Geriatric Physiologic Changes

A comprehensive set of question-and-answer flashcards covering the physiologic, dermatologic, sensory, cardiovascular, pulmonary, renal, genitourinary, musculoskeletal, gastrointestinal, hepatic, endocrine, immune, hematologic, neurologic, and pharmacologic changes associated with normal aging, as well as common benign and pathologic conditions in older adults.

What physiologic rhythm disturbances commonly occur with aging?

Changes in body temperature regulation, plasma cortisol/hormone secretion, and sleep patterns.

How does aging affect heart-rate and blood-pressure variability?

Both heart rate and blood-pressure variability decrease, reducing physiologic reserve.

Why are older adults more vulnerable to disease regarding homeostasis?

Diminished sensory perception and stress response make it harder to maintain homeostasis, increasing frailty.

What three structural skin layers thin with age?

Epidermis, dermis, and subdermal fat layer.

Which skin change explains increased wrinkling in the elderly?

Loss of collagen and elasticity.

Describe seborrheic keratoses.

Soft, wart-like "pasted-on" lesions, usually on back/trunk; benign.

What are senile purpura and where do they appear?

Non-palpable purple patches on forearms/hands after minor trauma; benign.

What nickname is given to lentigines and what causes them?

"Liver spots"; sun-induced tan-brown macules with moth-eaten borders.

Stasis dermatitis is secondary to what vascular problem?

Impaired venous circulation (peripheral vascular disease).

Why is actinic keratosis clinically important?

It is a precancerous lesion that can progress to squamous cell carcinoma.

Define presbyopia and its typical onset.

Age-related loss of lens elasticity causing difficulty focusing on near objects; onset early- to mid-40s.

What corneal finding presents as a bilateral gray-white ring in older adults?

Arcus senilis (corneal arcus).

In patients <40 years, what systemic disease can unilateral arcus senilis indicate?

Cardiovascular disease; check fasting lipid profile.

List two hallmark symptoms of cataracts.

Gradual night-vision loss and halos/glare around lights.

Which eye disease is a medical emergency due to sudden rise in intraocular pressure?

Angle-closure glaucoma.

What is the leading cause of irreversible vision loss in U.S. adults >60?

Macular degeneration (especially the dry type).

What type of hearing loss is presbycusis?

Sensorineural hearing loss affecting high-frequency sounds.

Name two anatomic cardiac changes that elevate systolic BP in the elderly.

Aortic stiffening/dilation and arterial arteriosclerosis (thickened intima).

Why are older adults prone to orthostatic hypotension?

Less sensitive baroreceptors and blunted autonomic BP response.

Which heart sound may be normal after age 75 in the absence of disease?

S4 heart sound.

How do FVC and FEV1 change with age?

Both decrease, while total lung capacity stays about the same.

What happens to residual lung volume with aging and why?

It increases due to reduced lung/chest wall compliance and premature airway closure.

Give two reasons cough effectiveness declines in older adults.

Weaker respiratory muscles and less efficient mucociliary clearance.

How much can renal mass decrease by older age?

25–30% overall; ~50% reduction in functional glomeruli.

Why may serum creatinine remain normal despite poor renal function in elders?

Lower muscle mass reduces creatinine production, masking reduced clearance.

What bladder change increases post-void residual urine volume?

Decreased bladder capacity and compliance.

List two typical male reproductive changes with aging.

Prostatic hypertrophy and longer refractory period between erections.

How does estrogen loss affect the female urinary tract?

Urethra thins/shortens, sphincter closure weakens, raising incontinence risk.

Why do fractures heal slower in older adults?

Reduced number and activity of osteoblasts.

Morning stiffness that improves with activity suggests what condition common after age 40?

Osteoarthritis (degenerative joint disease).

By what percentage can height decline by age 70?

2.5% to 5%, accelerating thereafter.

Name two GI factors that raise aspiration risk in elders.

Reduced esophageal muscle compliance and decreased tongue strength/coordination.

Which vitamin absorption commonly decreases with age, potentially causing anemia?

Vitamin B12 (also folic acid and calcium).

What age range sees increased colon cancer risk?

Between 40 and 50 years old.

How does aging affect liver drug metabolism?

CYP450 activity declines 20–40%, slowing drug clearance.

Why are LDL levels often higher in older adults?

Fewer hepatic LDL receptors with age.

Describe the typical pancreatic endocrine change with age.

Mild atrophy plus higher insulin levels and mild peripheral insulin resistance.

Which part of immunity (innate vs. adaptive) is more affected by aging?

Adaptive immunity (T and B cell functions).

Give two atypical infection presentations in elders.

