Principles 2 Fall 2025 > Geriatrics > Flashcards

Geriatrics Flashcards

Test 2 (37 cards)

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1
Q

By 2030 ___% of people will be over 65 yo. By 2050, ______ people will be over 60 yo.

A

20%

2 billion

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2
Q

What is aging?

A

Universal and progressive physiological processes

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3
Q

With aging, memory decline is seen in ___% of people >60yo. What does this depend on? What slows this?

A

40%

Depends on the ability to do ADLS

Memory loss is slowed by mental & physical exercise

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4
Q

How does the brain change with aging? (4)

A
  1. Cerebral atrophy
  2. Decreased grey & white matter
  3. Increased ventricle size
  4. Loss of memory, balance, mobility
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5
Q

How does aging affect your neuraxial? (3) How does this affect your anesthetic?

A
  1. Decrease epidural space
  2. Increased permeability of Dura
  3. Reduced CSF volume

Patient will require less volume of LA

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6
Q

In the peripheral NS, with aging the Inter-schwann cell distance is _______. Conduction velocity is ______ dt _________. How does this affect elderly?

A

Decreased

Decrease

Reduction in myelination

More sensitive to neuraxial/periperal nerve blocks

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7
Q

What are the cardiac effects in the elderly? (8)

A
  1. Myocytes decreased
  2. LV thickens/stiff ventricles
  3. SA node cell decreases – prone to arrhythmia
  4. Conduction velocity decreases
  5. Aortic valve calcified/thickens
  6. Decreased contractility
  7. Higher filling pressures
  8. Less beta adrenergic sensitivity –more susceptible to decompensation during drops in SVR; decrease max HR & EF during stress
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8
Q

How are the cardiac vessels affected in the elderly? (4)

A
  1. Vascular stiffness dt breakdown of collagen/elastin
  2. Coronaries can’t dilate effectively dt reduced levels of NO

(early wave deflection)
3. Increased afterload
4. Diastolic dysfunction

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9
Q

What are the pulmonary affects in the elderly? (6)

A
  1. Decrease VC
  2. Increase closing capacity/CV
  3. Increase RV
  4. Weaker pharyngeal muscles
  5. Decreased muscle mass
  6. Increased FRC
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10
Q

FEV1 decreases by ____ per decade

A

6-8%

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11
Q

How does age affect V/Q mismatch?

A

Mismatch increases w/ age

CC eventually exceeds FRC

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12
Q

How is the renal system affected in the elderly? (3)

A
  1. GFR decreases
  2. Blunted responses to Aldo, Vaso, renin (trouble balancing F&E)
  3. Urinary retention & UTI more common
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13
Q

How much does GFR decrease in the elderly?

A

1ml/min/m2

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14
Q

How is GI & hepatic affected in the elderly? (3)

A
  1. Liver function declines
  2. Phase 1 of metabolism most compromised
  3. Less PONV
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15
Q

How is musculoskeletal affected in the elderly? (5)

A
  1. Muscle mass/strength decreases
  2. SQ fat decreases
  3. Thermoregulation decreases
  4. Impaired wound healing
  5. Osteoarthritis
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16
Q

Elderly pts have a ____ vasoconstriction threshold. Thermoregulation is ______ less for adults ______ yo

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A

Lower

1 degree

60 - 80 yo

17
Q

T/F: nursing home residence have higher mortality

18
Q

You have a high mortality at _____ & up

19
Q

What are predictors of 6 months - 1yr mortality? (6)

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A
  1. Impaired cognition
  2. Recent fall
  3. Hypoalbuminemia
  4. Anemia
  5. Functional dependence
  6. Comorbidities
20
Q

What are factors that contribute to the patho of dementia? (4)

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A
  1. Amyloid B
  2. Tau
  3. Calcium
  4. Neuroinflammatory factors (TNF, IL-1)
21
Q

Describe the relevance of Amyloid B (4)

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A
  1. Associated w/ fragmentation of synaptic origin
  2. Form Amyloid plaques
  3. Disrupt the cell membranes
  4. In mice, accelerated onset of alzheimers in combo w/ halothane
22
Q

Describe the relevance of Tau

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A
  1. Protein –> phosphorylation –> large Plaques
  2. Causes neurofibrillary tangles (NFT)
  3. Decreases in temperature 2 -3 degrees C = increase amount of Tau
  4. Repeated exposure to Halothane, Iso, Sevo = increased phosphorylation
23
Q

Volatiles & Succs are known to be associated w/ ______________. Why?

Study These Flashcards
A

Malignant hyperpyrexia.

Exaggerated release of Ca++ from the endoplasmic reticulum

24
Q

What are 3 facts about dantrolene and malignant hyperpyrexia?

Study These Flashcards
A
  1. Doesn’t cross BBB
  2. Significant skeletal muscle weakness
  3. Not good prophylactic
25
Neuroinflammation enhances __________. What mediators contribute to this? (3)
cognitive decline 1. Cytokines 2. IL-6 3. TNF-alpha
26
What anti-inflammatory anesthesia drugs are capable of modulating inflammation?
1. Dexamethasone 2. Lidocaine 3. Toradol
27
What is the order of GA drugs that alter cognition in the elder? (3)
Iso > Des > Propofol (TIVA)
28
What are the risk factors for postop cognitive dysfunction (POCD)? (6)
1. Increasing age 2. Duration of anesthesia 3. Lesser education 4. A second operation 5. Postop infection 6. Respiratory complications
29
What were conclusions in the elderly with animal studies? (2)
1. Surgery itself can cause short term cognitive decline 2. Anesthesia alone is causative -- surgery is additive
30
What are anesthesia implications with the elderly? (8)
1. Use neuraxial/regional when possible 2. Avoid long acting NMB -- reverse adequately 3. Opioid sparing strategies -- avoid CYP450 pathways 4. Neutralize stomach acid with non-particulants 5. Consider EEG base titration 6. Avoid hypotension 7. Pad skin & nerve 8. Keep normothermic
31
With the elderly, what our challenges rt the heart?
Decreased cardiac output Everything goes slower: slower onset slower clearance slower distribution slower metabolism
32
With the elderly, what our challenges rt the neuromuscular junction? (4)
1. Increase distance between axon & motor end plate 2. Decrease concentration of Ach-receptors 3. Decrease amount of presynapse Ach 4. Decrease release of Ach
33
In the elderly, describe the difference between Kidney/liver dependent metabolism drugs vs non.
Dependent: -prolongation effect -decreased need during maintenance -delayed recovery phase for non-depolarizing NMB Nondependent (Succ, Cisatra, Remi): -no significant prolongation affect -same requirements during maintenance -no delay in recovery phase
34
With pulmonary resection in the elderly, there is a ___% mortality if you are ____yo. What are the chances of respiratory complication? Cardiac complications?
3% 80-92yo Respiratory = 40% (2x more than younger ppl) Cardiac = 40% (3x more)
35
Equation: predicted postop FEV1
Preop FEV1% x (1 - lung tissue removed/100) Ex) preop FEV1 = 70% & RLL removed 70 x (1 - 29/100) =49.7 --> 50%
36
How many total lung subsegments are there? How many is in the R lung? L lung? Describe them.
42 R lung = 22 L lung = 20 L lung -upper lobe = 10 -lower lobe = 10 R lung -upper lobe = 6 -middle lobe = 4 -lower lobe = 12
37
What is POCD?
Postop cognitive dysfunction Objectively measured decline in cognitive function that persists beyond the period expected
Principles 2 Fall 2025
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