Podcast
Questions and Answers
By 2030, the global population aged 65 and over is projected to comprise what percentage of the overall population?
By 2030, the global population aged 65 and over is projected to comprise what percentage of the overall population?
According to the provided study guide, which of the following is NOT explicitly identified as a 'perpetuating factor' affecting outcomes in older adults receiving critical care?
According to the provided study guide, which of the following is NOT explicitly identified as a 'perpetuating factor' affecting outcomes in older adults receiving critical care?
A patient in critical care is experiencing severely reduced awareness and lethargy. What subtype of delirium is the patient likely experiencing?
A patient in critical care is experiencing severely reduced awareness and lethargy. What subtype of delirium is the patient likely experiencing?
What is the approximate percentage decrease in brain volume expected by age 95?
What is the approximate percentage decrease in brain volume expected by age 95?
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Which of the following best describes the critical care priority designation for a patient who is terminally ill and receiving palliative care, with critical interventions being generally avoided?
Which of the following best describes the critical care priority designation for a patient who is terminally ill and receiving palliative care, with critical interventions being generally avoided?
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Which of these is NOT a recommended preventative measure for reducing the incidence of delirium in older adults in critical care?
Which of these is NOT a recommended preventative measure for reducing the incidence of delirium in older adults in critical care?
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What is the approximate percentage of mechanically ventilated patients who experience delirium?
What is the approximate percentage of mechanically ventilated patients who experience delirium?
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How long after critical illness can cognitive decline persist, according to the provided information?
How long after critical illness can cognitive decline persist, according to the provided information?
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Which of the following best describes the effect of aging on the respiratory system?
Which of the following best describes the effect of aging on the respiratory system?
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Why is atrial fibrillation particularly concerning in older adults?
Why is atrial fibrillation particularly concerning in older adults?
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Which of these best describes the trend of the glomerular filtration rate (GFR) with age?
Which of these best describes the trend of the glomerular filtration rate (GFR) with age?
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An older adult with a suspected infection presents with symptoms different from younger adults. Which of the following would be a typical presentation in the older adult population?
An older adult with a suspected infection presents with symptoms different from younger adults. Which of the following would be a typical presentation in the older adult population?
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What is a primary concern associated with the thinning of the epidermis in older adults?
What is a primary concern associated with the thinning of the epidermis in older adults?
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What is the recommended blood glucose management target range in hospitalized older adults with diabetes?
What is the recommended blood glucose management target range in hospitalized older adults with diabetes?
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Which component of the ABCDEF bundle of care in the ICU directly addresses the risk of delirium?
Which component of the ABCDEF bundle of care in the ICU directly addresses the risk of delirium?
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What is the primary goal of using the Beers Criteria?
What is the primary goal of using the Beers Criteria?
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An older adult's care plan should primarily be guided by:
An older adult's care plan should primarily be guided by:
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Which of these is a common cause for hypernatremia in older adults?
Which of these is a common cause for hypernatremia in older adults?
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Study Notes
Demographics and Aging Trends
- The global population aged 65+ is projected to increase from 9% in 2015 to 12% by 2030.
- In the U.S., the population of adults aged 65+ grew by 35% from 2007 to 2017, representing 15.6% of the population.
- The population over 85 years old is predicted to rise by 123% by 2040.
- Approximately 28% of older adults live alone, with most residing in non-institutional settings.
- Supportive care from family, friends, and community is common for older adults.
- Median income for older adults is $19,180 for women and $32,654 for men.
- 9.2% of older adults live below the poverty level.
Critical Care Challenges
- Critically ill patients requiring invasive therapies (e.g., mechanical ventilation, ECMO) are prioritized for care.
- Critically ill patients with progressively poorer prognoses have a lower priority.
- Palliative care is prioritized for terminally ill patients and often excludes intensive interventions.
- Factors impacting outcomes in older adults include: pre-existing frailty and multi-morbidities, acute illnesses like sepsis or pneumonia, and conditions such as delirium and polypharmacy.
- Critical care is resource-intensive and expensive, with rising demand from an aging population and reduced societal efficiency.
Neurocognitive Changes
- Brain volume decreases by approximately 20% by age 95.
- Neurotransmitter levels (e.g., dopamine, serotonin) decline, affecting cognition, motor skills, and sleep-wake patterns.
- The blood-brain barrier becomes more permeable in older adults, increasing their susceptibility to neuroinflammation.
- Delirium affects up to 80% of mechanically ventilated patients, and its presence is associated with a 33% mortality rate.
- Delirium subtypes include: hypoactive (reduced awareness, lethargy), hyperactive (agitation, restlessness), and mixed.
