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Geriatrics > Physiology of Aging > Flashcards

Physiology of Aging Flashcards

1
Q

What is aging?

A
  • gradual loss in reserve capacity (loss of fxning cells) of organs and organ systems
  • leads eventually to fxnl impairment, leading ultimately to death
  • gradual process begins in early adulthood
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2
Q

What is homeostasis? Effect of aging on homeostasis?

A
  • maintains stability of internal enviro
  • internal envrio becomes increasingly unstable w/ age
  • changes to which the body must respond exceed the body’s diminishing capacity to respond
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3
Q

What are reduced homeostatic responses that are common in elderly?

A
  • baroreceptor responsiveness: increased postural hypotension
  • thermoregulatory responses: higher hypothermia, hyperthermia
  • cardiac reserve: fluid overload
  • thirst: dehydration
  • dark adaptation: night driving hazardous
  • skin, mucous membranes: primary barrier - thinner, less blood supply
  • mucociliary defenses: cough reflex diminished
  • gastric: achlorhydria
  • BPH: residual urine
  • absence of fever - blunted response
  • PMNs altered, t cells altered
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4
Q

What are early signs of aging?

A
  • process that gradually leads to noticeable changes in many body systems
  • MC early sign of aging is difficulty staying up all night and working the next day
  • hair thinning in men begins often in 20s
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5
Q

SIgns of early aging in 30s?

A 
- 30s:
easier wt gain
graying hair, thinning hair
wrinkling forehead and eyes
concern about biologic clock, financial security, family obligations
injuries "weekend warrior"
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6
Q

Signs of early aging in 40s?

A
  • reflection on mortality, life’s limitations, unreached dreams and goals - mid-life crisis
  • skin changes: sagging, wrinkling, thinning, benign and malignant lesions, sweat glands
  • vision changes: presbyopia: MC age related eye problem in this age group, requires reading glasses
  • osteoarthritis: by 40 all adults have OA changes visible in radiographs of cervical spine, most of these changes are not sx at this pt - hands, jt, back
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7
Q

Signs of aging in 50s and early 60s?

A
  • sense of aging
  • menopause
  • becoming grandparent
  • death of parents, friends
  • oldest at work
  • physical limitations, medical problems
  • senior citizen discounts
  • AARP membership
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8
Q

signs of aging: 70s and 80s?

A
  • one or more chronic disabling conditions
  • arthritis, HTN, hearing loss, heart conditions, visual problems, bone problems
  • psych and social losses:
    retirement, death of spouse/close family member
    children moving away, freinds dying or moving.
    Moving into apt or retirement living.
    Inability to socialize from sensory or physical impairments
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9
Q

Rule of Thirds: aging changes?

A
  • 1/3 fxnl decline is result of disease
  • 1/3 is due to inactivity (disuse)
  • 1/3 of decline is caused by aging itself
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10
Q

What are the theories of aging?

A
  • programmed phenomena: all cells bear specific death genes
  • error theory: cellular DNA and RNA error, accumulation of inappropriate proteins and enzymes, unable to support cellular metabolism
  • repair failure: failure of DNA repair
  • redundancy failure: as cell ages, supply of redundant genes are exhausted
  • killer hormone theory: pituitary produces “killer” hormone, destroys cell fxn
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11
Q

What is the happiest adult age group?

A
  • in spite of potentially discouraging losses and limitations they face, men and women aged 65-70 yrs report greater happiness than adults in any younger age group
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12
Q

What advantages do older adults have over younger individuals?

A
  • greater independence
  • fewer responsibilities
  • reduces concern about day to day inconveniences
  • financial security: social security, retirement programs
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13
Q

Multiple etiologies in elderly?

A
  • multiple problems are the rule
  • illness results from several factors rather than from a single agent
  • often several factors combine w/ a decrease in host resistance to illness or injury
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14
Q

Aging Changes to hematologic system?

