I wish I had better
news about metabolism.
But as we age,
it also goes through some changes.
Now, particularly, I want you to pay
attention to carbohydrate metabolism.
This is one of the big risks
that changes with aging,
particularly if your client has a
family risk of developing diabetes,
because carbohydrate metabolism changes is
going to increase their risk for diabetes.
And if they already have a genetic
predisposition to have diabetes,
it could accelerate this.
So keep in mind,
we know that the metabolism is different.
As we age, carbohydrate is one of the
main things I want you to focus on,
because you want to ask
key questions about,
do they ever feel
Have they noticed an increase
in the amount of urine?
Those classic questions we asked to assess
for the signs and symptoms of diabetes.
Now let's talk about
So we're looking
at the gallbladder.
You know, that's that little tiny
organ that's meant to just house bile.
The liver makes the bile,
stores it in the gallbladder.
And then when it's needed, like when you
eat or it's stimulated with high fat food,
it'll squish out the bile into
that biliary common bile duct.
So age-related changes,
we know that as you age,
you're going to have an
increased risk of gallstones.
In fact, my dad had his gallbladder
until he was about 78 years old,
and then it had to go.
So know that your patients are at an
increased risk develop gallbladder disease,
particularly with the
development of stones.
Now the liver is
pretty big organ.
It's a super cool organ.
It does so many things.
But right here, we're going to
focus on what are the things
that happened to
Now, the blood flow to the liver
is how it all works, right?
It's like this giant filter, and it's
a factory that does all these things.
But as you age, blood flow starts to
decline as it's going through the liver.
So it's not perfused as well, which is
pretty much like the rest of your body,
but it has less
perfusion as you age.
Now, the reserve capacity is
enough to maintain function.
So you know, we talked about
how mostly if people are at rest
or their body is not
stressed, they're doing fine.
But if we stress that
organ or that system,
it's harder for a geriatric
patient to respond.
So the liver enzymes
will remain normal.
If there's no other problems with the
liver, those should remain normal.
But you are more susceptible to the things,
we've talked about overloading that liver.
Well, things like alcohol and tobacco
and other stressors can damage the liver.
And it takes a lot of the livers
energy to process that alcohol.
So as you age,
that's going to be different.
Now, we talked about the
liver not functioning the same
when you go after drugs with
the P450 system, right?
That's that cytochrome P450 system
that you study in pharmacology.
It's not working the same
as when he was younger.
So this might impact the
clearance of some medications,
And that's why you
want to be very careful
with administering benzodiazepines
to geriatric clients
them very closely.
Now lastly, geriatric patients
have an increased risk
for adverse reactions
related to the dosage.
Okay, so usually these medications have
to be adjusted by the healthcare provider.
And it's really not
a simple process.
Each geriatric client deserves
a healthcare provider,
a physician, a nurse practitioner,
who is skilled in gerontology
and knows how to adjust the
dosages of different medications
to keep the administration
safe for each patient.
Are you ready for
Why did geriatric clients have
a higher risk for infections
disease of the GI tract?
So pause and take a minute and see
if you can answer that question.
Okay, let's talk about
three of those reasons.
First of all, remember the immune
response as we age is less rigorous,
so we can't fight back as hard.
That's why we always encourage
vaccinations in our elderly population,
because they don't have the immune
response that they used to have.
It also leads to geriatric patients
present in an atypical manner.
They may not show you things like fever
that they normally would with an infection.
So keep that in mind.
First reason why they have
a higher risk for infections
disease of the GI tract
is they have a higher
risk for infections,
because we don't necessarily
pick them up as early
because they don't have similar
symptoms to someone in their 30s or 40s.
Now that isn't all, our saliva,
one of the way it protects us
is that has an
But as we age,
it is less antimicrobial.
And remember, patients also
experienced a drier mouth.
So we have less saliva,
and the saliva they do have has
less antimicrobial activity.
They're in higher
risk for infections
and inflammatory diseases
of the GI tract as you age.
Remember, we talked about diverticulosis
and the weakening of that wall,
which can lead to those little pockets,
the diverticuli that can become infected.