolonged circulation time which results in a faster inhalation induction and a slower intravenous induction time. Similar to infants, the elderly have a diminished tachycardic response to hypotension, hypovolemia, or hypoxia.
Which of the following statements accurately explains why geriatric patients have higher insulin requirements perioperatively?
They exhibit a lower insulin response to glucose loads
Elderly patients tend to have higher insulin requirements perioperatively, even when a diagnosis of diabetes is not present. They exhibit a lower insulin response to glucose loads as well as increased insulin resistance in skeletal muscle.
