Questions and Answers
Which of the following is NOT a common co-morbidity associated with dementia?
Hypotension
What is the primary reason for increased potency of opiates in the elderly?
Decreased central compartment volumes and decreased clearance
How does increased body fat affect the pharmacokinetics of drugs in elderly patients?
Increased volume of distribution and longer duration of action for lipophilic drugs
How should infusion rates be adjusted for fentanyl, sufentanil, alfentanil, and remifentanil in elderly patients?
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Post operative delirium is more frequent in patients with dementia
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What are the risk factors for postoperative delirium?
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What mental disorder increases the risk for major adverse cardiac events?
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Why are older patients more sensitive to neuraxial and peripheral nerve blocks?
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How much should the local anesthetic dose be reduced for geriatric patients?
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What cardiovascular changes are associated with aging?
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What are two echocardiographic changes commonly found in the geriatric population?
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What are the pulmonary structural changes that occur with aging?
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What are the functional consequences of aging on the pulmonary system?
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In aging, liver volume and hepatic blood flow ____
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What reactions are predominantly affected by the reduction of hepatic blood flow in the liver?
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Any ADL or IADL impairment carries a relative risk of 90-day mortality
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What is frailty defined as in geriatric patient care?
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Why are geriatrics more sensitive to the effects of anesthetic drugs?
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Why is rocuronium's duration of action prolonged in the elderly, and what may be delayed after sugammadex?
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What are the benefits of regional anesthesia in the elderly?
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What is the most important risk factor for post-operative cognitive decline?
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Why are atrial contractions important in geriatrics?
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What is the mechanism that causes decreased response to beta receptor stimulation in geriatrics? (select 2)
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What is the result of diastolic dysfunction in the aging heart?
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In geriatric patients, the response to hypoxia and hypercapnia is impaired due to ____?
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What is the effect of aging on residual volume and vital capacity?
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What is the functional consequence of decreased renal blood flow in the elderly? (select 2)
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What is dehydration linked to in geriatric patients?
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What happens to albumin and alpha-1 glycoprotein levels during aging?
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What is the effect of aging on the Minimum Alveolar Concentration (MAC) of an anesthetic?
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What type of anesthetic drugs are preferred in geriatrics?
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What are consequences of increased vascular stiffness in the elderly?
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Study Notes
Assessment and Management of Geriatric Patients
- Manifestations of dementia include agitation, depression, and sleep disturbances
Age-Related Frequency of Dementia
- In elderly patients aged 65+, 5-8% experience dementia
- In elderly patients aged 75+, 18-20% experience dementia
Co-Morbidities Associated with Dementia
- Vascular disease
- Diabetes
- Alcoholism
- Neurodegenerative disease
Risk Factors for Post-Operative Delirium
- Advanced age
- Visual impairment
- Severe illness/blood loss
- Impairment of ADL (activities of daily living) carries a relative risk of recovery of independent function from a disability
Strategies to Limit Post-Operative Delirium
- Not specified
Frailty
- Defined as a multisystem loss of physiologic reserve
- Characteristics include:
- Weight loss
- Malnutrition
- Fatigue
- Muscle wasting
- Unstable balance
Body Composition Changes in Elderly Patients
- Decrease in lean body mass
- Increase in body fat, leading to:
- Larger volume of distribution
- Longer duration of action for lipophilic drugs
- Decrease in total body water, leading to:
- Smaller central compartment
- Increased serum concentration of hydrophilic drugs
Age-Related Changes and Anesthesia Drug Disposition
- Elderly patients are more sensitive to the effects of anesthetic drugs
Age-Related Changes and Opiate Potency
- Potency is increased due to decreases in central compartment volumes and decreased clearance
- Potency is doubled for fentanyl, sufentanil, alfentanil, and remifentanil, so infusion rates should be decreased by 2/3
- Renal excretion decreases, leading to decreased clearance
Age-Related Changes and Non-Depolarizing Neuromuscular Blocking Agents
- Pharmacodynamics of NMBDs are generally unaffected by aging
- Duration of action may be prolonged for drugs dependent on liver or renal metabolism
- Clearance of vecuronium is slower in the elderly, possibly due to decreased hepatic or renal reserves
- Rocuronium duration of action is prolonged in the elderly, and recovery after sugammadex may be delayed
Advantages of Regional Anesthesia
- Blood loss and thrombotic/embolic events may be reduced
- Regional anesthesia ideally avoids instrumentation of the airway, and these patients are less likely to experience hypoxemia
- Regional anesthesia has an opioid sparing effect
Goals of Anesthesia Care for the Elderly
- To preserve or improve activity and independence
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Description
This quiz assesses your knowledge of geriatric patient care, including the manifestations and frequency of dementia, co-morbidities associated with dementia, and risk factors for post-operative delirium.
