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Royal College 2023 > Physiology of Aging > Flashcards

Physiology of Aging Flashcards

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1
Q

Age related changes to the ear

A

Cochlea
1. Hair cells in organ of Corti atrophy
2. Basilar membrane stiffens
Middle ear
3. Joints b/w ossicle bones calcify and thin
4. TM loses elasticity and compliance
External
5. Cerumen dry and thick, obstructs
6. Cartilaginous walls lose elasticity, degrade, collapse

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2
Q

4 physiologic changes of aging that increase risk for fecal incontinence

A
  1. Decreased tone of internal anal sphincter (smooth)
  2. Decreased resting and squeeze tone of external sphincter (voluntary, skeletal)
  3. Decreased rectal compliance (inc collagen)
  4. Decreased rectal sensation (progressive neuronal loss)
  5. Increased threshold to sense fecal volume
  6. Tchikening of muscular layers and inc water absorption = harder stools
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3
Q

3 reasons inflammatory cytokines are elevated in older adults

A
  1. Inc CV risk factors = local cell death = release inflammatory cytokines
  2. Prolonged antigenic stimulation from environmental exposure
  3. Inc adipose tissue (contains macrophages) makes IL-6, TNFa and adipokines
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4
Q

2 age related changes to BBB

A
  1. Decrease in P-gp efflux transport function (P-gp substrate/inh drugs build up in brain)
  2. Increased leakiness (inc diffusion of lipophilic drugs)
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5
Q

4 cognitive domains that decline with aging

A
  1. Decreased processing speed
  2. Decreased complex attention
  3. Decreased abstract reasoning
  4. Decreased free recall
  5. Decrease working memory
  6. Decreased visual construction skills
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6
Q

2 physiologic causes for change in balance

A
  1. Decreased vestibular hair cells = decrease proprioception
  2. Decreased joint proprioception
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7
Q

6 sleep changes with age

A

Longer time to sleep onset
Inc number of awakenings
Inc phase 1+2
Decrease phase 3 (slow wave)
Decrease REM sleep
Decrease total sleep duration
Decrease sleep efficiency
Phase shift of circadian rhythm (earlier waking, earlier onset)

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8
Q

Why does BB not work in older adults for systolic HTN?

A
  1. Stiffening of peripheral vasculature is what causes isolated systolic HTN (BB doesn’t act here)
  2. Decreased beta adrenergic receptors
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9
Q

What normal changes of aging contribute to anemia?

A
  1. Inc marrow adiposity = dec hematopoiesis and reserve = dec RBC precursors
  2. Reduced absorption of micronutrients for RBC (B12, folate, iron)
  3. Low grade chronic inflammation
  4. EPO response to anemia blunted
  5. Production of stimulating hormones decreased
  6. Dec RBC renewal capacity in response to stress
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10
Q

6 physiologic reasons for weight loss in elderly

A
  1. Decline in taste and smell
  2. Delayed gastric motility/emptying = early satiety
  3. Decreased muscle mass
  4. Dental wear and tear
  5. Increased fasting and post-prandial insulin = early satiety
  6. Chronic low grade inflammation = appetite suppression
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11
Q

6 physiologic changes of aging in respiratory system

A
  1. Dec FEV1
  2. Dec FVC
  3. Dec VC
  4. Dec DLCO
  5. Inc RV
  6. Inc FRC
    Other
    - Less vigorous cough
    - Thickened alveolar BM
    - Dec chest wall compliance
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12
Q

Age related changes causing diastolic dysfunction

A
  1. Cardiac wall is thicker and stiffer (dec # myocytes, inc myocyte size, inc connective tissue)
  2. Dec LV contractility
  3. Reduced LV elastic recoil in diastole
  4. Dilation and hypertrophy of LA
  5. Altered calcium handling (slow contract, delayed relax)
  6. Inc end diastolic pressure
  7. Elevated after load from stiff vasculature causing LVH and prolonged systolic contraction time
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13
Q

4 changes to ADME with processing pain medications in aging

A
  1. Absorption - no significant change
  2. Distribution - inc body fat with age therefore inc distribution (half life) of lipophilic medication (methadone, fentanyl) and inc conc of hypophilic (morphine, alcohol)
  3. Distribution - less albumin = less binding = inc serum levels (morphine, ibuprofen)
  4. Metabolism = dec first pass metabolism = higher conc medications
  5. Elimination - dec elimination of really excreted = morphine active metabolites accumulate
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14
Q

Young vs. old water deprivation difference in perception, behaviour, 3 lab

A
  1. Older has less ability to perceive thirst
  2. Older drink less when fluids freely available
  3. Older greater inc to Na
  4. Older greater inc serum osmolality
  5. Older lower urine osmolality (less able to concentrate urine)
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15
Q

4 criteria that a physiologic/anatomic change is due to normal aging

A
  1. Increased prevalence with age
  2. Occurs in all older adults
  3. Physiologic, not due to disease
  4. Irreversible
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16
Q

Urogenital changes due to normal aging

A
  1. Dec bladder capacity
  2. Dec sensation of filling
  3. Dec contractile function = inc residual
  4. Reduced sphincter tone
  5. Inc nighttime urine production
    Men only
  6. Inc prostate size
  7. Dec sensitivity of penis
  8. Dec volume of fluid during ejaculation
  9. Reduced forewarning of ejaculation
  10. Orgasm without ejaculation
    Women only
  11. Dec estrogen = inc risk urogenital atrophy
  12. Dec closure pressures
  13. Dec urethral length
  14. Dec muscle and connective tissues that support organs = inc risk prolapse
17
Q

Urogenital changes that predispose to UTIs, one F, one M, both

A

Female - dec estrogen = mucosal atrophy = dec barrier
Male - BPH leads to retention
Both - dec detractor contractility = inc retention and less flow

18
Q

Which frontal reflex is not normal?

A

Grasp reflex
Suck reflex

19
Q

What 2 features of palmomental make it clinically significant?

A

Strong, sustained and easily repeatable
Easily exhaustible if healthy, less fatigueable if neurological disease present
Can be elicited by other ares of the palm
Asymmetric may be more likely to indicate disease

20
Q

3 changes to skin with aging and clinical consequences

A
  1. Loss of elastin/collagen = wrinkles/saggy
  2. Loss of melanocytes at base of hair follicles = grey hair
  3. Reduced number and production of eccrine sweat glands = less sweat when hot
21
Q

6 barriers for effective pulmonary testing in elderly

A
  1. Cognitive impairment - apraxia
  2. Stress incontinence
  3. Hearing impairment
  4. Vision impairment
  5. Difficulty with full expiratory effort due to muscle weakness
  6. Transferring in/out box

Royal College 2023 (79 decks)

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