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Geriatrics > Physiological changes in the elderly > Flashcards

Physiological changes in the elderly Flashcards

1
Q

What happens to your PFTs?

A 
FVC, FEV1, VC all decrease
FRC unchanged
RV increased
TLC unchanged
Reduced airway function
Reduced response to hypoxia
Reduced PaO2
DLCO reduced
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2
Q

Heart rate

A

limited ability to increase HR/decreased responsiveness to catecholamines

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3
Q

Systolic BP during exercise compared with young patients

A

Increase

Also increase at rest

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4
Q

Diastolic BP on exertion

A

Increase

Same at rest

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5
Q

Cardiac output on exercise

A

Increase but to lesser extent

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6
Q

Stroke volume with exercise

A

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

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7
Q

Cardiac output over time

A

Reduce by 3% per decade

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8
Q

Contribution of atrial contraction to CO

A

Increased contribution

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9
Q

Modest LV hypertrophy normal or not?

A

Normal

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10
Q

What changes to the vessels?

A

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

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11
Q

Pulse pressure?

A

Increased

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12
Q

What happens to the glomeruli and GFR?

A

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

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13
Q

What happens to renal blood flow?

A

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

GFR 8mL/min/decade

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14
Q

Basal metabolic rate

A

Reduce 1% per year after age 30

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15
Q

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

A

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

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16
Q

What happens to the grey matter?

A

Decreases

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17
Q

what spinal cord changes?

A

Decreased proprioception and demyelination

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18
Q

What happens to body fat?

A

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
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19
Q

What happens to protein binding?

A

Reduced protein binding and increased free drug availability

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20
Q

What happens to urine osmolality?

A

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

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21
Q

Bladder capacity

A

Reduced

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22
Q

Detrusor activity

A

Detrusor hyperactivity

urge incontinence most common in the elderly

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23
Q

What happens to urethral outflow resistance

A

Reduced in women

Increased in men

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24
Q

What happens to nocturnal polyuria

A

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

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25
Q

Basal renin excretion

A

Reduced 30-50%

26
Q

Aldosterone

A

Reduced in proportion to aldosterone

27
Q

Renin to aldosterone ratio

A

Unchanged

28
Q

Because of reduction in aldosterone, increased risk of…

A

Hyperkalaemia

29
Q

Albumin change

A

DOES NOT decline in the well elderly

30
Q

LFTs

A

no change

31
Q

Liver volume and weight and blood flow

A 
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
32
Q

L atrial size

A

Can increase with age

33
Q

Valve mobility

A

Decreased

34
Q

V/Q mismatch

A

Increases due to rise in physiological dead space

35
Q

Response to declining PaO2 and increasing PaCO2

A

blunted

36
Q

Mucociliary clearance

A

decreased

37
Q

Immune globulin overall and subclasses

A

Stable overall

IgA and IgG increase

38
Q

Antibody response

A

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

39
Q

Tendency to form autoantibodies

A

Increased

40
Q

Monoclonal immunoglobulins

A

increase after age 70

41
Q

Thymus

A

Involutes

42
Q

CD4 count

A

Increased

43
Q

CD8 count

A

Decreased

44
Q

Hypersensitivity reactions

A

Decreased due to impaired T cell response

45
Q

Insulin

A

increased in response to insulin resistance

46
Q

PTH

A

Increased

47
Q

ADH

A

Reduced

48
Q

ANP

A

Increased–>nocturia

49
Q

FSH and LH

A

Increased in both sexes

50
Q

Uterus and vulva

A

atrophy

51
Q

Why increased UTIs?

A

Reduced peroxidase secretion of vaginal lactobacilli

52
Q

Testosterone

A

Decrease in males

53
Q

Growth hormone

A

Reduced

54
Q

Absorption of drugs

A

unaltered

Except may be early stomach emptying

55
Q

First pass metabolism

A

decreased

56
Q

Tubular secretion

A

Decreased

57
Q

Muscle fibresq

A

loss type 2 which are fast greater than type 1

58
Q

Baroreceptor response

A

reduced

59
Q

Preload

A

reduced

60
Q

sitting HR

A

reduces (supine unchanged)

61
Q

O2 max consumption at peak work

A

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

62
Q

Temp response to IL1, 6, tNFq

A

reduce with age

Geriatrics (8 decks)

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