Falls or acute delirium (often without fever).

How does platelet function change with age and what risk does this pose?

Platelet responsiveness increases, shortening bleeding time and elevating thrombo-embolic risk.

What neurologic hallmark contributes to fall risk in the elderly?

Slowed reaction time and decreased proprioception.

Which executive cognitive domain declines most after age 70?

Executive function including problem-solving speed.

List three pharmacokinetic factors that prolong drug action in elders.

Reduced renal clearance, less efficient liver CYP450 metabolism, and larger fat-to-muscle ratio (for lipophilic drugs).

Why must benzodiazepines be used cautiously in older adults?

Increased central nervous system sensitivity leading to over-sedation, falls, and confusion.

What is the Beers Criteria?

American Geriatrics Society list of potentially inappropriate medications for older adults.

Name four common anticholinergic side effects problematic in elders.

Constipation, urinary retention, blurred vision, and orthostatic hypotension.

How do baroreceptor changes influence cardiovascular responses in elders?

They become less sensitive, resulting in blunted heart-rate/BP adjustments to posture changes.

What pulmonary position maximizes airway expansion in seniors?

Standing upright.

Why is serum albumin slightly lower with age and why is that important clinically?

Normal hepatic aging lowers production; low albumin increases free fractions of protein-bound drugs.

What endocrine rhythm change commonly disrupts sleep in older adults?

Altered circadian secretion of hormones like melatonin and growth hormone.

Define xerosis in geriatric dermatology.

Dry skin due to decreased sebaceous and sweat gland activity.

Which ocular test screens central vision loss from macular degeneration?

The Amsler grid.

Name two vision complaints typical of cataracts when driving at night.

Glare from headlights and halos around lights.

What ocular finding disappears when a cataract becomes mature?

The red reflex.

Which glaucoma type commonly proceeds silently until central vision is affected?

Open-angle glaucoma.

What specific auditory structure loss contributes to presbycusis?

Atrophy of hair cells in the cochlea (plus fewer auditory neurons).

Explain why older adults are more prone to drug toxicity from NSAIDs.

Reduced renal clearance and higher susceptibility to nephrotoxic insults.

What physiologic change underlies isolated systolic hypertension?

Arterial stiffening increasing vascular resistance, raising systolic BP while diastolic may remain normal.

Why is the serum creatinine alone insufficient to judge elder renal function?

Because decreased muscle mass lowers creatinine production, masking reduced GFR.

What musculoskeletal change begins around age 50 and continues, leading to weakness?

Sarcopenia – loss of skeletal muscle mass and fiber size.

State two reasons constipation is common in older adults.

Slower large-bowel transit and increased laxative/medication use.

Which liver pigments accumulate with age causing brownish coloration?

Lipofuscin deposits.

How do HbA1c targets sometimes differ in very old adults?

Less stringent targets may be used due to higher risk of hypoglycemia and comorbidities.

What hematologic change delays response to blood loss or hypoxia in elders?

Reduced hematopoietic functional reserve in the marrow.

Why might older adults not mount a fever during infection?

Blunted inflammatory cytokine response and lower baseline body temperature.

Which sensory declines contribute to fall risk besides proprioception?

Decreased vision (e.g., cataracts, macular degeneration) and diminished vestibular function.

What typical age-related cardiac structural change increases pulmonary capillary wedge pressure?

Left-ventricular hypertrophy and stiffening.

Name two GI structural changes that impair nutrient absorption.

Reduced gastric acid & intrinsic factor (affecting B12) and decreased small-intestine transporter efficiency.

How does aging affect esophageal motility and aspiration risk?

Loss of muscle compliance and coordination slows bolus transfer, increasing aspiration risk.

What normal pulmonary auscultation finding may mimic disease in older adults?

Bibasilar crackles due to early airway closure without pathology.

Which kidney endocrine components decline, affecting BP regulation?

Renin and angiotensin II levels are lower in older adults.

Explain why older adults experience more nocturia.

Reduced bladder capacity/compliance and impaired concentrating ability of kidneys.

Which endocrine organ shows minor atrophy yet increased insulin levels?

Pancreas.

What musculoskeletal sign often indicates vertebral compression fractures?

Kyphosis and measurable loss of height.

List two neurologic exam findings that may vary normally with age.

Absent ankle reflexes or brisk knee jerks without upper-motor-neuron pathology.

Why is polypharmacy especially risky for cognition?

Multiple drugs with CNS and anticholinergic effects compound, causing delirium or cognitive decline.

Which adaptive immune cells decline in number and responsiveness with age?

Both T cells (cellular immunity) and B cells (humoral immunity) show reduced precursor numbers and responsiveness.