Week 1 Normal Aging Flashcards
1
Q
What are the most common long term conditions reported by people aged over 65?
A
- eye problems (90%)
-
musculoskeletal problems (66%)
- arthritis (49%)
- hypertension (38%)
2
Q
What was the estimated life expectancy for indigenous australians born in 1996-2001 compared to white australians born in 1998-2000?
A
- Indigenous males = 59.4 yrs
- Indigenous females = 64.8 yrs
- Approx. 17 years lower than for Australian males and females
3
Q
What are the most prevalent long-term health conditions among older Indigenous Australians?
A
- were eye/sight problems (89%)
- heart and circulatory problems/diseases (61%),
- arthritis (49%)
- diabetes/high sugar levels (36%).
(2004–05)
4
Q
In 2005 what was the % of Indigenous people aged >65 years projected to be? comared to non-indiginous australians?
A
- 2.8% of the total Indigenous population.
- 13.1% of the total non-Indigenous population
5
Q
Define normal aging??
A
- loss of physiologic organ reserves = greater risk of developing infections and diseases.
- Risk can be modified by behavioral and life style interventions at almost any age.
6
Q
Define HOMEOSTENOSIS?
A
- This is a the progressive reduction in an individual’s capacity to maintain homeostasis as he or she ages;
- Thus requiring more and more physiological reserves to maintain homeostasis leaving a finite amount to fight infection/disease
7
Q
What physiological systems may be affected during “normal” aging?
A
-
Brain and nervous system
- Decreased brain weight
- Loss of gray matter
-
Senses
- Presbyopia (far-sightedness)
- Presbycusis (hearing loss)
-
Vestibular function
- Loss of hair cells
- Decline in vestibular sensitivity
-
Strength
- Loss of lean body mass / skeletal muscle
8
Q
Describe and compare the change in bone density in males and females over time
A
- Males and females reach peak bone mass at around 30yrs but males havea higher peak than females
- males have a steady decline with age
- females have a sharp drop in bone density during menopause then a steady decline
- so it is advised that (especially women) people get as high peak density as possible while still young so that you have more reserves at is declines with age
9
Q
What are some lifestyle factors that accelerate age related change?
A
- Diet
- Exercise
- Smoking
- Mental health – loss of a loved one?
- Environmental factors
10
Q
Describe the decline in balance and mobility within the aging population
A
- Reaction time is impaired
- Increased sway in standing
- Reduced limits of stability (ie the distance able to reach)
- Reduced speed of steps
- Slower gait
- Reduced strength
11
Q
What are some age related conditions that effect mobility?
A
Conditions that contribute to a general deterioation in function:
- Vision – galucoma; artherosclerosis.
- Vestibular – drug toxicity; Meniere’s Disease
- Peripheral sensation – neuropathy (diabetes)
Conditions causing marked changes in function:
- Alzheimer’s Disease
- Stroke
- Parkinson’s Disease
12
Q
What are some structural changes to the Cardiovascular System?
A
- ^^ elastin and collagen levels => vessel membranes thicken, less elastic = ^^ arterial stiffness. (balloon analogy)
- Vascular smooth muscle changes (vasodilation/constriction).
- less myocardial cells => enlarged remaining cells to compensate.
- left ventricle wall thickens + ^^atrium size = increased heart weight.
13
Q
What are some functional changes to the Cardiovascular System?
A
- an aging heart is less able to tolerate increased workloads, because of an inabillity do cope with ^^ pumping demand
- Young heart during vigorous exercise
- start of heart beat same size as at rest
- end of heart beat, heart is smaller than at rest
- Old heart during vigorous exercise
- size at start of heart beat is larger than at rest
- size at end of heart beat is same as at rest
14
Q
How is the commumication between the CNS and the heart affected with age?
A
- Decreased response to catecholamines
- Diminished cardiac output with exercise
- Decreased blood flow to brain, heart, kidney, liver.
- Slower adaptation to change in activity.
- Conditioning takes longer
15
Q
How can blood pressure be affected with age?
A
- Systolic pressure may ^^ whilst diastolic remains the same.
- Thought to be due to thickening of arterial wall =>less distensible and thus less able to buffer rise in pressure that occurs with cardiac ejection. (eg balloon)
- Thus elevated systolic with an unchanged diastolic blood pressure.
- Decreased baroreceptor sensitivity in the elderly contributes to postural hypotension.
16
Q
Describe postural hypotension?
A
form of low BP occuring when you stand up from sitting or lying down.
- Baroreceptor reflex sensitivity to low blood volume/cardiac output decreases with age=>>barroreceptors not being triggered to normal BPcan =>> dizziness, syncope, falls.
- in standing blood pools in the lower extremities, decreasing venous return
- Within 3 minutes of standing, if there is a
systolic blood pressure drop > 20 mm Hg, or a
diastolic blood pressure drop > 10 mm with or
without an increase in heart or pulse rate, or
with or without symptoms, the individual may
have postural hypotension.
17
Q
What are some normal STRUCTURAL/ANATOMICAL & PHYSIOLOGICAL changes to the lungs (with age)?
