Pathophysiology 1.2

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Pathophysiology 1.2
2010-09-20 00:08:02
Geriatric Pathophysiology

Geriatric Pathophysiology
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  1. Developmental-Genetic Theory
    Changes occurring with age are genetically programmed
  2. Stochastic Theory
    • changes result from random evens or environmental influences.
    • ex. aging skin from sun, which causes change in DNA
  3. Young-old
  4. Middle-old
  5. Old-old
    > 85
  6. Physical skin changes with aging
    • Wrinkled, Dry
    • Uneven pigmentation
    • Sparse, gray hair
    • Decreased elasticity
    • Decreased dermis layer (20%), increased transparency
    • Decreased blood flow
  7. Functional Skin changes with aging
    • decreased sensory perception
    • decreased protection
    • decreased perspiration
    • decreased fluid/electrolyte balance
    • decreased metabolism
  8. Physical changes in the musculoskeletal system
    • decreased height
    • change in body composition (decreased lean muscle and body water, increased adipose)
    • decreased type II fibers
    • Bone mass loss (age 35 is peak)
    • decreased distance between vertebra
    • cartilage loss
  9. Functional changes in the musculoskeletal system
    • decreased strength
    • decreased high speed performance & recreation
    • slowed movements
    • altered gait
  10. Muscle changes that affect performance and endurance
    • decline in high-speed performance and reation time because of a decrease in type II muscle fibers.
    • type I muscle fibers remain consistent with age, which offers endurance.
  11. Process of bone loss
    • process of bone formation is slowed in relation to bone resorption
    • loss of bone mass
    • weakened bone strucuture
  12. Common changes in blood pressure regulation
    • orthostatic hypotension
    • drop in systolic pressure in assuming an upright position or after a meal
    • compensatory mechanisms are delayed or insufficient
    • diminished changes in heart rate and diastolic pressure
    • changes of autonomic nervous system function
    • inadequate function of the circulatory system
  13. Physical changes of the cardiovascular system
    • increased systolic BP
    • decreased left ventricular diastolic relaxation
    • decreased cardiac output
    • increase left ventrical wall thickness
    • increased afterload
    • atrial hypertrophy and enlargement
    • decreased elasticity of vessels (increased pressure)
  14. Functional changes in the cardiac system
    • decreased responsiveness to catecholamines
    • venous stasis
    • decreased compensatory mechanisms
  15. Physical changes of the respiratory system
    increased respiratory rate
  16. Functional changes of the respiratory system
    • decreased max O2 consumption
    • calcification of soft tissue
    • increased workload of respiratory muscles
    • decreased cough mechanism
    • increased rate of infection
  17. Physical changes of the neurologic system
    • decreased brain weight
    • neuron loss (cerebral cortex)
    • diminished electrochemical reactions
    • change in dopamine, acetylcholine and 5-HT
  18. Functional changes of the neurologic system
    • slowing of thought process
    • decreased ability to perform normal tasks
    • decreased sensory motor system
    • changes in perception, auditory, speech and memory
  19. Physical changes in vision
    • visual acuity
    • decreased pupil diameter
    • decreased refractive power of the lense
    • atrophy of ciliary muscles
  20. Functional changes of vision
    • decline in night vision
    • decline in color discrimination
  21. Physical changes of hearing
    • presbycusis
    • cerumen impaction
  22. Functional changes in hearing
    • loss of high pitch sounds
    • speech discrimination
    • symmetrical hearing loss
    • thicker ear wax
    • compensate with lip reading
  23. Physical changes in taste and smell
    decreased olfaction
  24. Functional changes of taste and smell
    • concerns of safety; can't smell fire
    • decreased appetite
  25. Physical changes in immune function
    increase in various auto antibodies
  26. Functional changes in the immune system
    • relatively unchanged
    • T-cell function is decreased
    • Increase in autoimmune diseases such as rheumatoid arthritis
    • no spike in blood cells
    • no fever spike
  27. Physical GI changes
    • presbyesophagus (inability to relax sphincter to stomach)
    • gastric mucosa atrophy
    • achlorhydia (increased pH)
    • decreased transit time
  28. Functional changes of GI
    • alterations in absorption rates
    • decreased exposure to drug
  29. Physical changes of the GU system
    • Changes in bladder structure
    • Decreased sex hormones
    • changes in genital structures
    • decreased elasticity of bladder
  30. Functional changes of the GU system
    • Males: BPH, Androgen deficiency
    • Females: vaginal atrophy
    • sexual activity
    • incontinence not common
  31. Physical changes in renal function
    • decreased renal mass
    • decreased filtration rate
    • decreased blood flow
    • decreased thirst
  32. Functional changes in renal function
    • altered ability to maintain homeostasis
    • predisposition to dehydration
    • prone to electrolyte imbalance
    • urine is not concentrated as well
  33. Four risk factors for falls in older individuals
    • compounding age related changes
    • Gait changes (heal & toe lift)
    • environmental hazards
    • Medication contributions
  34. Vitamin D
    increased muscle strength
  35. Creatinine clearance
    • creatinine comes from muscles
    • decreased muscle = decreased creatinine
    • overestimate creatinine clearance