Physiological changes in elderly

Question 1

Skin

Answer 1

thinner epidermis/dermis and subcu layer

thinner and dryer and less elastic

increased risk of skin tears and slower wound healing

Question 2

Actinic Keratosis

Answer 2

squamous cell pre-cancer lesion

looks rough and red

lesions on sun exposed areas ( cheeks, nose, chest, arms)

Question 3

Seborrheic Keratosis

Answer 3

Benign, family hx

raised wart like - lesions

Question 4

senile purpura

Answer 4

purple macules or patches that are well demarcated

benign recurrent brusises

Question 5

Solar Lentigines

Answer 5

” liver spots” brown macules on the dorsum of hand and fore arms from sun damage

Question 6

Eyes

Answer 6

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)

Question 7

Ears

Answer 7

Presbycusis - high frequency is lost first ( talking)

it is a sensorinerual hearing loss

Question 8

Arcus Senilis or Corneal arcus

Answer 8

cholesterol and calcium deposits

opaque- greyish white ring located on the periphery of cornea

Question 9

Heart

Answer 9

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)

Question 10

S4 sound

Answer 10

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

Question 11

Autonomic Nervous system

Answer 11

• baroreceptors less sensitive - blunted BP response
• high risk for postural hypotension and syncope
• slower response to changes in position

Question 12

Lungs

Answer 12

• decreased cough reflex, mucus clearing, response to hypoxemia.
• decreased FVC and FEV1
• increased residual volume

Question 13

FVC and FEV1

Answer 13

max amount of air that can be breathed out following max inhalation

forced expiratory volume in 1 sec

Question 14

Liver

Answer 14

increased cholesterol levels, decrease in liver size

AST/ALT and alk phos - NO change

increase in half0life of many drugs = toxicity

Question 15

MSK

Answer 15

can loose 1-3 inches in height, more rapid after 70

compression fractures are a sign of osteoporosis

muscle loss and increase body fat

Question 16

GI tract

Answer 16

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 )

Question 17

Endocrine

Answer 17

increase levels of insulin w/ mild periheral insulin resistance

changes in cicadian rhythm can cause insomina

Question 18

Kidneys

Answer 18

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

Question 19

Immune system

Answer 19

not as active and slower to respond. Humoral immunity intact but cellular immunity is less active

ability to react to vaccines lessens ( less effective)

Question 20

Females

Answer 20

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

Question 21

flu vaccine for adults

Answer 21

the inactivated flu vaccine quad and triv = end of oct every year

high dose Fluzone ( 4 times higher dose) - 65 or older

Question 22

Tetanus vaccine

Answer 22

Tdap - needs

needs a Td booster once in a lifetime

Question 23

Shingles

Answer 23

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)

Question 24

Pnuemococcal Vaccine

Answer 24

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

Question 25

who is considered frail elderly

Answer 25

> 85

Question 26

what medication can depress the CNS

Answer 26

antihistamines, benzos, antipychotics, anticonvulsants, bet blockers, anticholinergics