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121 Cards in this Set
- Front
- Back
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What part of population is aging the fastest? By how much?
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The oldest old - 85 and up; they're aging 3X faster than the rest of us
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What is meant by the term LIFESPAN?
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The maximum lifespan that we're programmed to live.
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What is Life expectancy?
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The average lifespan expected of a group.
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Are life span and life expectancy the same thing? Which is typically longer?
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No; lifespan is longer
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What is changing in america; lifespan or life expectancy?
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Life expectancy
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Why is life expectancy increasing?
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Because the number of infant mortalities is decreasing!
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What is the one strategy that works to extend life? In what?
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Calorie restriction - in rodents
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What is chronological age?
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Their age age
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What is biological age?
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How old their body is regardless of chronological age
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If you say a 50-yr old with end organ damage has the body of a 90yr old, is it true?
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No; a 90-yr old can have the biological age of a 50-yr old
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What is considered young old?
Old old? |
Young old = 65-75
Old old = older than 75 |
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What are the 3 truths about WHAT AGING IS?
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1. Universal
2. Progressive 3. Irreversible |
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2 examples of changes that are due to aging:
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-Gray hair
-Menopause |
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What is unchanged physiologically throughout aging?
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Resting measures
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Are functional reserves left intact during aging?
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Maybe
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Is aging an illness?
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NO
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Does aging occur at the same rate in all individuals?
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no
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What are the 2 ways in which aging occurs at different rates?
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1. Among different individuals
2. Within individuals - organs can age at different rates |
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What is the main thing that aging does?
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Increases susceptibility to many conditions
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What does aging not do?
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Generally does not cause symptoms
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When looking at research on aging, what 3 important concepts must be kept in mind?
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1. Population cleanup
2. Longitudinal studies 3. Cross-sectional studies |
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What does population clean up mean?
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The population of geriatric patients analyzed did not include diseased patients
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What does a longitudinal study measure?
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Trends over a long period of time
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What does a cross-sectional study measure?
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Something at one time
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What is the epoch effect?
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Something that looks like a trend but it's actually an environmental effect.
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What was thought to be a geriatric trend that turned out to be an epoch effect?
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Serum uric acid levels increasing linearly with age
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What did further analysis of the increase in uric acid show?
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That it was increasing in EVERYBODY not just aging.
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What is the cohort effect?
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A effect that is present in all the people being tested (the cohort) that affects the results
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What happens to blood vessels with age?
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Their calcium content goes up - they calcify
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Where in the vessel does the normal increase in calcium occur?
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In the tunica media and adventitia
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What is increased calcification of the tunica media and adventitia called?
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Arteriosclerosis
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What is Atherosclerosis
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Increased calcium in the tunica intima
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What is the result of calcified vessels?
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You can palpate the radial vessel even when the bp cuff is inflated above systolic bp!
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How does the pulse pressure contour change with age?
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Systolic pressure becomes elevated to like 160/80 instead of 120/80
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What should you suspect if you DO measure a "normal" bp of 120/80 in an old person?
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Suspect aortic stenosis - that causes pathological narrowing of the pulse pressure but you'll measure the normal 120/80
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What is a Positive Osler's maneuver?
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Palpation of the radial artery above systolic BP to rule out pseudohypertension
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What happens to TPR with age?
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It goes up
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What happens to Renin activity with age?
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It goes DOWN
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So what drugs become less effective with age?
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ACE inhibitors
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How does responsiveness to catecholamines change with age?
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It goes down
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How do these 4 Adrenal secretions change with age?
-NorEpi -Epi -Aldo -Cortisol |
-Norepi increases
-Epi is unchanged -Aldosterone decreased -Cortisol is unchanged |
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What happens to baroreceptor sensitivity with aging?
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They become less sensitive
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Why does baroreceptor sensitivity decrease?
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Bc the carotids are stiffer
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What happens to cardiac output with age?
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It decreases
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What happens to systolic BP with age?
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It increases
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What happens to diastolic BP with age?
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It goes up, peaks, then declines
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Is it normal for blood pressure to increase with age?
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No; this is not normal
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What is the level of bp in older folks at which you should become concerned about CAD?
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140/80
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What happens at bp of 140/80?
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The risk of CAD is pathological and unacceptable
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What is the probability of death due to CV event at SBP of 195 in
-A 35-yr old? -A 70 yr old? |
35: very low probability
70: very high probability! |
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How does the structure of the heart change with aging?
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-Increases in weight
-The left ventricle thickens |
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What pigment can be seen in the aging heart?
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Lipofuscin and basophilic degeneration
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What happens to the sinus and AV nodes with aging?
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They become infiltrated with fatty connective tissue
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When is the Cardiac index highest? What level?
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Highest at age 10
CI 4.5 L/min/mm^2 |
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When is the CI lowest? What level?
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In old age
CI = 2.5 L/min/mm^2 |
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What happens to the Ejection fraction at rest with age?
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It doesn't change!!
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What happens to the Ejection fraction during exercise with age?
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It does decrease
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Are we SURE that CO decreases with age?
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No
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Why did early studies show that CO decreases with age, but now studies show that it doesn't change?
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Because early research techniques didn't use population cleanup
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Does Cardiac output increase with exercise as normal in aging people?
