Geriatrics

Nutritional changes that occur with aging

• reduced metabolism

• reduced protein mass

• reduced energy need

Slightly higher protein for geriatrics is recommended to

maintain nitrogen equilibrium

What changes should be made to dietary fats to reduce risk of heart disease

reduce saturated fats and increase poly/mono saturated fats

What changes should be made to dietary CHO to improve bowel motility and decrease cholesterol?

more complex CHO

The geriatric population is more likely to get a vitamin deficiency from

water soluble vitamins including C and B12

Vitamin C deficiency

delayed wound healing

Vitamin B12 deficiency

irritability, lethargy and dementia

People are less likely to become deficient in

fat-soluble vitamins (A, D, E and K) d/t liver storage

Has a higher risk of toxicity than deficiency

vitamin A

Does mineral intake change for geriatric population?

no

Does water intake change for geriatric population?

1500 ml/day regardless of caloric intake,

What changes occur to the oral cavity with aging

increased likelihood of oral trauma, increased difficulty chewing food, reduced smell and taste

What changes occur to the esophagus with aging?

swallowing disorders are common, GERD

What changes occur to the stomach with aging?

no significant changes, most common conditions include atrophic gastritis, peptic ulcer disease and GERD

What changes occur to the pancreas with aging

no significant changes, most common conditions include acute pancreatitis and chronic primary inflammatory pancreatitis

What changes occur to the liver with aging

the liver gets smaller, causing a reduction in drug metabolism and protein synthesis

What changes occur to the small bowel with aging

• lactose intolerance and celiac disease are more common

• common issues include bacterial overgrowth, radiation enteritis, IBD, malabsorption and dehydration

what changes occur to the large intestine with aging

most common conditions include colon cancer, diverticulitis and constipation

Is GI treatment different for elderly populations

no

Malnutrition treatment

35kcal/kg of BW, 1g/pro per kg of BW

Vascular changes with aging are impacted by

age, CVD, lipid levels, DM, sedentary lifestyle, genetics

Arterial wall changes with aging include

• decreased elasticity and increased collagen fibers to the adventita, intima and media causing increased SBP and decreased DBP

• lipid deposits in intima

BP changes with aging

increase in SBP, pulse pressure, MAP

ANS changes with aging

declines with aging causing

• increased SNS activity, decreased PNS activity

• decreased reactivity of cardiopulm reflexes

• orthostatic hypotension

Vascular response to peak exercise for elderly population

• reduced sweat

• increased CO in skin

• VO2 max decreased

Vascular response to exercise training for elderly population

• prevents EDV

• decrease decline

• attenuates arterial stiffness

Does core temperature change for the elderly?

no, but has a longer time to adapt to temperature, which makes this population more likely to have hypothermia/hyperthermia

core temperature over 106

heat stroke, irreversible brain damage

core temperature below 94

impaired hypothalamus, loss of motor control, sensation, consciousness, followed by v-fib and death

hypothalamus controls

temperature

Best way for elderly population to avoid temperature dysregulation

avoid environmental challanges

What happens to the skin with age

thinner dermis that is less vascularized

innate immunity

present at birth, does not require exposure. This includes macrophages and phagocyte cells which are nonspecific

acquired immunity

requires exposure, pathogen-specific

T and B lymphocytes

involved in acquired immunity, they recognize foreign pathogens and retain memory of them to produce antibodies

Because of elderly immune system changes, they are at greater risk for

infection unrelated to changes in immune system

Early signs of infection include

feeling unwell, change in mentation, reduced appetite, fever may be ABSENT

infections that occur frequently in elderly populations

pneumonia, tuberculosis, bacteremia, infectious diarrhea, septic arthiritis, UTI

do elderly populations have increased or decreased metabolism of drugs

increased, meaning they need more for the correct effect

opioids can effect the elderly population by

more susceptible to reactions like confusion, anxiety, hallucinations and euphoria

non-opioid analgesics can effect the elderly population by

increased GI distress, but cox-2 NSAIDs can produce CV issues

acetaminophen may cause

hepatotoxicity

Glucocorticoids can cause these ADRs in elderly populations

collagen breakdown, HTN, glucose intolerance, gastric ulcer, glaucoma, adrenocortical depression

Psychotropics include

benzodiazapines and nonbenzodiazapines

Do benzodiazapines have a longer or shorter half life in the elderly population

longer, causing toxic levels causing confusion, slurred speech, dyspnea, weakness, incoordination

