Physiological changes in the elderly

Question 1

What happens to your PFTs?

Answer 1

FVC, FEV1, VC all decrease
FRC unchanged
RV increased
TLC unchanged
Reduced airway function
Reduced response to hypoxia
Reduced PaO2
DLCO reduced

Question 2

Heart rate

Answer 2

limited ability to increase HR/decreased responsiveness to catecholamines

Question 3

Systolic BP during exercise compared with young patients

Answer 3

Increase

Also increase at rest

Question 4

Diastolic BP on exertion

Answer 4

Increase

Same at rest

Question 5

Cardiac output on exercise

Answer 5

Increase but to lesser extent

Question 6

Stroke volume with exercise

Answer 6

Increase with exercise to greater extent, and increased slightly at rest also (ie rely on SV to increase CO with exercise)

Question 7

Cardiac output over time

Answer 7

Reduce by 3% per decade

Question 8

Contribution of atrial contraction to CO

Answer 8

Increased contribution

Question 9

Modest LV hypertrophy normal or not?

Answer 9

Normal

Question 10

What changes to the vessels?

Answer 10

Reduced aortic compliance–>increased aortic systolic pressure–>increased ventricular afterload

Question 11

Pulse pressure?

Answer 11

Increased

Question 12

What happens to the glomeruli and GFR?

Answer 12

GFR reduced by 1% per year after age 20
Loss of cortical glomeruli
Glomeruli sclerosed increasingly

Question 13

What happens to renal blood flow?

Answer 13

Reduced 10% per decade after age 50 , greatest in those with highest BPs

GFR 8mL/min/decade

Question 14

Basal metabolic rate

Answer 14

Reduce 1% per year after age 30

Question 15

Vision (cones, pupil size, tear formation, lens compliance)

Answer 15

All decrease—>reduced night vision, colour vision, increased dry eyes, presbyopia, reduced accommodation

Question 16

What happens to the grey matter?

Answer 16

Decreases

Question 17

what spinal cord changes?

Answer 17

Decreased proprioception and demyelination

Question 18

What happens to body fat?

Answer 18

Increase proportion fat, reduced lean body mass

• lipid soluble drugs like diazepam have greater apparent volume of distribution with longer t1/2
• water soluble drugs like dig and alcohol have reduced vol of dist and higher concentrations

Question 19

What happens to protein binding?

Answer 19

Reduced protein binding and increased free drug availability

Question 20

What happens to urine osmolality?

Answer 20

Reduction in max and min oslomality , reduction in sodium conserving ability

Question 21

Bladder capacity

Answer 21

Reduced

Question 22

Detrusor activity

Answer 22

Detrusor hyperactivity

urge incontinence most common in the elderly

Question 23

What happens to urethral outflow resistance

Answer 23

Reduced in women

Increased in men

Question 24

What happens to nocturnal polyuria

Answer 24

Increased as reduced nocturnal ADH, more drugs, CCF, reduced bladder capacityalso

Question 25

Basal renin excretion

Answer 25

Reduced 30-50%

Question 26

Aldosterone

Answer 26

Reduced in proportion to aldosterone

Question 27

Renin to aldosterone ratio

Answer 27

Unchanged

Question 28

Because of reduction in aldosterone, increased risk of...

Answer 28

Hyperkalaemia

Question 29

Albumin change

Answer 29

DOES NOT decline in the well elderly

Question 30

LFTs

Answer 30

no change

Question 31

Liver volume and weight and blood flow

Answer 31

``` reduced volume 37% by age 90 Reduced weight (50% by age 90) 35% reduction in blood flow- !0% per unit volume reduction)- this interferes with drug clearance ```

Question 32

L atrial size

Answer 32

Can increase with age

Question 33

Valve mobility

Answer 33

Decreased

Question 34

V/Q mismatch

Answer 34

Increases due to rise in physiological dead space

Question 35

Response to declining PaO2 and increasing PaCO2

Answer 35

blunted

Question 36

Mucociliary clearance

Answer 36

decreased

Question 37

Immune globulin overall and subclasses

Answer 37

Stable overall | IgA and IgG increase

Question 38

Antibody response

Answer 38

Diminished peak and duration of response Response needs larger antigenic stimulus Response to vaccines still ok clinically

Question 39

Tendency to form autoantibodies

Answer 39

Increased

Question 40

Monoclonal immunoglobulins

Answer 40

increase after age 70

Question 41

Thymus

Answer 41

Involutes

Question 42

CD4 count

Answer 42

Increased

Question 43

CD8 count

Answer 43

Decreased

Question 44

Hypersensitivity reactions

Answer 44

Decreased due to impaired T cell response

Question 45

Insulin

Answer 45

increased in response to insulin resistance

Question 46

PTH

Answer 46

Increased

Question 47

ADH

Answer 47

Reduced

Question 48

ANP

Answer 48

Increased-->nocturia

Question 49

FSH and LH

Answer 49

Increased in both sexes

Question 50

Uterus and vulva

Answer 50

atrophy

Question 51

Why increased UTIs?

Answer 51

Reduced peroxidase secretion of vaginal lactobacilli

Question 52

Testosterone

Answer 52

Decrease in males

Question 53

Growth hormone

Answer 53

Reduced

Question 54

Absorption of drugs

Answer 54

unaltered | Except may be early stomach emptying

Question 55

First pass metabolism

Answer 55

decreased

Question 56

Tubular secretion

Answer 56

Decreased

Question 57

Muscle fibresq

Answer 57

loss type 2 which are fast greater than type 1

Question 58

Baroreceptor response

Answer 58

reduced

Question 59

Preload

Answer 59

reduced

Question 60

sitting HR

Answer 60

reduces (supine unchanged)

Question 61

O2 max consumption at peak work

Answer 61

reduce 50% due mostly to reduced CO (20% due to oxygen utilisaiton by less muscle)

Question 62

Temp response to IL1, 6, tNFq

Answer 62

reduce with age