Changes to the RESPIRATORY SYSTEM
A
- @~55yrs muscle atrophy/weaken + loss endurance & rigidity/chest wall stiffness (decreasing compliance)
- thickened membranes, alveoli, capillaries
- size of alveolar ducts increases = decreased surface area by up to 20%
- increased mucus producing cells = ^^mucus production
- activity and number of cilia decreases
- Total lung capacity relatively constant over lifespan but Vital capacity decreases as Residual volume increases
therefore more vulnerable to respiratory infection
18
Q
What effect can ageing have on the GI System?
UPPER GI TRACT
(From pharynx to stomach)
A
- ^^ prevalence GI disorders; drug induced oesophagitis caused by NSAIDS or bisphosphonates. - Pts should swallow in upright position with glass H2O
- poor dentition = impaired chewing = reduced caloric intake
-
Dysphagia - from slight decrease in saliva production
- = less efficient digestion
- = increased dental problems
- may contribute to severity of acid reflux
- decreased No. taste buds starts ~ F=40, M=50
- taste decrease ~ 60yrs if at all - usually salty/sweet
- slight slowing of gastric emptying
- prolong gastric distention
- increase meal-induced fullness
- = decrease food intake = some weight loss
- achlorhydria (insufficient production of stomach acid) 30% of >50yo = mc cause of B12 defficiency
-
Atrophic gastritis (with/without achlorhydria) = stomach disorder
- shrinking/inflamm. of inner lining of stomach
- may be asymptomatic but ^^ risk of stomach cancer
- could be caused by prolonged infestation of helicobacter pylori/campylobacter pylori
-
Gastroesophageal reflux prevalent and tends to be associated with more severe disease
- reduced intraabdominal length of lower esophageal sphincter + incresed incidence of hiatus hernia
19
Q
How is HR and ventilatory responses to HYPOXIA & HYPERCAPNIA diminish with ageing?
A
- PERIPHERAL AND CENTERAL chemoreceptor responses diminish as do their integration of CNS pathways
- ventilatory response to hypoxia is reduced by 51% in healthy men aged 64 to 73 compared with healthy men aged 22 to 30; the ventilatory response to hypercapnia is reduced by 41%.
- As these responses are reduced RISK of hypoxia/hypercapnia increases and other contributing risk factors include:
- pneumonia, COPD, obstructive sleep apnea
- Effects are greater in people who are deconditioned.
20
Q
Why should clinically significant changes to the GI system be thoroughly investigated and not quickly dismissed as old age?
A
Aging has little effect on the GI sytem because of the large functional reserve capacity of most of GI tract so significant abnormalities in Function (i.e. reduced food intake) sould be evaluated and not attributed to aging.
21
Q
What effect can ageing have on the GI System?
LOWER GI TRACT
(From duodenum to rectum)
+ liver , pancreas
A
-
Reduced BF to Liver = reduced ability to regenerate damaged liver cells
- decreased ability for metabolism
- thus drug dosage must be reduced as they are not inactivated as quickly
- decreased ability to withstand stress as toxic substances cannot be expelled as quickly
- Bile flow and production decreases = gallstones likely to form (stagnant bile)
- Pancreas = reduced size, duct hyperplasia, lobular fibrosis
-
Insulin secretion decreases:
- decresed responsiveness of pancreatic beta cell to glucose
- insulin resistance increases = higher risk of glucose intolerance and type II diabetes
- The prevalence of diverticulitis increases from:
-
weakness in intestinal wall + increased pressure in the colon (impaired intestinal muscle function)
- asymptomatic or inflamed/painful
- prevented by high fibre intake
-
less lactase is produced in small intestine
- = diminished lactose absorption >> lactose intolerance
- rectum enlarges + constipation more common
22
Q
Vitamin B12
- natural sources
- what does absorption require
- symptoms
A
natural sources:
- Eggs, meat, poultry, fish, shellfish, milk, milk products
- fortified grain products = cereals
what does absorption require:
- adequate amounts of gastric acid
- “intrinsic factor”
- digestive enzyme pepsin
symptoms:
- extreme fatigue
- dementia
- confusion
- tingling and weakness in arms + legs
liver has high storage so can be up tp 5yrs for deficiency to show
must be detected early as neurological damage may be irreversible
misdiagnosed since presentation similar to Alzheimer’s or other chronic conditions
23
Q
Describe NORMAL BLADDER FUNCTION
A
- first urge to urinate = 200ml
- Av. person can hold = 350- 550ml
- External urethral sphincter = contract to prevent leakage
- detrusor muscle = relaxed for bladder expansion
- Blader emptying = sphincter (relaxes), then detrusor (contract)
- Must have normal anatomy, a normally functioning nervous system
24
Q
List some changes to INTRARENAL VASCULATURE in the elderly population
and Kidney changes
A
- BF to kidneys decreases by 10% per decade
- >80yrs have 1/2 young person
- with age No. + size of nephrons decreases
- kidneys can lose 1/4 to 1/3 their mass.
