Volatile MAC is reduced by _____% per decade of age over 40
years.
4%
Recovery from anesthesia with a volatile anesthetic may be
prolonged in the elderly due to:
1. Increased volume of distribution (increased body fat)
2. Decreased hepatic function
3. Decreased pulmonary gas exchange
If there is a decrease in cardiac output in the elderly patient,
will the induction be rapid or slowed with inhalational
agents?
Rapid with inhalational agents
Slow with IV anesthetics in a patient with decreased cardiac
output.
Which of the following physiologic changes occurs in the
geriatric patient?
A. Decreased lung compliance
B. Decreased chest wall compliance
C. Decreased residual volume
D. Decreased closing volume
B. Decreased chest wall compliance
Geriatric cardiovascular changes that occur include all
EXCEPT:
A. Elevated afterload
B. Left ventricular hypertrophy
C. Elevated systolic blood pressure
D. Increased arterial elasticity
D. Increased arterial elasticity
The geriatric population has renal changes. As renal function
declines, all of the following also decrease EXCEPT:
A. BUN
B. Creatinine production
C. ability to excrete drugs
D. ability to handle diuretics
A. BUN
The principle pharmacodynamic change associated with
aging is:
A. arthritis
B. pulmonary changes
C. Lipid solubility
D. Reduced anesthetic requirements
D. Reduced anesthetic requirements
The onset of drug action in the elderly is determined mainly
by:
A. Alveolar ventilation
B. Lipid solubility
C. Increased circulation time
D. Decreased circulation time
C. Increased (longer in circ) Circulation time
Aged men have a prolonged effect with Anectine but aged
women do not. What explains this?
A. Lipid solubility
B. Water solubility
C. Lower plasma cholinesterase concentration
D. Fewer motor end-plates
C. Lower plasma cholinesterase concentration
Which MAC number would be appropriate for a 65-year old
person receiving Desflurane?
A. 10
B. 9
C. 8
D. 4
D. 4
The geriatric patient needs special attention while
positioning. Which joint is most vulnerable?
A. Hip/leg
B. Knee
C. Arms/brachial plexus
D. Neck
D. Neck
The onset of muscle relaxants in the elderly is prolonged
because of:
A. Increased cardiac output
B. Low muscle blood flow
C. Decreased kidney clearance
D. Decreased hepatic function
B. Low muscle blood flow
Which drug would have prolonged action in the geriatric
patient?
A. Fat soluble drug
B. Water soluble drug
C. Both fat soluble & water soluble drugs
D. Makes no difference
A. Fat soluble drug
All of the following contribute to increased pulmonary
complications in the elderly undergoing surgery EXCEPT:
A. type of surgery
B. duration of surgery
C. fat content (obesity)
D. age greater than 70 years old
A. Type of surgery
A short-term increase in cardiac output in the elderly is due
to all of the following EXCEPT:
A. increase in heart rate
B. increased left ventricular end-diastolic volume
C. larger stroke volumes
D. decreased preload
D. decreased preload
Which of the following statements best describes Desflurane
in an elderly patient?
A. uptake will be slower
B. build-up will occur first in the brain
C. it works slower because of bradycardia
D. it is very blood-soluble
B. build-up will occur first in the brain
Choose the correct change in lung parameters in the elderly
FRC VITAL CAPACITY
A. Increases Increases
B. Increases Decreases
C. Decreases Increases
D. Decreases Decreases
B. FRC increases, VITAL CAPACITY decreases
The most sensitive indicator of renal function in the elderly is:
A. BUN
B. Creatinine produciton
C. Serum creatinine levels
D. Creatinine clearance
D. Creatinine clearance
Which of the following physiologic changes occurs in the
geriatric person?
A. decreased lung compliance
B. increased chest wall compliance
C. decreased residual volume
D. increased closing capacity
D. increased closing capacity
In aging, does the systolic or diastolic BP remain unchanged?
Diastolic BP
Industrial Societies has increased longevity mainly due to . . .
advanced technology
1 in ______patients is over the age of 65.
4
Elderly patients account for ____% of all hospital care days in
the in the US.
48%
What is the age of the "Elderly" or "Geriatric" patient?
65 years of age or older
How old are the "Aged"?
80 years or older
"Life span" is defined as . . .
The maximal attainable age under optimal conditions
(110-115 years)
"Life expectancy" is defined as . . .
typical longevity under typical conditions.
Affects policies & economics
In 2040, _______% of the US population will be over 65 years
old. ______% of these people will require surgery before they
die.
24%
50%
Which studies are more helpful when looking at long term
evaluations: Cross-sectional or Longitudinal
Longitudinal - Expensive & more difficult but more helpful than
Cross-sectional ->(is easier to do)
What does stochastic mean?
Random, involving chance or probability
Not everyone ages in the same way due to _________
____________ ____________ reserve.
Organ system functional
By age 75, the elderly patient's PaO2 drops from 93 to ____.
73
Why does plasma creatinine do not increase in the elderly?
Secondary to decreasing muscle mass. Must have larger
muscle mass to create creatinine
Why are the elderly prone to hyponatremia?
Secondary to the inability to retain sodium in the kidney
More than ______% of healthy elderly population have sub-
clinical hypothyroidism
13%
Why would it be safer to do a RSI on a diabetic patient?
Due to delayed gastric emptying in the diabetic patient
(gastroparesis), they are considered FULL STOMACHS
What is a very important predictor of closing volume?
Functional Reserve , Poor functional reserve may justify other
exams: myocardial perfusion imaging, Dobutamine stress
ECHO
What are some advantages in the elderly patient with
Regional anesthesia?
