Week 2 - Geriatric paitents

Question 1

what is fratility?

Answer 1

a medical syndrome caused by dysregulation of multiple organs systems
- multiple causes can contribute- diminished strength and endurance, reduced pysiological function and increased individual vulnrability

Question 2

what are the 4 factors that influence frailty?

Answer 2

Ageing, acute illness, social vulnerability, chronic disease

Question 3

what are some challenges in managing older adults with fratility issues?

Answer 3

multiple diagnosis, longe term and acute symptoms/diseases
present with non-specific sings and symptoms
complex history and physical exam
polypharmacy

Question 4

what are the different levels of fratility on the clinical fratility scale?

Answer 4

1- very fit - active/energetic
2- well - no disease symptoms but less fit
3 managing well - medical problems well controlled
4- vulnrable - not dependent on others but symptoms limit activites
5 -mildly frail more evident slowing high order ADLs
6 - moderatly frail - need help woth all outside activities/houshold activities maybe bathing
7 - sevre frail - completley dependant for personal care
8- very sevre- completely dependant and nearing end of life
9- terminally ill - life expectancy less than 6 months

Question 5

what are the cardiovascular cahnges in older people?

Answer 5

reduced vessle wall complience - reduced elastin and endothelium is less resoponsive to responde to vasoactive substances

reduced ability to maintain BP - decreased baroceptor sentitivity

reduced cardiac function
decreased elastin/increased calcium deposition
heart valve sclarosis
- increased arythmias, hypertension

Question 6

what are the respiritory changes in older adults?

Answer 6

reduced lung complience
reduced defusion compacity
decreased elastic recoil
decreased resp muscle strngth
increased chest wall stiffeninf
decreased cough/gag reflex
loss of cilia in airways

Question 7

what are the heamotoglogical changes in older pepople?

Answer 7

decreased immune function
B-cells presered but decreased specific antibody production
t cells decreases
20-30% of older people have decreased fibril response to infection

Question 8

what are the endocrine changes in older people?

Answer 8

increased fat composition- more central
development of T2D
increased insulin resistence due t increase in adopoise tissue
impared thermoregulation due to changes in hypothalamic function- more vulnrable to tempreture

Question 9

what are the musculoskeletal changes in older adults?

Answer 9

decreased bone and muscle mass
- atrophy and hormal changes- impared protein changes
reduced gait and posture stability

Question 10

what are the genitourinary systemes of older people?

Answer 10

less renal mass after 40
mostly in cortex, with loss of nephrons
thickening of basment mebranes
increased renal artery resistence - reduced kidney blood flow

Question 11

what are the differences in gastrointestoray systems of older people?

Answer 11

reduced oesophageal motility - imapared swallowing and GORD
weakened connective tissue with colonic mucosa

Question 12

what are the CNS system changes in geriatric paitents?

Answer 12

reduced neural transmission and alteration in concentration of neurotransmitters - slowing of processes

Devaleopment of hearing imparement - high frequency hearing loss

development of vision imparment

Question 13

what are the changes in the skin of older paitents?

Answer 13

skin become thinner less elastic, drier, finly wrinkled, reduced vascular supply

this results in more easily bruising, tearing and impared healing

Question 14

what effects on pharmocodynamics does aging have?

Answer 14

alterations in body mass
decreased hepatic metabolism
decreased glomular fitration rate and ecretion of drugs
increased fat and distribution of fat soluble drugs
decreased body water and decreased distribution of water-soluble drugs