Nonbenzodiazapine effect on elderly

less effective, but less side effects

Side effects for antidepressants

sedation, orthostatic hypotension and anticholinergic effects (inhibit PNS)

Most recommended antidepressant for elderly

SSRI bc less side effects

Common side effects of antipsychotics

sedation, orthostatic hypotension, anticholinergic effects (inhibits PNS) and movement disorders

This antipsychotic medication is most recommended for elderly populations

atypical antipsychotics

Parkinsons disease presents as

bradykinesia, rigidity, resting tremor

Primary drug used to treat parkinsons

l-dopa can cause GI irritation, psychotic symptoms

Seizure medications work by

reducing neuron excitability

seizure medication can cause side effects of

sedation, fatigue, weakness, incoordination, ataxia, visual disturbances

Alzheimer’s disease drugs can

slow progression, but not cure. These can cause loss of appetite and GI distress

diuretics and ACE inhibitors are

most safe for elderly

Sympatholytics and vasodilators can produce

severe side effects and should be limited

CCB should be avoided bc of

rapid dec in BP and inc risk of MI

a risk factor for all antihypertensives

hypotension

CHF medications

digoxin (toxicity)

ACE inhibitors (much less side effects)

digoxin toxicity

GI distress, confusion, blurred vision, cardiac arrhythmias

Medications for hyperlipidemia may have these side effects

GI irritation, muscular pain, weakness and inflammation

Lab value changes in elderly are related to

disease processes, not normal aging

When a patient takes anti-cholesterol meds, labs are required for

liver function

If a patient is on blood thinners, they require these labs

INR

Declining renal function may be assessed by

BUN and creatinine

CT imaging is used when

speed is a priority, someone cannot stay still for a long period of time

US imaging is used for

soft tissue visualization

real time, multiplanar imagine

no radiation

can guide needle biopsies

MRI imaging is used for

selectively remove things

soft tissue and vascular structure

Nuclear medicine imaging is used for

show changes in function of physiology

bone scans

cellular function

recognize tumors

This screening has shown good evidence to reduce mortality

breast cancer

lung cancer

IV contrast can cause these side effects

hives, nausea, swelling, bronchospasm, bradycardia

Iodinated contrast induced neuropathy is a risk in patients with

renal failure

These patients are at risk for lactic acidosis and renal failure following IV iodinated contrast

on metformin

DM

chronological age

DOB

Physiologic age

cross sectional measurements

Synergistic morbidity model

history of multiple chronic diseases result in chronic morbidity, eventually losing functional capacity

Attribution Model

The patient believes their worsening condition is because of a diagnosed chronic condition, but, examination reveals decline is not related to that condition

Casual Chain Model

One illness can cause another illness, this cycle continues until loss of funciton

Unmasking event model

Patient does a compensation, without knowing about the pathology. The pathology is only found when the compensation is no longer possible.

Final common outcome in disorders in elderly population

restriction of independent function

Is the correlation between the type/severity of problems and the disease problems good or bad

it is bad, meaning a multidisciplinary approach is best

Aerobic exercise has shown these benefits

reduced risk of cancer, improved immune system,

Disengagement theory

as the world progresses, elderly individuals become disengaged in society

Activity theory

the more active you are, the slower aging

Biological theory

the longer we live, the more wear and tear, causing pathology and death

Biological time clock

there is a prescribed amount of time the body will live based on cell replication

Free radical theory

oxygen radicals contribute to pathological changes that cause aging

cross-linkage theory

aging occurs in response to chemical reactions, which cause damage to DNA, leading to cellular death

immune theory

aging is enhanced by the breakdown of the immune system

error catastrophe theory

aging is associated with errors in RNA transcription

What changes in the cross sectional area of the muscle with aging

increased cross sectional area, meaning fibers are distributed in a larger area

Changes that lead to sarcopenia include

decreased number of nerve terminals, fragmentation of nm junction, decrease NTM release, lower number of acetylcholine recpetors

muscle weakness may result from

inability to activate muscle, reduction in quantity of muscle and reduced force

muscle atrophy may result from

reduction in motor neurons in sc, incomplete innervation of mm, loss of sarcoplasmic reticulum

Fused tetanic contraction

increased muscle efficiency, but longer relaxation time

inflammation in elderly can cause

immune response and sarcopenia, this can be prevented with resistance exercise

Endochondral ossification

method of appendicular skeleton, vertebral column and base of skull

this is the method of fracture healing

Intramembranous ossification

method of flat bone formation

less common in adult life

cortical bone

dense, compact, outer layer