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87 Cards in this Set
- Front
- Back
What are 8 normal aging changes?
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1) Cardiovascular
2) Pulmonary 3) Musculoskeletal 4) Homeostasis 5) Sensory (taste, smell, hearing, vision, touch) 6) GI 7) Hepatic 8) Kidneys |
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Definition of Eugeric
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Trying to distinguish between changes related to natural aging processes from changes associated with pathology.
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Definition of Eugeric Death
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Progressive decline in function, continuing to the point that it is no longer compatible with life (natural cause of death/wore out)
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What are 4 aspects of aging successfully?
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1) Enjoy life
2) Maintain mental function 3) Maintain physical function 4) Avoid diseases |
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What does successful aging come down to?
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Restoring homeostasis
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What puts elderly at high risk for mortality?
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1) weak muscles
2) high amount/rate of muscle loss (sarcopenia) |
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What is the 3rd leading cause of death in the US?
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Physical inactivity
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What plays a role in chronic illness of aging?
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Physical inactivity
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What can increase immune system function?
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Moderate exercise
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What is the most important age related difference?
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The ability to respond to physical and emotional stressors, then return to pre-stressor levels
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What is normal aging associated with?
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Reduction of functional reserve capacity
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What are some examples of reduction of functional reserve capacity (normal aging)?
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1) Different max heart rate (declines linearly with age)
2) Kidney function--loss of nephrons 3) Loss of type II fibers--less force |
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What are 2 examples of complete loss of functional reserve capacity?
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1) Female reproduction
2) Loss of high frequency sounds |
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What are some cardiovascular changes with age?
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1) Change in fibers/electrolyte balance
2) Decrease in heart response to stress 3) Increase systolic BP 4) Increase peripheral resistance (LV effort) 5) Decrease cardiac output at rest 6) Decrease diastolic fill rate 7) Decrease max heart rate 8) Decrease ventricular compliance 9) Thickening of mitro valves 10) Cardiovagal Baroreflex--decrease sensitivity to barroreceptors 11) Increase norepinephrine 12) Decrease myocardial cell size |
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What do changes in cardiac muscle fibers and electrolytes lead to in older people?
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Prone to arrhythmias
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What do you have to be cautious about when an older patient has a decreased heart response to stress?
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Extend warm-ups and cool-downs to be aware of their homeostasis
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What do you have to be cautious about when an older patient has decreased diastolic fill rate?
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Need frequent rests when exercising
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What are some pulmonary changes with aging? (8)
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1) Decrease chest wall expansion and lung recoil
2) Increase calcification of ribs 3) Decrease abs and intercostal muscles 4) Changes in spine (kyphosis) 5) Decrease max voluntary ventilation 6) Decrease vital capacity 7) Increase in residual volume 8) Less cilia and cilia strength |
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What must you be cautious about when an older patient has calicified ribs?
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Special mobilization techniques and be aware of osteoporosis
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What should you consider when a patient has weak primary and secondary respiratory muscles (i.e. weak abs and intercostal)?
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May present with low endurance and will fatigue easily
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What should you consider when a patient has decreased max voluntary ventilation?
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Slowly progress the patient through exercise program and gradually return them to baseline
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What do you need to consider when a patient has a reduced vital capacity of their lungs?
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Patient will not be able to do the same type of exercise they did when they were 20 yo
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What will changes of lung mechanical properties lead to in an older patient?
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1) Influences air flow
2) Lung volume is different 3) Alteration in gas exchange 4) Impairment in lung defenses *Increase work of breathing! |
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Describe how V/Q ratio decreases with age
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Airway size increases, amount of collapsible small airways increase causing net effect of decrease partial pressure of O2 in blood when breathing room air (O2 sats down)
*VQ mismatch caused by poor ventilation |
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What is osteoarthritis?
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Deterioration of cartilage
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What are some musculoskeletal changes with aging?
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1) Cartilage
2) Muscle 3) Skeletal |
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What changes occur with cartilage as we age?
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1) Deteriorates
2) Decreased hydration 3) Decreased elasticity 4) Increase fibrous growth around joints |
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What are the effects of dehydration in cartilaginous joints?
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Amount of glycoproteins in cartilaginous matrix determines the amount of fluid that is drawn into cartilage--no shock absorption
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How could you influence fluid levels in cartilage?
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Cyclic loading and unloading a joint with muscle activity to move the synovial fluid in and out of the joint (increase BS and nutrients)
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What happens to cartilage if there is prolonged physical inactivity?
