Physiological Changes In Geriatric Patients

Question 1

Elderly

Answer 1

65-74

Question 2

Aged

Answer 2

75-74

Question 3

Very old

Answer 3

> 85

Question 4

Geriatric

Answer 4

> 65

Question 5

Anatomical Upper respiratory

Answer 5

Edentulous
Loss of buccal fat
Decrease cervical spine extensions

Question 6

Anatomical lower resp

Answer 6

Altered collagen network
Loss of elastic recoil
Incidenced alveolar airspace with reduced exchange

Question 7

Anatomical MSK

Answer 7

Muscle loss
Vertebral column degeneration
Rib calcification
Increased chance of atelectasis impaired diaphragm function, loss of muscle mass and structural changes

Question 8

Floop

Answer 8

Ristrictive pattern

Question 9

Physiological resp

Answer 9

IRV reduced
ERV REDU
DECRE vital capacity
High closing volume
RV increase

Question 10

Implications

Answer 10

High FRC with high closing volume which exceed FRC making patients prone to atelectasis

Question 11

Central resp

Answer 11

Response to hypoxia and hypercabia is impaired with high sensitivity to sedatives

Question 12

Implications

Answer 12

Decrease clearance of secretions
Decrease mucociliary function
Less efficient cough
Reduced oesophagial motility
Less effective protective upper airway reflexes

Answer 13

Neirexial
Avoid sedatives
Avoid intermediate and long acting neuromuscular Blockers
Neutralize stomach acide

Question 14

Anaesthesia implications

Answer 14

Increase work of breathing
Basal atelectasis
Reduced baseline paO2
High A-a gradient
Impaired cough and pharyngeal function
Compromised compansation, early collapse, high risk of post-op pulmonary complications

Question 15

Cardiac vascular

Answer 15

Atherosclerosis
Aeteril stiffening+ thickning
Arterial fibrosis
Arrhythmia AF

Answer 16

Increased afterload
Diastolic dysfunction
Labile blood pressure
Less sensitive to Badrenagic

Question 17

Dystonia of aging

Question 18

Anaesthesia implications

Question 19

Other associated CVS conditions

Answer 19

Asymptomatic IHD
Calcific AS
Calcification of conduction sy

Question 20

CNS

Answer 20

Decrease brain mass
Loss of brain cells
Low blood flow
Cognitive dysfunction
Impaired senses
BP and temp control

Question 21

Cognitive dysfunction diagnosis

Question 22

Cognitive dysfunction pathophysiology

Answer 22

Inflammatory mediators
BBB dysfunction
Microglial activation resulting in apoptosisand and oncre pro inflammatory cytokine release

Question 23

Cognitive dysfunction

Question 24

Neuro cognitive disorders spectrum

Answer 24

Emergence delirium - immediately PACU
Postpartum DELIRIUM- 24-72hrs postop
Postop cognitive dysfunction - weeks - months post anaesthetic

Answer 25

Peripheral nerve detriation Gene dysfunction with decrease mylination Decrease conduction from reduced mylinated nerves Change sensation : decrease spinal cord volume and bony degeneration

Question 26

Autonomic

Answer 26

``` Limited adaptation to stress Decrease activity of parasympathetic and Sympathetic activation Decrease baroreceptor reflex sensitivity Slow and weak homeostasis Increased sympathetic tone ```

Answer 27

Avoid drugs with sympathomimetic

Question 28

Pain control

Answer 28

Altered pin threshold Reduced pain tolarance Increased sensitivity to opioid Risk of accumuation

Question 29

Renal

Answer 29

GFR, Creat excretion reduced Blunted RAAS Prostate UTI

Question 30

Implications

Answer 30

Renal function assessment using forest or BUN may underestimate severity

Question 31

Implications RASS

Answer 31

Ability to adjust volume and electrolyte imbalance

Question 32

Renal

Answer 33

Increased concentration of renaly excreted drugd Ability to dilute urine impaired cannot handle water and salt load Suceptible to contrast and nsaids renal failure

Question 34

Temp

Answer 34

Lowe BMR Validation of skin vessels Impaired thermoregulation

Answer 35

Shivering High O2& met demand Slow drug metabolism At risk for mi

Question 36

Preop

Answer 36

Is patient in optimum heath Is there room to improve physical or cognitive function Asses meds that may impact anaesthesia

Question 37

Goals

Question 38

Consent issues

Question 39

Comprehensive geriatric assessment

Answer 39

