ANE 664: Geriatrics Exam Study Guide
CO = HR x SV, so....
Connective tissues stiffen due to replacement of elastic by collagen leading to HTN and
eventual aortic stiffening. This causes an *increase in LV afterload* and may result in
ventricular myocardial hypertrophy and stiffening decreasing ventricular compliance.
Compliance decrease leaves more volume at the end of diastole (*↑LVEDV*). The
increased afterload combined with hypertrophy prolongs myocardial contraction and
delays early diastolic filling. With passive filling (early diastole) nearly removed from the
equation, *atrial contribution (atrial kick) is even more important to maintain cardiac
output*.
Aging also brings a *decrease in conduction fiber density and the number of sinus
nodes* in the heart, resting heart rate is often decreased, further contributing to a lower
cardiac output.
Another factor affecting CO is the *decrease in overall blood volume, which decreases
preload*, sarcom - ANSWER What age-related changes would lead to decreased CO?
> 50% - ANSWER What percentage of people over the age of 65 will have a surgical
procedure?
65 - ANSWER At what age is one considered "elderly" according to definition?
Organ function peaks in the 4th decade of life. Functional reserve is maintained in most
individuals until 60 years of age. - ANSWER When in one's life span does organ function
peak? How long is functional reserve maintained?
The dermis thins by 20%, becomes stiffer, and is more vulnerable to injury. - ANSWER
As one ages, what changes occur in the skin?
Sarcopenia takes place (loss of muscle mass); the number of muscle fibers decrease, as
do the size of the fibers (but to a lesser extent) - ANSWER What happens to skeletal
muscle as one ages?
Reabsorption begins to exceed formation starting in the 3rd decade of life leading to
progressive loss of bone mass.
The bone loss is due to osteocyte breakdown, decrease in insulin-like growth factor,
and an increase in parathyroid hormone.
Joints begin to lose flexibility. - ANSWER What happens to bones and joints as we age?
40%
,Decrease in number of 5HT, Dopamine, and Ach receptors. - ANSWER After the age of
60, what percentage of patients show decline in memory? What are some speculated
causes?
Decrease dopamine leads to a decrease in both cognitive and motor function.
May see declines in reasoning, episodic memory, and perception. - ANSWER How does
a decrease in dopamine affect aging?
Decreased synaptic plasticity and neurogenesis. - ANSWER A decrease in serotonin
and brain-derived neurotrophic factor (BDNF) levels leads to what neurological changes
as we age?
Decrease in 5-HT, Ach, and Dopamine receptors. - ANSWER Why are sleep/wake cycles
disrupted with increasing age?
Both decrease. White matter up to 15% and accelerated in the presence of HTN and
vascular disease. - ANSWER What happens to white and gray matter with age?
More permeable. - ANSWER The blood brain barrier becomes [ more / less ] permeable
with age?
1) Increased sensitivity to anesthetic meds (MAC decreases)
2) Increased risk of post-op delirium
3) Increased risk of post-op cognitive dysfunction
4) Increased threshold for sensory modalities, such as pain - ANSWER What are some
changes that occur in the nervous system as people age that are important to remember
when providing peri-operative care?
CMRO₂ is decreased, but auto regulation is preserved. - ANSWER What happens to
cerebral CMRO₂ with age? Cerebral autoregulation?
MAO inhibits some neurotransmitters. With increased levels of this, neurotransmitters
are reduced. They also naturally decrease with age, leaving elderly significantly more
vulnerable to psychological and neurological disturbances involving neurotransmitter
imbalance. - ANSWER What might be the combined effect of decreased
neurotransmitter production and increased MAO (monoamine oxidase) production?
[Both occur with aging].
Decreased area of epidural space (less effective blocks);
Decreased volume of CSF;
Increased permeability of the dura;
Decreased diameter and number of myelinated fibers (dorsal and ventral roots);
, Decreased distance peripheral nerve nodes;
*ALL NEUROAXIAL CHANGES DECREASE Cm (minimum anesthetic concentration) -
ANSWER What are some neuroaxial changes to be aware in the elderly population?
The 75-year-old would likely have a stronger response due to increased catecholamines
and sympathetic tone. - ANSWER Who would you expect to respond to laryngoscopy
stimulation more strongly: a 75-year-old or a 35-year-old. Why?
Decreases - ANSWER What happens to parasympathetic activity with age?
Decreased baroreceptor response with age. - ANSWER Why do elderly persons often
have a decreased response to hypovolemia, PPV, and position changes all leading to a
drop in BP?
Decreased coupling with adenylyl cyclase may be due to down regulation secondary to
an increase in circulating catecholamines with age. - ANSWER Why does the
responsiveness of β-adrenergeic receptors decrease with age?
The left ventricular wall thickens, but myocytes numbers do not increase. This means
just thickening and not extra muscle for stronger pumping. - ANSWER Why effect does
the increase in afterload have on the heart with age?
The intima thickens and microvascular deformities form. - ANSWER What structural
changes occur in the vasculature that lead to arteriosclerosis?
Ventricular filling pressures: Increase
Afterload: Increase
Contractility: Decrease - ANSWER What happens to each of the following with age:
[Increase, decrease, or no change]
Ventricular filling pressures
Afterload
Contractility
Arteriosclerosis leads to INCREASED vascular resistance and DECREASED perfusion
pressure. - ANSWER Arteriosclerosis leads to [increased/decreased] vascular
resistance and [increased decreased] perfusion pressure.
