What are the environmental factors that affect lifespan?
Increased caloric intake Smoking Sedentary lifestyle Alcohol use
What is the normal GFR of age 30 compaired to age 80?
Age 30: 140 ml/min Age 80: 97 ml/min
Drug dosage adjustment in elderly should be based on what?
Creatinine clearance (best way to asses renal function!!!) But serum creatinine level ALONE is not an adequate indicator of renal function Decreased muscle mass + decreased GFR = stable serum creatinine level
What serum creatinine level in the elderly typicall indicated renal pathology?
Serum creatinine level more than 1.5 mg/dl
What type of test may become a new and better way to assess renal function?
Cystatin-C More reliable in pts w/ high risk of CV dz who have a normal serum creatinine level Protein found in blood that is filtered by kidneys NOT affected by age, rafe, gender, or lean muscle mass
What labs increased with aging? Decrease?
Increase: ESR, alkaline phosphatase, autoantibodies Decrease: PaO2, albumin, vit B12
What are the RF for adverse drug reactions (ADRs) in elderly?
Increasing age Gender (women) Small body size Duration of therapy Patient non-compliance with therapy Underlying disease states
What lipophylic drugs can penetrate the CNS due to changes in CNS function of the elderly?
TCA, barbiturates, opiates
What electrolyte is affected when kidney changes occur in the elderly?
Sodium - hyponatremia Decline in active renin/aldosterone = sodium loss Inability to excrete large volumes of free water = dilutional hyponatremia
What host factors can increase risk of infection?
Associated diseases: Type II DM, PVD, valvular heart dz Prosthetic devices Nutritional deficiences
What is a type of primary prevention? Secondary? Tertiary?
Primary- prevent disease (immunization) Secondary- early detection before it becomes symptomatic (colonoscopy) Tertiary- optimize health once disease is detected (medication)
What are the 5 aspects of behavioral counseling that optimize the pt's interest and adherence to lifestyle changes that promote health?
Assess Advise Agree Assist Arrange
Elderly over age 65 that have received a pneumoccoccal vaccination prior to age 65 should receive a re-vaccination when?
6-7 years after initial vaccination
How do you dose Tetanus vaccinations?
3 doses if never vaccinated Previously vaccinated = booster every 10 yrs *Most cases of tetanus in US occur in unvaccinated older persons
What are some different statins that can treat hyperlipidemia?
More complex task Transportation Shopping Cooking Using the telephone Managing money Taking meds Cleaning Laundrey
New or subtle declines in IADL function may indicate what?
Presence of disease (CAD, CVD) Loss of vision or hearing Fear of falling Depression and/or dementia
How do elderly pts present differently than younger pt when it comes to ACS?
Acute MI more likely to present W/O chest pain Asymptomatic ischemia found more often on ECG Conduction defects signal onset of CAD in almost 2x more often in elderly SOB, pulmonary edema, CHF, cardiac rupture, and shock are common complaints related to acute MI Delirium may be presenting symptom after an MI in elderly
CHF is most commonly associated with what?
Proonged systolic HTN Presence of CAD second most common
What drugs do what in CHF?
Afterload reduction = ACEI Volume overload = diuretics Digoxin = reduces frequency of CHF exacerbations BB should be prescribed unless CI
What is the second most common indication for heart surgery in the elderly?
Second MC = Aortic stenosis (AS) MC = CABG
What is the MC valvular disorder in the elderly?
Mitral Regurgitation Mod-severe = ACE inhibitors
How do you diagnose and treat A-fib/flutter?
Echo to dx Rate/rhythm control and thrombolytic for tx
Hyperthyroidism imitates what other non-endocrine diseases?
Delirium CHF Classic eye findings are less common Tremor- may be a benign finding
What medication may cause hyperthyroidism?
Amiodarone Contains iodine and may cause iodine excess
What drug is recommended for an elderly pt with the flu?
Tamiflu (Oseltamivir) Symmetrel (Amantadine) - Influenza A only
What are some medications that may cause constipation?
Opoid analgesics Antacids CCB Diuretics Iron supplements Anticholinergics
What are some transient causes of urinary incontinence?
Cortical - affects memory, language, problem-solving and reasoning (amnesia, aphasia, apraxia, agnosia) Subcortical - affects attention, motivation and emotionality (amnesia, slowness of thought, apathy) - Movement and gait findings early
What are some diseases that cause cortical dementia?
Alzheimer's disease Pick's disease- atrophy of cerebral cortex; frontal lobe findings like delusions, flat affect, loss of speech, progressive dementia Stroke syndrome Jakob-Creutzfeldt dz -"mad cow dz"- infectious prion Lewy Body dementia - visual hallucinations, movement d/o assoc. w/ PD signs
What are some diseases that cause subcortical dementia?