- number of glomeruli fall by 30- 40% and another 30% may become sclerotic and nonfunctional.
These changes reduce the rate of kidney filtration
25
List some **sudden/temporary causes** of INCONTINENCE in the elderly population
1. **bedrest** – for example when recovering from surgery
2. **drugs** (diuretics, antidepressants, antihistamines, cough and cold remedies)
3. **mental confusion**
4. **prostate infection or inflammation**
5. **severe constipation**, causing pressure on the bladder
6. **urinary tract infection** or inflammation
7. **weight gain**
26
List some long term causes of INCONTINENCE in the elderly population
1. **dementia**
2. **bladder cancer**
3. **bladder spasms**
4. **depression**
5. **prostate enlargement**
6. **neurological conditions** (spinal injuries, stroke, MS, nerve damage following pelvic radiation)
7. **pelvic prolapse in women**
8. **post surgical weakness of the sphincter** following prostate or vaginal surgery
27
What are the 4 Types of URINARY INCONTINENCE?
1. OVERFLOW
* urethral blockage
* bladder unable to empty properly
2. STRESS
* relaxed pelvic floor
* increased abdominal pressure
3. URGE
* bladder oversensitivity from infection
* neurologic disorders
4. FUNCTIONAL
* inability to go to toilet due to impaired cognition/physical functioning
28
What are some presenting symptoms of MENOPAUSE
By mid **60s all women experience the menopause. Ovulation frequency decreases by the age of 40**, and reproductive ovarian function ceases in the vast majority of women within the next 15 years.
* **Hot flushes** (or hot flashes), are typically described as a feeling of intense heat, with sweating, and sometimes increased heartbeat.
* Effects face, neck, chest, even the whole body.
* 2 minutes to half an hour and may occur throughout the day or several times per week.
* Their frequency diminishes over time.
* Hormone replacement reduces but does not eliminate such episodes.
29
Define ANDROPAUSE and list some **clinical features**
**In healthy men, there is a gradual but progressive age-dependent decline in testosterone levels.**
CLINICAL FEATURES:
1. increased fat mass,
2. loss of muscle and bone mass,
3. fatigue,
4. Depression,
5. anaemia,
6. poor libido,
7. erectile deficiency,
8. insulin resistance
9. higher cardiovascular risk.
30
Define SOMATOPAUSE
**The progressive decline in Growth Hormone (GH) secretion.**
RESULTS IN:
* **reduction of protein synthesis**
* **decrease in lean body mass and bone mass**
* **decline in immune function.**
31
Define ADRENOPAUSE
The major age-related change in the adrenal cortex is a striking decrease in the biosythesis of dehydroepiandrosterone (DHEA).
- Decrease in function of the androgen-secreting zone of the adrenal glands
32
Compare **Menopausal Bone Loss** to **Age-related Bone Loss**
**Menopausal Bone Loss**
* High remodeling rate
* Removal of trabeculae
* \> risk of vertebral & Colles' fractures
* \> osteoblast formation, \< lifespan of osteoblasts
* \> osteoclast formation, \> lifespan of osteoclasts
* \< lifespan of osteocytes
**Age-related Bone Loss**
* Low or variable remodeling rate
* Thinning of cortices & residual trabeculae (women)
* \> risk of vertebral & hip fractures
* \< osteoblast formation, lifespan unknown
* \< osteoclast formation, lifespan unknown
* \< lifespan of osteocytes
33
How is VISUO-SPACIAL ABILITY affected in the elderly population?
* It declines
* resulting in difficulty
* identifying incomplete figures
* recognizing embedded objects
* arranging blocks into a design.
* perceiving + reproducing figures in three dimensions.
34
What SENSORY CHANGES occur and when do these changes accelerate?
**Timing and severity of changes varies between individuals**
Changes accelerate at approximately:
* Vision – mid 50’s
* Hearing – mid 40’s
* Touch – mid 50’s
* Taste – mid 60’s
* Smell – mid 70’s
35
What are the **benefits of exercise** in older adults?
**Cardiovascular** –
* VO2 max and cardiac output improves
* Improves blood pressure
* Decreased risk of CAD
**Diabetes Mellitus Type 2 –**
* Improves glycaemic control
* Improves insulin sensitivity
**Osteoporosis** –
* Moderates bone density loss
* Reduces risks of falling
**Osteoarthritis -**
* Improves functional capacity
* Reduces pain
**Cancer** –
* Reduces the risk of some cancers
**Neuropsychologic health -**
* Improves sleep
* Improves cognitive function
Other
* Decreases all-cause mortality
* Decreases all-cause morbidity
* Decrease risk of **obesity**
36
**Recommendations** for **exercise** for the elderly by the _Department of health and ageing_
1. Older people should do some form of physical activity, no matter what their age, weight, health problems or abilities.
2. Should be active every day doing a range of physical activities that incorporate fitness, strength, balance and flexibility
3. 30 minutes daily of moderate intensity physical activity
4. start at a level that is easily manageable and gradually build up the recommended amount, type and frequency of activity.
5. If you enjoy vigorous physical activity do it within safe and recommended levels