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Hyaline cartliage converts into fibral cartilage
*WB exercises important to help with increase in hyaluronic acid to lubricate joints |
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Why do joints look larger as we age?
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Joints appear larger due to increase fibrous growth and decrease in muscle strength
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What are the considerations for cartilage deteriorating?
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Patient will need more strength around joints to decrease stress
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What are the implications to reduced elasticity in cartilage?
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May take longer to stretch and need more modalities/mobes for increasing ROM
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What are the changes to muscle as we age?
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1) Decrease type II fibers (small increase in # of type I)
2) Decrease in AMN 3) Decrease max strength (force) 4) Decrease in muscle mass |
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What are the therapeutic considerations for decrease in type II fibers?
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Progressive resistive exercsise (PREs) aimed at specific weakness
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What are the therapeutic considerations for decline in AMNs?
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May see faster gains in strength in older patients b/c of neurotrophic influences
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What are some skeletal changes with aging?
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1) Decrease calcium--take from bones
2) Decrease vitamin D 3) Decrease bone strength 4) Decrease reserve to quickly accelerate production of RBCs |
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What are the therapeutic considerations for decreased calcium in bones?
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Patient must take calcium supplements or medication in conjunction with exercise for significant results
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What are the therapeutic considerations for decreased vitamin D in bones?
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Patient must get at least 10 minutes of sun exposure 3 x wk or take vitamin D supplements to increase bone strength
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What can be done with a patient who has decreased bone strength
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WB, PREs exercises to increase bone strength
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What causes decreased circulating levels of vitamin D?
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Imbalance of osteoblasts to osteoclasts activity
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What must you consider when a patient has decreased reserve to accelerate production of RBCs in bone?
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Patient may become anemic more easily when stressed and may take longer to respond
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What characteristics increase chances of having osteoporosis?
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1) Hypothyroidism
2) Steroid therapies 3) Post-menopausal women (decrease estrogen that influences calcitonin to increase bone resorption) |
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What are normal changes in homeostasis when aging?
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1) Decrease in hypothalamic thermostat
2) Decrease in BMR 3) Decrease in ANS reactivity 4) Vasomotor less responsive to adjust core temperature 5) Decrease hormone balance 6) Decrease blood flow to brain 7) Decrease nerve cells (PNS) 8) Decrease blood flow to nerve cells (PNS) |
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What controls body core temperature?
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Hypothalamus
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What is an example of changes in hypothalamus with aging to consider?
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Too warm to be outdoors and patient cannot adjust or restore homeostasis (can't sweat)--can lead to death
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What are the therapeutic considerations to decrease BMR?
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BWT increases and wt gain is easier
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What are the therapeutic considerations for decrease in ANS reactivity?
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Skin hydration and circulation may be slow to respond
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What are the therapeutic considerations to a less responsive vasomotor system?
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Older patients may be more prone to hyper-or hypothermia
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What are the therapeutic considerations for decreased hormonal imbalance?
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Exercise tolerance will be affected. Older people may be slower to reach homeostasis during exercise and the return to homeostatic state may be prolonged after exercise.
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What are the precautions for decreased blood flow to the brain?
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Possible synscope (fainting) when exercising. Monitor vitals.
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What are the therapeutic considerations for decreased nerve cells (PNS)?
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Slower reaction times--decrease power, decrease type II
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What are the therapeutic considerations for decreased blood flow to the nerves (PNS)?
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Increased activity improves blood flow to nerves, helps with sensation
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Patient is sensitive to heat, had hip fracture and is white female. How do you adapt your therapy?
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Short durations of increased intensity with frequent rest breaks to hydrate. Slow warm-up and cool-down. Advise to wear light clothing and bring in fan.
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What are some changes in touch with aging?
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1) Decreased sensitivity of receptors and nerve fibers
2) Skin changes (decreased elasticity/vascularity)--thins 3) Decrease # and size of sweat glands--hyperthermia when exercising |
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What do you have to be cautious about when applying modalities to elderly patients?
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Could easily burn. Add layers of towels and check on them often! They have decrease sensitivity to receptors and nerve fibers.
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What are some vision changes with age?
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1) Decrease in muscle tone
2) Decrease in elasticity/orbital fat 3) Decrease in tear production (dry eye) 4) Smaller pupils-can't adapt to light changes 5) Intraocular pressure 6) Increase in lens density 7) Decrease in visual receptors in retina |
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What is a common vision condition that occurs with aging?
