Elderly Flashcards
1
Q
What is the definition of elderly?
A
>65 years old
2
Q
What are some issues the elderly have?
A
- chronic disease
- surgical intervention
- strength and coordination changes
- less able to compensate physiologically under stressful cirucumstances
- May be sedentary, difficult to assess exercise tolerance
3
Q
What are the changes in body composition seen in the elderly
A
- Oxygen consumption decreases
- d/t decreased lean mass/muscle
- Basal resting metabolic rate decreases
- heat production decreases
- poor thermoregulation (elderly suffer heat stroke in the summer)
- decreased serum albumin production
- affects protein binding
- decreased ability to handle glucose load
4
Q
What are specific body composition changes to women vs men?
A
- Women
- increase in body lipid reservoir
- store more fat
- decrease in bone mass
- decrease in intracellular water
- Men
- decrease in body mass (not as much increase in lipid reservoir/fat)
- decrease skeletal muscle
- decrease in other tissue mass (liver)
- decrease in intracellular water
5
Q
What happens to CNS function in the elderly?
A
- brain size decreases- gray matter atrophies more than white
- neuronal shrinkage- 50,000 neurons lost per day
- cerebral and cerebellar cortices
- decrease in short term memory
- decrease in visual and auditory time
- More complex neurons are better maintained
- language, comprehension, long term memory
- Decrease stores of neurotransmitters (have be part of elderly depression)
- MAOs elevated
- No change to:
- autoregulation of cerebral blood flow
- vasoconstrictor response to hyperventilation
6
Q
What hapens to PNS function in the elderly?
A
- Peripheral motor nerve conduction velocity decreases
- from decrease in nerve myelination
- lowed conduction of pain impulses
- leads to higher pain tolerance
- dynamic muscle strength, control, and steadiness of extremities declines 20-50% by the age of 80 years
7
Q
How is autonomic function different in the elderly?
A
- Plasma levels of NE higher
- more sympathetic discharge than parasympathetic
- Beta-adrenergic agonist response of heart is blunted
- Endogenous beta blockade
- drugs that increase inotropy and chronotropy of heart will not have as much of an affect
- Little change to Alpha-adrenergic and muscarinic cholinergic response
- baroreceptor reflex response decreased
- Autonomic regulation less tightly regulated
- delay in re-stabilization (make position changes slowly)
- wider variation from homeostasis
- autonomic dysfunction
8
Q
What are the anatomic and physiologic cardiovascular changes seen in the elderly?
A
- Anatomic
- increased ventricular wall thickness
- increased myocardial fibrosis
- increased calcification of valves
- physiologic changes
- decreased ventricular compliance
- decreased cardiac output hemodynamics
- systemic BP increases
- HR decreases
9
Q
What CV changes would you expect in the elderly regarding:
Aorta
arteries
Atrial kick
A
- Aorta
- dilation, increase in thickness and stiff
- this causes increased pressure the LV has to pump against, decrasing LV function
- Arterials become less elastic
- pulse pressures increase with decreased compliance, diastolic pressures are reduced
- Atrial kick
- Elderly really need the squeeze of the atria to fill the ventricles
- As ventricle becomes stiffer, it becomes more difficult for the atria to pump against it, causing atrial stiffness, afib, CHF, etc
10
Q
How do the elderly handle volume?
A
- The eldely are volume dependent yet volume intolerant
- the heart needs volume to maintain SV
- if overloaded, will not be able to mobilize fluid
11
Q
What is increased in the elderly CV system?
A
- LV wall thickness and tension
- afterload
- cardiac workload
- systemic BP
- peripheral vascular resistance
- circulation time (longer)
- conduction system fibrosis
- incidence of dysrhythmias
- SA node cell loss
- symptoms of diastolic dysfunction
- vagal tone
12
Q
What is decreased in the elderly cardiovascular system?
A
- Cardiac reserve
- CO and max CO
- resting and maximal HR
- LV compliance
- arterial compliance
- SV
- coronary blood flow
- perfusion to vital organs
- chronotropic and inotropic responses
- baroreceptor function
- adrenergic sensitivity decreases leading to decreases in HR
13
Q
What are the structural changes seen in the lungs of the elderly?
A
- loss of elastic recoil- can cause small airway collapse and air trapping
- altered surfactant production
- increased lung/alveolar compliance
- loss of elastic elements associated with enlargement of respiratory bronchioles and alveolar ducts
- decreased chest wall compliance
- barrel chest appearance with diaphragmatic flattening
- signs of both obstructive and restrictive disease
- skeletal changes leading to kyphosis
14
Q
How is gas exchange impaired in the elderly?
A
- Alveolar surface area reduction
- altered surfactant production
- alveolar-capillary membrane thickens
- anatomic deadspace increases
- decrease diffusing capacity
- pulmonary capillary blood volume declines
- Progressive V/Q mismatch
15
Q
How is pulmonary function changed in the elderly?
A
- Increases:
- FRC
- closing capacity
- residual volume
- PVR and pulmonary artery pressure
- Decreases
- Vital capacity
- expiratory and inspiratory reserve volumes
- FEV1 (by 6-8% per decade)
- cross sectional area of pulmonary capillary bed
- hepoxic pulmonary vasoconstriction is blunted
- protective airway reflex
- Sleep apnea common
- more stimulation needed for vocal cord closure–increase risk of aspiration
