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121 Cards in this Set

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