Geriatric medicine

1. AGE RELATED CHANGES ON
RESPIRATORY SYSTEM
DR RANJAN
RESIDENT
GERIATRICS
MMC

2. Normal Respiratory System
Changes Related to Aging
Anatomical changes of the spine and chest wall
structures
 Calcification of articulating surfaces of ribs &
ossification of cartilage makes the chest wall stiffer
 Vertebrae also affected by loss intervertebral space
they compression of vertebral bodies makes
reduced vertebral height.
 These changes modify shape of thorax and results
in KYPHOSIS & Barrel shaped chest.

3. CONTD…
SENILE EMPHYSEMA
Alveolar dilatation without any destructive changes to the
alveolar walls
Environmental lung insults accumulate over a life time
affect the alveoli and change their structure
Alveoli lose their recoil and enlarge with age

4. Normal Respiratory System
Changes Related to Aging
Muscular weakness and atrophy
The muscular weakness that accompanies the
aging process also effects the muscles of the
respiratory system
Diaphragm and other muscles near airway
structures are weakened, decreasing their ability
to keep lung structures fully open and able
perfuse oxygen appropriately

5. Contd….
Expiration is largely a passive process , while inspiration
is depends on diaphragm
Changes in chest wall lead to increase load on
accessory muscle of respiration
Compared to young adults, healthy older persons have
approximately 25% lower diaphragmatic strength.
Maximal inspiratory pressure in old age is 30% lower
than younger population, so lower MIP associated with
decreased hand grip strength, lower body mass index
and low functional vital capacity

6. Normal Respiratory System
Changes Related to Aging
Decreased Immune System
Eventually with aging most people experience a
decrease in their body’s immune response
This decrease or weakening of the immune
system puts the elderly at increased risk of
contracting respiratory infections and diseases

7. LUNG VOLUMES &
CAPACITIES

8. TOTAL LUNG CAPACITY

9. RESIDUAL VOLUME
• Residual volume increases with aging
• RV/TLC ratio will be high - called
hyperinflation, seen in COPD & ASTHMA
also.
• Vital capacity decreases with age

10. SPIROMETRY
• It measures dynamic lung function
• FEV1 (volume of air in litre exhaled 1st sec)
• FVC (maximum amount of air you can forcibly
exhaled from your lungs after full inhalation
• FEV1/FVC <0.65 Indicate airway obstruction in older
Population

11. RESPIRATORY MECHANICS
V/Q VENTILATION PERFUSION RATIO
• Decreased FEV1/FVC, Increased FRC, Increased RV
will further decrease ventilation, so V/Q RATIO much
low in older population
• With increasing age pulmonary vascular resistance
increased and decreased density of pulmonary
capillaries V/Q decreases

12. DLCO
DIFFUSION LUNG CAPACITY FOR CARBONMONOXIDE
• Performed using a single breath DLCO technique
• DLCO vary with age, sex, height
• Higher in obese
• Lower in anemia
• DLCO declined 5% for every decade after 40 years

13. Effects of Respiratory Changes
On The Elderly
 Decreased Oxygen
 All the pulmonary disorders in the aging will
have shortness of breath (SOB) as a primary
symptom.
 SOB causes, limiting a persons ability to
perform simple tasks of daily living without
feeling out of breath and exhausted
 Supplemental oxygen is often prescribed in
efforts to increase blood oxygen levels

14. Effects of Respiratory Changes
On The Elderly
 Poor Sleep Quality
 Respiratory changes with aging can cause frequent
coughing and SOB, disturb quality & duration of
sleep

15. Ways To Adapt with
Age-Related Respiratory
Changes
 Avoid smoking and other known respiratory irritants
 Participate in physical exercise to increase lung
function with a physicians guidance20
 Stay active and engaged in your daily life. Being
sedentary increases the risk of respiratory mucus
production, muscle weakness, and lung infections
 Stay Informed – Take time to educate yourself on your
condition and ways to improve or help prevent
furthering your symptoms.

16. Common Respiratory Illnesses of
The Elderly
 Pneumonia: Inflammatory infection of the lungs that
can be both viral and bacterial
 Bronchitis: Swelling and inflammation of the main air
passages to the lungs. This swelling narrows the
airways, making it harder to breathe and causing other
symptoms
 Atelectasis: Partial collapse of portions of the lung
causing shortness of breath and impairing oxygen
perfusion

17. Secondary/Abnormal Respiratory
System Changes Related to Aging
 Pulmonary Disorders
 Asthma: Inflammation and narrowing of the
airways causing wheezing, coughing,
shortness of breath, and at times respiratory
distress5
 COPD (Chronic Obstructive Pulmonary
Disorder): Progressive disease that
worsens with time. Similar symptoms with
asthma as well as increased respiratory
mucus production causing increased cough
and airway irritation6

18. Secondary/Abnormal
RespiratorySystem
Changes Related to Aging
 Pulmonary Hypertension: Changes in arterial
pressure in the pulmonary arteries, making it
difficult for the heart to get blood to the lungs to
receive oxygen, causing shortness of breath7
 Sleep Apnea: Pauses in the breathing cycle during
sleep usually caused
by changes to the respiratory structures of the
throat and larynx8

19. TAKE HOME MESSAGE
• Elastic recoiling of lung decreases
• Chest wall becomes stiffer with aging
• TLC unchanged
• RV increased
• Vital capacity decreases
• V/Q decreases with aging
• DLCO declined with age

20. THANK YOU