May decrease magnitude of blood loss
May decrease incidence of pulmonary embolism & DVT
May have prolonged effects, DECREASE the dosages
In post-op confusion in the elderly patient, always
consider________&_________first.
Hypoxemia & Hypercarbia
Can lead to INCREASE morbidity
Define Delirium & pathophysiology
Transient, potentially reversible disorder of cognition &
attention
ACUTE in nature
Disturbances in neurotransmitter activity
Determine cause & treat (Physostigmine will cross BBB)
List patient population at risk for post-op delirium
occurs in 10-60% in hip fractures
cataract surgery & cardiac bypass surgery
Causes of post-op Delirium
Polypharmacy
Anticholinergics
Intra op hypotension
Perioperative Arterial Hypoxemia
Opioids or benzodiazepines
Advanced age a strong predictor
Central Cholinergic System affected
Delirium is a common complication of ___________.
Dementia
Define Dementia
Acquired, persistent, impairment of cognitive & emotional
abilities that interfere with daily life.
Happens primarily LATE in life.
1% @ 60 years
Doubling every 5 years
30-50% by age 85
Define Cortical Dementias & diseases associated with it
Disease of the cortex of the brain
(Frontal lobar degeneration)
Alzheimers, Pick's
Define Sub cortical Dementia & diseases associated with it
Diseases below cortex of brain, centrally located
Parkinson's, Huntington's, Creutzfeldt Jacob
What is logorrhea?
Unfocused speech
What is echolalia?
Saying the same thing over & over
What is palilalia?
Compulsive repetition
What is Pick's Disease?
Cortical (Frontal lobe) Dementia
Impaired ability to plan & initiate goals
Deny problems
Logorrhea, echolalia, palilalia
LESS COMMON than Alzheimer
What could be the problem in an elderly patient who has a
gait disturbances, Urinary incontinence & cognition declines?
Normal Pressure Hydrocephalus
(Brain shrinks)
May need to be treated with a shunt
What drugs are a good idea to avoid in Parkinson's disease?
Phenothiazines, butyrophenones, & metocloproamide,
droperidol.
All antagonize the dopamine in the basal ganglia
What medication is good to give a Parkinson's patient for
preop med & sedation?
Diphenhydramine
Why should you avoid Ketamine in Parkinson's?
It produces an exaggerated sympathetic response.
Nursing Home patients = Immobility. List things to watch out
for in these patients.
Decrease circulating plasma volume
Decrease cardiac output
Arterial hypoxemia
Skeletal muscle atrophy (up regulation of receptors - may
affect use of Succhs)
Orthostatic hypotension
Malnutrition is present in _____-_____% of elderly patients
admitted to the hospital.
20-40%
List common conditions that predispose patient to
Malnutrition
CHF
COPD
Cancer
What is the most common fluid & electrolyte disorder in the
long term care setting?
Dehydration
What is Isotonic Dehydration?
Balanced loss of water & sodium
Vomiting & Diarrhea
What is Hypertonic Dehydration?
Serum Sodium > 145mEq/L
Water losses exceed sodium losses
Sweating
What is Hypotonic Dehydration?
Serum Sodium < 135 mEq/L
Sodium losses exceed water losses
Diuretics
List ways to diagnose dehydration
3% or more in weight loss
S/S may be vague
Orthostasis
BUN/CR ratios greater than 25
N20 is contraindicated in What vision impairment in the
elderly?
Retinal Detachment
What is presbyopia?
Stiffness & thickness to lens of an elderly person
Normal aging process
Define Glaucoma
Intraocular pressure exceeding 20 mm Hg due to obstruction
of the outflow of aqueous humor
Extremely high & prolonged pressures can cause blindness.
What is Macular Degeneration?
The loss of central vision (central retina), it is the most
common cause of vision loss in patients over 60 years.
It is progressive
Risk factors are: genetic presdisposition, DM, HTN, & cigarette
smoking
List conductive hearing impairments?
Cerumen impaction
Otosclerosis
List sensorineural hearing impairments?
Decreased thresholds for air & bone conduction
Retrocochlear
Cochlear
What is Iatrogenic illnesses & how is it acquired?
Acquired through medical personnel, treatment, or procedures
that cause exposure to the environment.
Causes:
Drug therapy
Therapeutic Procedures
Nosocomial Infections
Electrolyte Disorders
Trauma
Associated with Falls & Delirium
What is Progeria or Hutchinson-Gilford Syndrome?
Premature aging, death by 25 years old is common.
Mean age is 13.
It is an autosomal recessive disorder
**Difficult airway**
Micrognathia
Mandibular Hypoplasia
Osteoarthritis is caused by Wear & tear which is __________.
Primary
Secondary causes is due to Trauma
Positioning & airway very important in anesthesia
Where is cancellous bone located in the body & Osteoporosis
effects this area?
Spinal column & the ends of long bones
Effects females more than males.
Taking Estrogen replacement in postmenopausal women helps.
The elderly have a blunted response the the B-adrenergic
response. How does this cause Autonamic dysfunction?
SNS cranks up but response is slow due to aging, so there is a
more increased release of catecholamines to get a response
(beta receptors become down regulated over time secondary to
high adrenergic levels?)
PNS is decreased
What is the difference b/w osteoarthitis & Rheumatoid
arthritis?
Osteo is due to wear & tear
Rheumatoid is due to Immune disorder
If an elderly patient is beta blocked & in severe bradycardia,
which drug would you use?
Glycopyrrolate is ideal because it does not cross BBB,
However, in severe bradycardia, Atropine works better &
faster, especially if patient is beta blocked already.