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Presbyopia--can't focus on objects close up due to loss of elasticity of lens
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What age is common for the lens changes to occur in order to read?
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40 yo
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What are the therapeutic considerations of decreased muscle tone in eyes?
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Less response to eye movements
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What are the therapeutic considerations of intraocular pressure?
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Patient is more prone to glaucoma and should get their eyes check every year
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What are the therapeutic considerations of increased density of the lens?
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Difficulty distinguishing similar colors
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What are the therapeutic considerations of loss of visual receptors in the retina or macula?
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Decreased acuity; HEP should have larger print for ease of reading
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When the lens opacifies, what does it influence?
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Color perception
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What happens to focusing when the lens loses elasticity?
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When lose elasticity, increases the distance of focusing
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What is the most common eye surgery for older adults?
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Cataract surgery (opacity of lens)
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What can facilitate depth perception in older patients?
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Increased contrast
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What is a common eye disease in elderly?
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Macular degeneration
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What are some hearing changes that occur with aging?
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1) sclerotic changes in tympanic membrane (can't hear high freq)
2) coclear osteosclerosis (can't discriminate consonants) 3) decreased corti receptors (can't hear soft sounds) 4) degeneration of auditory nerve (can't localize sound) |
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What are the therapeutic considerations of sclerotic changes in tympanic membrane?
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Patients may not be able to hear high frequencies--talk in lower tone
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What are the therapeutic considerations of cochlear oteosclerosis?
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Patients may not be able to discriminate consonants--speak slowly
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What are the therapeutic considerations of decreased corti receptors?
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Patients may not be able to hear softer sounds--speak loudly
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What are the therapeutic considerations of degeneration of auditory nerve?
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Patient may have difficulty locating sound--face the person when talking
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What do you need to do when speaking with elderly patient who has difficulty hearing?
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Speak in a lower tone, loud voice and slower speed. Make good visual contact to allow patient to read your lips.
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What are some neural changes that occur with aging?
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1) Decrease cellular availability for sensory interpretation--don't know where they are in space
2) Decrease in sensory receptors in otoliths/SCC (vestibular) |
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What will a patient with vestibular problems compensate with?
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Vision
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What are some neuromuscular changes with aging that increase fall risk?
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1) Decrease sensory input
2) Decrease nerve speed conduction 3) Decrease AMN 4) Decrease type II fibers 5) Decrease muscle mass |
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What are some CNS changes when aging?
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Brain mass decreases 6-7% by 80 yo due to post-mitotic cells.
# and efficiency of cells in CNS decrease with age |
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What are the changes to smell and taste as we age?
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1) Decrease taste buds by 80%
2) Decrease saliva production--increases choking (Xerostomia) 3) Decrease in olfactory bulb cells 4) Chemosensory decrement |
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What are some GI changes due to aging?
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1) Decrease in motility of esophagus--substernal fullness
2) Decrease in esophageal resting pressure/sphincter--heartburn 3) Decrease motility of stomach (peristalsis) 4) Decrease BS to gut--could cause fecal impaction |
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What are the changes to the liver when we age?
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1) Decrease BF to detoxify--decrease cytochrome p450 (enzyme breakdown toxins)
2) Decrease liver mass |
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What are renal changes as we age?
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1) Decrease mass
2) Decrease protein binding of meds (prolonged drug effect) 3) Decrease glomerular filtration 4) Decrease ability to dilute urine 5) Decrease response to sodium changes 6) Decrease response to acid load |
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What are some urinary changes when we age?
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1) Decrease vascularity
2) Decline in excretory and reabsorptive capacities 3) Decrease urine concentrating abilities--urine less concentrated 4) Increase residual urine--can't fully empty bladder 5) Increased reflux to urters |
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What happens to absorption of meds when we age?
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Gastric pH is higher (basic) with decreased motility and absorption--can't breakdown the meds
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What happens to the distribution of fluids when we age?
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We have reduced total body water, decreased proteins, decreased LBM and higher total body fat
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What are the 2 fundamental problems of meds and aging?
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Decreased hepatic/renal function, which decrease metabolization of the drug.
Decreased gastric absorption and changes in pH that reduces the effectiveness of meds into the blood. Once meds are in, they may be longer lasting. |
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What are some questions to ask when elderly patients are on medications?
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1) What are your current meds?
2) Do you have any changes to your meds? 3) What time do you take your meds? |