Physiological changes in elderly Flashcards
Skin
thinner epidermis/dermis and subcu layer
thinner and dryer and less elastic
increased risk of skin tears and slower wound healing
Actinic Keratosis
squamous cell pre-cancer lesion
looks rough and red
lesions on sun exposed areas ( cheeks, nose, chest, arms)
Seborrheic Keratosis
Benign, family hx
raised wart like - lesions
senile purpura
purple macules or patches that are well demarcated
benign recurrent brusises
Solar Lentigines
” liver spots” brown macules on the dorsum of hand and fore arms from sun damage
Eyes
presbyopia - loss of near vision
starts at forty
lens become stiffer and denser
pupils slower to react ( slow accomadation)
decrease in depth perception and night vision
drier eyes ( less tear preoduction)
Ears
Presbycusis - high frequency is lost first ( talking)
it is a sensorinerual hearing loss
Arcus Senilis or Corneal arcus
cholesterol and calcium deposits
opaque- greyish white ring located on the periphery of cornea
Heart
elongation and more tortuousity of arteries
thicken intimal layer of ateries ( atherscloerosis)
Increase in SBP due to increased PVR ( stiffer ateries)
mild increase in the left ventricle ( mild LVH)
S4 sound
can be “ normal finding “ in elderly if NOT associated with a valvular dx or HF
It is due to a increased arterial contraction at the end of diastole
Autonomic Nervous system
- baroreceptors less sensitive - blunted BP response
- high risk for postural hypotension and syncope
- slower response to changes in position
Lungs
- decreased cough reflex, mucus clearing, response to hypoxemia.
- decreased FVC and FEV1
- increased residual volume
FVC and FEV1
max amount of air that can be breathed out following max inhalation
forced expiratory volume in 1 sec
Liver
increased cholesterol levels, decrease in liver size
AST/ALT and alk phos - NO change
increase in half0life of many drugs = toxicity
MSK
can loose 1-3 inches in height, more rapid after 70
compression fractures are a sign of osteoporosis
muscle loss and increase body fat
GI tract
receding gums and dry mouth
decreased taste and smell = decreased apetitie
decrease in absorbing vitamine ( b12, folic acid)
large bowel transit time is decreased
increase risk of colon cancer ( age over 50 is strongest risk factor)
less lactase ( lactose intolerance )
Endocrine
increase levels of insulin w/ mild periheral insulin resistance
changes in cicadian rhythm can cause insomina
Kidneys
GFR declines at 40 by 70 renal function is lost by 30%
serum creatinine is a less reliable factor in elderly due to decrease in muscle mass, creatinine production
Immune system
not as active and slower to respond. Humoral immunity intact but cellular immunity is less active
ability to react to vaccines lessens ( less effective)
Females
menopause = ovarian failure and estrogen/progesterone deficiency
the urethra becomes thinner and the ability of the urinary sphincter to close tightly decreases
Atrophic vaginitis = dyspareunia
**breast contain more fat w/ atrophy of milk glands , it will feel softener on examine w/ less volume and pendulous
flu vaccine for adults
the inactivated flu vaccine quad and triv = end of oct every year
high dose Fluzone ( 4 times higher dose) - 65 or older
Tetanus vaccine
Tdap - needs
needs a Td booster once in a lifetime
Shingles
Perferred is Shingrix
Age 50 or older - give even if had shingles before or hx of chicken pox/ vericella
2 doses ( 2- 6 months apart)
Pnuemococcal Vaccine
Age 65 and older :
- PPV13 then PPSV23 one year later
- PPV13 can be given prior to people with certain medial conditions
- if PPSV23 given prior to 65 , give every 5 years
who is considered frail elderly
> 85
what medication can depress the CNS
antihistamines, benzos, antipychotics, anticonvulsants, bet blockers, anticholinergics