- Prevention focuses on reducing environmental stimuli, maintaining orientation, promoting mobility, and minimizing sedatives.
- Factors increasing delirium risk are pre-existing dementia diagnoses, age over 75, cerebrovascular conditions, and frailty.
- Persistent cognitive decline may last up to 6 years following critical illness.
- The duration of delirium is a significant predictor of long-term cognitive impairment.
Respiratory Changes
- Reduced chest wall compliance, diaphragm strength, and pulmonary elasticity are common respiratory changes in older adults.
- Residual lung volume and air trapping are also frequent.
- Decreased PaO2 is observed in older adults, about 0.3 mmHg yearly after age 30.
- COPD prevalence is noticeably elevated in older adults; infections are a common cause of exacerbations.
- Pneumonia manifestations can differ in older adults, presenting with confusion or falls rather than a typical cough.
- Pulmonary embolism risk is higher in older adults due to immobility and potential malignancy.
- Prolonged mechanical ventilation (MV) is linked to roughly 50% 1-year survival.
- Non-invasive ventilation (NIV) is frequently preferred over MV for COPD exacerbations.
- Weaning from MV can be challenging in the aged due to their limited respiratory reserve.
Cardiovascular Changes
- Left ventricular (LV) wall thickening impedes diastolic filling in older adults.
- Atrial contractions are crucial for older adults, making atrial fibrillation more problematic.
- Arterial stiffening from aging increases afterload and contributes to hypertension.
- Endothelial dysfunction reduces nitric oxide, promoting thrombosis in older adults.
- Heart failure (HF) impacts 50% of adults over 75, leading to increased hospitalizations.
- Older adults experiencing myocardial infarction (MI) often display atypical presentations (e.g., shortness of breath, confusion instead of chest pain).
- ST depression in older adults with MI is often more common than ST elevation.
- Medication adjustments are necessary for beta-blockers, diuretics, and ACE inhibitors in older adults.
- Monitoring for polypharmacy, particularly regarding anticoagulants, is crucial.
Kidney and Fluid Balance
- Glomerular filtration rate (GFR) gradually decreases approximately 8 mL/min per decade after age 40.
- Reduced renal blood flow and nephron loss lead to compromised sodium retention and urine concentration in older adults.
- Around 40% of end-stage renal disease patients are over 65 years old.
- Common causes include diabetes and hypertension.
- CKD's complications include anemia, bone diseases, and increased cardiovascular risks.
- Mortality rate in critical care patients with acute kidney injury (AKI) exceeds 50%.
- Risk factors include the use of contrast agents and nephrotoxic drugs.
- Early renal replacement therapy in older adults with AKI remains a subject of debate.
- Hypernatremia, caused by dehydration, cognitive impairment, and impaired thirst perception, and hyponatremia, linked with SIADH, frailty, and gait instability, are common electrolyte imbalances in older adults.
Immune and Integumentary Systems
- Older adults have a higher risk (3–5x) of death from infections.
- Sepsis symptoms might include confusion and weakness instead of fever in older adults.
- Skin integrity is compromised due to epidermal thinning, increasing vulnerability to wounds and pressure sores.
- Chronic wounds affect 10–35% of older adults.
- Preventing these issues involves utilizing pressure-relieving surfaces, supporting proper nutrition, and adequate hydration.
Nutrition and Metabolism
- Malnutrition risk includes conditions like sarcopenia and protein-energy malnutrition in older adults.
- Enteral nutrition is recommended within 48 hours for high-risk individuals.
- Diabetes is prevalent among ~25% of older adults, leading to complications like neuropathy and vision loss.
- Blood glucose target range to be maintained in hospitalized patients is approximately 140-180 mg/dL.
Clinical Strategies and Tools
- The ABCDEF bundle is crucial for ICU care in older adults: Assess/manage pain, Breathing trials, Light sedation, Delirium screening, Early mobility, Family engagement.
- Assessment tools such as the CAM-ICU (Delirium assessment), Glasgow Coma Scale (neurological function), and nutritional screenings are critical.
- Medications should be properly monitored, avoiding inappropriate ones (e.g., high-dose NSAIDs, anticholinergics), using the Beers Criteria for potentially harmful drugs.
Ethical Considerations
- Patient autonomy and aligning care goals with patient values must be prioritized while caring for older adults.
- Educating families regarding potential long-term outcomes of critical illnesses is essential.
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Description
Test your knowledge on the demographics and aging trends affecting the global population, particularly those aged 65 and older. This quiz will cover statistics, living arrangements, income levels, and the challenges faced by older adults, as well as implications for care. Assess your understanding of the critical care issues that arise in this demographic.