CO = HR x SV, so....
Connective tissues stiffen due to replacement of elastic by collagen leading to HTN and
eventual aortic stiffening. This causes an *increase in LV afterload* and may result in
ventricular myocardial hypertrophy and stiffening decreasing ventricular compliance.
Compliance decrease leaves more volume at the end of diastole (*↑LVEDV*). The
increased afterload combined with hypertrophy prolongs myocardial contraction and
delays early diastolic filling. With passive filling (early diastole) nearly removed from the
equation, *atrial contribution (atrial kick) is even more important to maintain cardiac
output*.
Aging also brings a *decrease in conduction fiber density and the number of sinus
nodes* in the heart, resting heart rate is often decreased, further contributing to a lower
cardiac output.
Another factor affecting CO is the *decrease in overall blood volume, which decreases
preload*, sarcom - ANSWER What age-related changes would lead to decreased CO?
> 50% - ANSWER What percentage of people over the age of 65 will have a surgical
procedure?
65 - ANSWER At what age is one considered "elderly" according to definition?
Organ function peaks in the 4th decade of life. Functional reserve is maintained in most
individuals until 60 years of age. - ANSWER When in one's life span does organ function
peak? How long is functional reserve maintained?
The dermis thins by 20%, becomes stiffer, and is more vulnerable to injury. - ANSWER
As one ages, what changes occur in the skin?
Sarcopenia takes place (loss of muscle mass); the number of muscle fibers decrease, as
do the size of the fibers (but to a lesser extent) - ANSWER What happens to skeletal
muscle as one ages?
Reabsorption begins to exceed formation starting in the 3rd decade of life leading to
progressive loss of bone mass.
The bone loss is due to osteocyte breakdown, decrease in insulin-like growth factor,
and an increase in parathyroid hormone.
Joints begin to lose flexibility. - ANSWER What happens to bones and joints as we age?
40%
,Decrease in number of 5HT, Dopamine, and Ach receptors. - ANSWER After the age of
60, what percentage of patients show decline in memory? What are some speculated
causes?
Decrease dopamine leads to a decrease in both cognitive and motor function.
May see declines in reasoning, episodic memory, and perception. - ANSWER How does
a decrease in dopamine affect aging?
Decreased synaptic plasticity and neurogenesis. - ANSWER A decrease in serotonin
and brain-derived neurotrophic factor (BDNF) levels leads to what neurological changes
as we age?
Decrease in 5-HT, Ach, and Dopamine receptors. - ANSWER Why are sleep/wake cycles
disrupted with increasing age?
Both decrease. White matter up to 15% and accelerated in the presence of HTN and
vascular disease. - ANSWER What happens to white and gray matter with age?
More permeable. - ANSWER The blood brain barrier becomes [ more / less ] permeable
with age?
1) Increased sensitivity to anesthetic meds (MAC decreases)
2) Increased risk of post-op delirium
3) Increased risk of post-op cognitive dysfunction
4) Increased threshold for sensory modalities, such as pain - ANSWER What are some
changes that occur in the nervous system as people age that are important to remember
when providing peri-operative care?
CMRO₂ is decreased, but auto regulation is preserved. - ANSWER What happens to
cerebral CMRO₂ with age? Cerebral autoregulation?
MAO inhibits some neurotransmitters. With increased levels of this, neurotransmitters
are reduced. They also naturally decrease with age, leaving elderly significantly more
vulnerable to psychological and neurological disturbances involving neurotransmitter
imbalance. - ANSWER What might be the combined effect of decreased
neurotransmitter production and increased MAO (monoamine oxidase) production?
[Both occur with aging].
Decreased area of epidural space (less effective blocks);
Decreased volume of CSF;
Increased permeability of the dura;
Decreased diameter and number of myelinated fibers (dorsal and ventral roots);
, Decreased distance peripheral nerve nodes;
*ALL NEUROAXIAL CHANGES DECREASE Cm (minimum anesthetic concentration) -
ANSWER What are some neuroaxial changes to be aware in the elderly population?
The 75-year-old would likely have a stronger response due to increased catecholamines
and sympathetic tone. - ANSWER Who would you expect to respond to laryngoscopy
stimulation more strongly: a 75-year-old or a 35-year-old. Why?
Decreases - ANSWER What happens to parasympathetic activity with age?
Decreased baroreceptor response with age. - ANSWER Why do elderly persons often
have a decreased response to hypovolemia, PPV, and position changes all leading to a
drop in BP?
Decreased coupling with adenylyl cyclase may be due to down regulation secondary to
an increase in circulating catecholamines with age. - ANSWER Why does the
responsiveness of β-adrenergeic receptors decrease with age?
The left ventricular wall thickens, but myocytes numbers do not increase. This means
just thickening and not extra muscle for stronger pumping. - ANSWER Why effect does
the increase in afterload have on the heart with age?
The intima thickens and microvascular deformities form. - ANSWER What structural
changes occur in the vasculature that lead to arteriosclerosis?
Ventricular filling pressures: Increase
Afterload: Increase
Contractility: Decrease - ANSWER What happens to each of the following with age:
[Increase, decrease, or no change]
Ventricular filling pressures
Afterload
Contractility
Arteriosclerosis leads to INCREASED vascular resistance and DECREASED perfusion
pressure. - ANSWER Arteriosclerosis leads to [increased/decreased] vascular
resistance and [increased decreased] perfusion pressure.
