Physiologic Changes in Aging Flashcards
What are some factors that influence aging?
What are the enviornmental factors that can impact age?
- Chronologic age
- Nutrition
- Enviormental
- Illness
- Injury
- Social Support
- Hormone Replacement
- Shift-work
Stress, tobacco, ETOH, sun exposure
What is an important body system to keep in mind when caring for elderly patients?
Psychology and Mental Health
What is Senescence?
What is the short definition?
Term that means predictable age related to changes as opposed to those caused by disease. Not everyone experiences these disease processes, but everyone does undergo senescence. When superimposed, they can exhaust reserve and predispose to poor outcomes.
Everyone gets older whether or not you have pathological changes or not
What is homeostenosis?
What are some causes that may lead to mortality due to homeostenosis?
Reduction in the ability to maintain homeostasis. Stenosis is a narrowing of the resilience window, and increasing vulnerability to additive stress and illness.
Hip fracture, infection
*Examples because they cause death in elderly but not younger adults
What are some normal cardiovascular changes associated with age related changes?
- Decreased arterial elasticity
- Decreased compliance
- Elevated afterload
- Elevated SBP, decreased DBP, widened PP
- LVH (compensatory)
- Decreased beta adrenergic responsiveness
- Decreased resitng HR and max HR
- Decreased baroreceptor reflex
- Decreased number of pacemaker cells in sinus node as well as conduction velocity
What are some common cardiovascular pathophysiology associated with increasing age?
- Atherosclerosis
- CAD
- Essential HTN
- CHF
- Cardiac arrhythmias
- Aortic Stenosis
Does the risk of valvular heart disease (VHD) increase significantly with age?
What is the most common VHD associated with aging?
Yes
Mitral Regurgitation
Decisions about surgical treatment vs medical management of valvular disease requires what?
Shared decision making with a consideration of QOL and life expectancy
Do elderly patients typically have surgery to correct AVR?
What is an alternative?
No, they are not good surgical candidates
TAVR (Transcatheter aortic valve replacement)
What is a reasonable SBP goal in elderly patients?
Why are there different recommendations?
< 120 (functional adult)
< 150 (less functional or higher fall risk)
Fall risk and risk of orthostatic hypotension
What side effects of antihypertensive agents should be considered in elderly patients?
- Fatigue
- Constipation
- Risk for orthostatic hypotension
- Electrolyte abnormalities
- Dizziness
- Falls
What agent can reverse warfarin anticoagulation?
Vitamin K
What agent can reverse DOAC treatment (apixaban/rivaroxaban)?
What agent can reverse Dabigatron?
Andexanet alfa
Idarucizumab
What are first line treatments for AF and VTE?
Why are these preferred to Warfarin?
DOACS
No INR testing and don’t have same response to leafy greens or vit K
What are some normal respiratory physiologic changes that occur with aging?
- Decreased pulmonary elasticity
- Decreased alveolar surface area
- Increased residual volume
- V/Q mismatch
- Increased chest wall rigidity (decreased compliance)
- Decreased muscle strength (diaphragm, intercostal, abdominal)
- Decreased cough
- Blunted response to hypercapnia and hypoxia
What are some pathologic respiratory conditions that may be associated to aging?
- Emphysema
- Chronic bronchitis
- Pneumonia
- Asthma
- Interstitial Lung Disease
What are the four types of comorbidities?
- Coincidental
- Intercurrent
- Sharing common pathways
- Complicating
What are some chronic lung diseases that increase in prevalence with age?
- Idiopathic pulmonary fibrosis (IPF)
- COPD
- Emphysema
What urinary medication can cause pulmonary fibrosis when used for a long time for UTI prophylaxis?
Nitrofurantoin
What are some normal renal physiologic changes associated with increasing age?
- Decreased renal blood flow
- Decreased GFR
- Decreased renal mass
- Decreased tubular function
- Impaired handling of sodium
- Decreased concentrating/diluting ability
- Decreased drug excretion
What are some common renal pathologic changes associated with increasing age?
- Diabetic nephropathy
- Hypertensive nephropathy
- Urinary obstruction (prostate)
At what age does the kidney volume start to shrink?
What co-morbidity can increase or accelerate?
Age 50
Atherosclerosis
What equation can calculate glomerular filtration?
MDRD equation
What is presbyphagia?
Is it a pathologic or physiological change associated with aging?
Changes in swallowing in the older adult
Physiologic
Is the ability to absorb B12 impaired with increasing age?
What is required to digest and absorb B12?
Yes
Intrinsic Factor
What are some common pathologic GI conditions associated with aging?
- GERD
- Dysphagia
- Esophageal spasm
- Achalasia
- Xerostomia
- Diverticular disease (-osis, -itis)
- Constipation
- Sensory/gustatory changes
Is the decrease in number and function of insulin producing beta cells a normal physiologic change associated with aging?
Yes
What are some common endocrine pathophysiology associated with aging?
- Hypothyroidism
- Hyperthyroidism
- Male impotence
- Diabetes
- Osteoporosis (F > M)
What age related endocrine changes occur in women?
- Decreased estrogen
- Lower FH
- Lower LSH
- Bone loss
- Decreased cardioprotection
What age related endocrine changes occur in men?
- Decreased testosterone and estradiol
- Lower sperm count
- Delayed sexual response
- Decreased libido
- Muscle atrophy
What are some common hematologic pathologic changes associated with aging?
- Anemia
- Leukemia
- Lymphoma
- Plasma cell disorders
Do elderly have the same response to vaccines as younger individual?
No, reduced response due to weakened immune response
Does muscle mass decline annually as we age?
Yes
What are some common external mechanisms that lead to disease specific mechanisms in elderly?
Are they modifiable or non-modifiable risks?
- Vitamin D deficiency
- Undernutrition
- Malnutrition
- Decreased muscle or physical activity
- Decreased protein intake
- Immobilization
Modifiable
What symptoms shound not be overlooked in older patients?
- Dyspnea
- Falls
- LOC
- Chest pain
- Dizziness
- Confusion
- Fatigue
- Depression**
How does the quality of life and overal morbidity and mortality for elderly patients with Asthma-COPD overlapping syndrome compare to asthma patients without COPD?
Worse outcomes and mortality