``` Systematic evaluation of cormobidities Functional status Neuro cognitive function Sensory impairment Substance abuse Fraility Nutrition Medications ```

Question 40

Fraility

Answer 40

Fraility is a syndrome of decreased physiological reserves and resistance to stressor.

Question 41

Fraility types

Answer 41

Physical | Index

Question 42

Fraility screening tool

Answer 42

``` F R A L Prefrail frail Robust ```

Question 43

Time up and go test

Answer 43

Patient should sit in a standard chair with a line 10fee in length in front of the chair. They should use standard footwear and walking aid and should not receive any assistance.

Question 44

Surgical risk calculator geriatric

Question 45

Cognition definition

Answer 45

Level of cerebral function that describes the mental process of acquiring knowledge and understanding through thought, experience and senses

Question 46

Cognition

Answer 46

``` Working memory Comprehension Language production Calculation Reasoning Problem solving Decisions making ```

Question 47

Assessment of cognitive function

Answer 47

DSM V (5)

Answer 48

Preexisting cognitive impairment

Question 49

Postoperative de

Answer 49

Emergence delirium | Persistent or recurrent delirium

Question 50

Post op cognitive impairment

Answer 50

Delayed neuro cognitive recovery <30 days post op | Neuro cognitive disorder postoperative >30 - 12/12

Question 51

Postoperative cognitive dysfunction

Answer 51

An objective measure in cognitive function that typically persists beyond the period expected for normal recovery from the physiological and pharmacological effects of anaesthesia

Question 52

Diagnosis

Answer 52

Preop neurophysiological testing decline of > 1.96SD for >2 domains

Question 53

Screening test

Answer 53

MiniCog

Question 54

MiniCog assessment tool step 1

Answer 54

Step 1 3 word registration

Question 55

Step 2

Answer 55

Clock drawing 10min past 11

Question 56

Step 3

Answer 56

Reask word recall

Question 57

Scoring

Answer 57

Word recall 0-3 Xlock draw 0-2 Total < 3 dementia

Question 58

New efinition

Answer 58

Cognitive concern Daily living activity assessment Objeive test

Question 59

Function status

Answer 59

``` Bathing Dressing Toileting Transferring Continence Feeding ```

Question 60

Instrumental activity of daily living

Answer 60

``` Ability to telephone Shopping Food prep Housekeeping Laundry Mode of transport Responsibility for own meds Ability to handle finances ```

Question 61

Postop delirium

Answer 61

Acute state of confusion and inattention, which may be accompanied by an altered level of consciousness

Question 62

Mnemonic for post op delirium

Answer 62

A I C D _ disorganized thinking

Question 63

Diagnosis delirium

Answer 63

Acute Inattention Conscious ultered Disorganized thinking Presence of 1st 2 +3rd or 4th point

Question 64

Risk factors for postoperative delirium

Answer 64

``` Cognitive and behavioural disorders Disease/illness Metabolic Functional impairment Other ```

Question 65

Alcohol abuse

Answer 65

C- A- G- E-

Question 66

Strategies to prevent delirium

Question 67

Cormobidities patient factors

Question 68

Fraility

Question 69

Nutritional status assessment

Question 70

Nutrition

Question 71

AGS Beers criteria

Question 72

AGS Beers criteria

Question 73

Preoperative testing

Answer 73

HB Renal Albumin

Question 74

Exan

Question 75

Anaesthesia

Question 76

Monitoring

Question 77

Positioning

Question 78

Hypothermia

Question 79

Drug adjustment

Question 80

Drugs avoid in beers list

Question 81

Postoperative concerns

Answer 81

Pain CVS redp function Delirium and cognitive dysfunction Recovery