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Yes; CO does not decline pathologically with age
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What happens to HR with age?
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Heartrate decreases!
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How can CO still be maintained at normal levels if HR is low?
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CO = HR x SV
-The heart got bigger remember? -SV increased |
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Is increased heart mass the only mechanism that keeps CO normal?
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No, EDV - preload is increased.
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So does CO decrease with age?
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No
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What happens to TLC with age?
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It stays the same
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What changes in the lungs with age?
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RV increases and FRC decreases
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What happens to arterial PO2 with age?
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It decreases
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How do you estimate the PO2 in a person?
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Po2 = 100 - (.33 x Age)
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What is the measure of overall cardiopulmonary function?
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VO2 max
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What is VO2 max?
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Maximum oxygen consumption with exercise
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What happens to VO2 max with age?
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It declines progressively
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Why does VO2 max decline? (3 reasons)
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1. Loss of lean muscle mass
2. Loss of max heartrate 3. Deconditioning |
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What happens to body weight with age?
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First it increases
At 60 yrs old it declines |
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What happens to height with age?
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It decreases
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Where does the height decrease?
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In the intervertebral discs
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Where is most of the body's potassium stored?
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In lean mass
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So what happens to total body potassium with aging?
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It declines
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In whom do Potassium levels decline more significantly?
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Men
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What happens to cell mass with age?
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It doesn't change
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What happens to fat free mass with age?
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It decreases
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What happens to fat mass with age?
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It increases
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Why is it important to remember that body fat increases with age?
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Because it affects how drugs work
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What happens to the body's percentage of water with age?
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It decreases in reciprocation with body fat
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What happens when old people drink?
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They have less body water for it to distribute in, so the higher concentration gives a higher buzz faster.
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What happens to renal mass with age?
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It declines
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Why does renal mass decline?
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Because of glomerular atrophy
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how much do the glomeruli decrease?
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From like 2.3 million to 1.5 million
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What is Hyalinization?
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The formation of scar tissue in the glomeruli
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What happens at the vascular pole of glomeruli with aging?
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Afferent/efferent arteriolar shunting
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Why is the shunting from afferent to efferent arterioles bad?
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It washes out the ISF concentration in the medulla and decreases the countercurrent multiplier effect.
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What happens to renal bloodflow with age?
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It decreases
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What happens to GFR with age?
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It decreases
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How much does renal plasma flow decline every decade?
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10%
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What happens to renal vascular responsiveness with age?
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The renal arteries become less sensitive to ACh and so they are less able to dilate
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What is Creatinine clearance an index of?
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GFR
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What happens to creatinine clearance and excretion in old people?
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They are significantly reduced
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What happens to plasma creatinine in old folks?
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It is not changed.
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So if production and excretion of creatinine were unchanged, where did the reduction in creatinine occur?
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In the fact that the TOTAL LEAN BODY MASS IS DECREASED IN OLDER PEOPLE
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But if the muscle mass producing creatinine is reduced, even though the production rate is normal, why aren't plasma levels lower?
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Because the GFR declines with age too
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So what are the 2 reasons for why Plasma creatinine remains the same and Creatinine excretion/clearance decline with age?
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1. Decreased lean body mass
2. Decreased GFR |
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What is the best way to calculate Creatinine clearance in older folks?
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By using the Cockgroft Gault equation
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What is the Cockgroft Gault equation?
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(140-Age) x Weight (kg)
----------------------- 72 x Serum creat |
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What do you do in addition for women when using the Cockgroft Gault equation?
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Multiply by 0.85
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Does thyroid hormone change with age?
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No
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What 3 ovarian changes occur with age?
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-Loss of follicles
-Vessel obliteration -Parenchymal fibrosis with atrophy of corpora lutea and albicania |
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What happens to FSH/LH excretion at menopause?
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They surge all of a sudden
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Why do FSH/LH surge at menopause?
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Due to the ovaries failing and loss of estrogen and progesterone
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Why do the ovaries fail?
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Because all the oocytes died off and when LH and FSH try to stimulate the development of 6-8 folliles at the start of the cycle, fewer respond so less estrogen is produced.
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So what happens to estrogen levels excreted at menopause?
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The fall
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What is the side effect to be aware of with menopause?
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Bone loss is accelerated
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Why is bone loss accelerated with menopause?
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Because estrogen is a natural promotor of bone formation, and inhibitor of bone resorption.
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What is the main change that we see take place in the male gonad?
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Prostate enlargement
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How does patchy degeneration of the leydig cells and seminiferous tubules affect male reproduction with aging?
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Testosterone secretion declines
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What does the decline in testosterone production with age result in causing in some old men?
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Hypogonadism
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Is hypogonadism normal?
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No
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Do fasting blood glucose levels change with age?
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No
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Do serum insulin levels change with age?
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No
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Do blood glucose levels after a 2 hr challenge change with age?
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YES
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Why does blood glucose after a 2 hr challenge remain elevated in older patients?
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Because of a decreased function of something beyond the insulin receptor..
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What are the main changes in adrenal cortex hormones with age?
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-Cortisol itself doesnt change, but is less suppressed by DXMS and more stimulated by ACTH
-DHEA is markedly decreased |
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How does growth hormone change with age?
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It decreases
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