A
  • after 65: RBC, Hgb, Hct decrease slightly
  • WBCs increase in lobulation and decrease in granulation: impairment of phagocytic activity
  • total lymphocyte unchanges, subsets change
  • ESR increases slightly
  • physiologic anemia of aging
  • decreased reserve of red cell mass
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15
Q

Aging chages to ht and wt? (musculoskeletal)

A
  • ht: avg loss is 2-4 inches (40-80yrs)
  • wt:
    men - peak in 50s and then decline
    women - peak in 60s and then decline
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16
Q

Aging changes of the CT? (musculoskeletal)

A
  • increase in density, decrease in water content of CT: loss of skin elasticity, jt stiffness (increased fibrous tissue) - TBW men: from 60-54%, women 54-46%
  • calcification of CT:
    atherosclerotic changes
    degenerative jt disease
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17
Q

Aging changes of the bone? (musculoskeletal)

A
  • decreased bone mineral content causes changes - osteoporosis
    age 20: women have greater bone mass
    age 50: women=men
    age 65: women2x less than men
  • reduced 35-30% in women
    -10-15% men
  • bone loss in women due to decreased estrogen production - increase in osteoclastic activity, PTH production, decrease in calcitonin
  • vit D absorption declines= decrease in calcium absorption
18
Q

Aging changes of the muscle? (musculoskeletal)

A
  • decrease in muscle mass due to reduction in number and size of muscle fibers - 30%
  • change in muscle strenght begins at age 35
  • degree of muscle loss varies - large muscle affected more than smaller muscles
19
Q

Aging changes to the skin?

A
  • decreased tone and elasticity
  • decline in subq adipose tissue: poor thermal insulation (susceptible to hypothermia)
  • yellowing of nails, rigid nails
  • hair loss after 30 in men
  • decrease in pigment
20
Q

Aging changes to the respiratory system?

A
  • physiologic work capacity of 70yo only half that of 20 yo
  • decrease in alveolar size - reduces total surface area for gas exchage
  • vital capacity decreases progressively 30-70 yrs old (17%)
  • elastic recoil decreases due to changes in collagen
  • forced residual capacity increases 60% by age 80, changes in chest wall muscles, bone and CT cause decrease in ventilatory fxn
  • reduced expiratory flow velocities
  • all timed pulm fxns decrease w/ age
21
Q

Aging changes to the CV system?

A
  • increased collagen in vascular smooth muscle + decreased elastic tissue: reduced vascular compliance
  • CO decreases by 1%/yr b/t 25-70: decreases from 4.6 to 3.3 x resting CO, SV deceases 0.7%/yr
  • slight reduction in resting HR
  • decreased organ perfusion (increased PVR and decreased CO)
  • age 80: blood flow reduced by 50% in kidneys and 20% in cerebral hemisphere
  • increased peripheral resistance + decreased vascular compliance = increased systolic BP
22
Q

Aging changes of the Kidneys?

A
  • after 40 - decrease in nephron units:
  • kidneys begin to lose mass
  • renal blood vessels thicken, lose elasticity
  • medullary CT increases, replaces interstital cells - decreases in medullary hydration
  • loss of juxtamedullary glomeruli - account for decreased renal concentrating ability and decreased renal perfusion
  • GFR and CrCl decline after age 40 (1%/yr)
  • by 80 - GFR decreased by 50%, and CrCl by 33%
  • peak bladder capacity reduced
  • residual urine increases
  • blood flow best at night, decreased renal perfusion = nocturia nad frequency
  • prostate gland doubles in size (20-80 yrs)
23
Q

Aging changes to the alimentary canal?

A
  • loss of teeth occurs secondary to bone and CT changes - 1/2 pop over 65 is edentulous
  • periodontal disease is more common in middle and old age: decreases ability to chew food adequately
  • all contribute to poor nutritonal status
  • lack of dental care and poor hygiene contributes
  • lower esophageal sphincter fails to relax w/ peristaltic waves = uncoordinated -
    delayed entry of food into stomach
    decrease in gastric emptying time
    GERD
24
Q

Gastric aging changes?

A
  • age related changes in stomach lead to atrophic gastritis and pernicious anemia (can present like dementia)
  • gastric secretions reduced (achlorhydria)
  • unable to absorb B-12
25
Q

Aging changes of the colon?

A
  • decreased motor fxn
  • depression of defecation reflex - lead to chronic constipation
  • decreased colonic muscle tone - lead to diverticulosis
  • decreased perfusion of GI tract secondary to vascular changes - bowel ischemia
26
Q

Aging changes of the pancreas?

A
  • decrease in pancreatic lipase activity = may have effect on digestion
  • no alteration in hepatic or biliary fxn, however increaesd incidence of cholelithiasis
27
Q

Aging changes specific to a man?

A
  • increase in fibrous tissue of intertubular spaces of the testes
  • thickening of basement membrane around seminiferous tubules = decrease in sperm transport
  • sperm production only decreases 50% from ages 20-80
28
Q

Aging changes of the PTH?

A
  • at 20: 2x as high in women as men
  • levels decrease in women at 40: rise in middle age, very high in those who develop osteoporosis
  • in men, progressively rise until age 60, then decline
29
Q

Aging changes of cerebral blood flow? Neuro changes?

A
  • decrease (20%)
  • by 80 - 7% reduction in cerebral hemisphere mass
  • NTs esp dopamine in basal ganglia decrease
  • delay in monosynaptic reflex arc - slowed reflexes
  • motor time increases w/ aging: slowing of activity from reduction in conduction velocity
  • decreased vibratory sensation
  • decreased hand grip, strength, coordination, writing (micrographia - parkinsons)
30
Q

Aging changes of sleep?

A
  • 90% of adults complain of some problems sleeping
  • slowing of alpha rhythm and altered sleep patterns
  • more time in bed, less time sleeping
  • frequent night time urination
  • arthritic pain
31
Q

Memory loss as we age?

A
  • short term is common in elderly and differentiating this “benign forgetfulness” from early dementia is often impossible
  • formal mental status eval is indicated if there is concern about cognitive impairment
  • worrying about memory loss itself is a sx of normal aging rather than alzheimers, which the sufferer is generally unaware of any mental impairment
32
Q

Ocular changes as we age?

A
  • cataracts (MC cause of blindness in the world)
  • macular degeneration
  • decrease in visual receptors:
    amt of light reaching the retina diminished by 70%, reduced pupillary size, yellowing and clouding of lens
  • presbyopia
  • decreased number of retinal rods, dark vision
33
Q

Hearing changes as we age?

A
  • decrease w/ age, varies by individual: high pitched sounds
  • decrease in vestibular fxn:
    loss of hair cells in crista ampullaris, leads to balance problems
34
Q

Change in taste as we age?

A
  • number of tongue papillae and taste buds decrease (70%) - adverse effect on appetite and nutrition
  • olfaction declines**
  • leads to poor nutrtion
  • don’t want to eat b/c they can’t taste or smell
  • leads to wt loss - and can lead to FTT
35
Q

Psychological aspects of aging?

A
  • role changes: retirment
  • coping w/ illness
  • loss of spouse
  • friends dying
  • kids are adults and far away or occupied w/ their own family matters
36
Q

Lab value changes as we age?

A
  • ESR increases
  • CrCl decreases
  • blood glucose rises
  • cholesterol rises
  • albumin falls
  • T3 falls
37
Q

What is healthy aging?

A
  • doesn’t imply that there are an absence of limitations
  • rather an adaption to changes assoc w/ aging process that is acceptable to the individual
  • great variation in responses is seen, the goal is that the older adult lives a personally satisfying and socially satisfactoy life
  • healthy aging involves prepartion, adaption, and good fortune
38
Q

What are the 3 factors of healthy aging?

A
  • low probability of disease and disability
  • higher cognitive and physical fxning
  • an active engagement in life: this concept represents the concept of successful aging most fully, going and doing something meaningful
39
Q

What is the disengagement theory?

A
  • voluntary cutting back on work, social and even family ties
  • becomes more satisfied w/ vicarious activities and especially w/ reminiscence
  • comes to terms w/ and accepts past failures
40
Q

What is the example of the prototypical disengaged person?

A
  • well known
  • loved by neighbors
  • happily spends day rocking on front porch, offering cheeful word to everyone who passes by
41
Q

What is the activity theory?

A
  • staying as active as possible
  • cont. professional or volunteer work
  • social activities, family, hobbies
42
Q

What is the continuity theory?

A
  • successful psych adaption to aging involves allowing personal preferences from earlier yrs to manifest themselves as the individual responds to the stress and challenges of older age
  • thus, some individuals will remain more active b/c it suits their personality, whereas others will become more disengaged

Geriatrics (16 decks)

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