09-10-23 - Ageing and health care Flashcards
Learning outcomes
- To gain a brief public health view on ageing and its implications for health and care services
- To be aware of some recent key reports on health care relating to the ageing population
- To understand the scientific basis and clinical consequences of ageing
- To understand the concept of frailty and the holistic approach required in the care of elderly patients
What are 5 parts to realistic medicine?
- 5 parts to Realistic medicine:
1) Shared-decision making
2) Reduced harm and waste
3) Risk management
4) Building a personalised approach to care
5) Reduce unnecessary variation in practise and outcome
What are 3 factors in multifactorial decision making that lead to evidence based practise?
- 3 factors in multifactorial decision making that leads to evidence-based practise:
1) Relevant scientific evidence
2) Clinical judgement
3) Patient values and preferences
What are 3 theories ageing?
- 3 theories of ageing:
1) Genetic/cellular
2) Environmental
3) Evolutionary theory
Molecular theory of ageing.
What is epigenetics the study of?
How do they alter DNA sequences?
What are 3 epigenetic modifications seen in ageing?
- Molecular theory of aging
- Epigenetics is the study of how your behaviours and environment can cause changes that affect the way your genes work.
- Unlike genetic changes, epigenetic changes are reversible and do not change your DNA sequence, but they can change how your body reads a DNA sequence
- There are age related “programmed” genetic regulation by epigenetic modifications
- 3 epigenetic modifications seen in ageing:
1) Gene methylation (to turn genes off)
2) Histone modification eg by acetylation to promote transcription of DNA and control storage
3) Accumulation of mutations
What are 3 parts of the cellular theory of ageing?
- 3 parts of the cellular theory of ageing:
1) Telomere shortening progressive loss of chromosome “caps”
2) Free radical damage to DNA
3) Apoptosis- programmed cell death – each cell has a defined lifetime, with some types being better at regenerating than others
What are 3 parts of the environmental and evolutionary theory of ageing?
- 3 parts of the environmental and evolutionary theory of ageing:
1) “Wear and tear” - inability to regenerate damaged tissue
2) Cumulative uv and ionising radiation damage
3) “Disposable soma” ie no evolutionary advantage in survival beyond reproduction and rearing children
How is maximal energy input and organ function affected with age?
- Maximal energy input and organ function decreases with age
- This is true for every organ system
How is disease incidence linked with age?
What are problems with this?
What must we be aware of?
- With the exceptions of accident/suicide, most health issues are more common with increasing age
- With increasing age, many will have several chronic conditions
- A problem with this is each condition may have several medications prescribed (polypharmacy) which may be for symptoms or risk reduction
- We must be aware of the relative and absolute risk
- Absolute risk of a disease is your risk of developing the disease over a time period
- Relative risk is used to compare the risk in two different groups of people.
- Is it worth taking medication to lower the chance of MI from 4% to 2%?
- It is hard to measure benefit for one individual
How are health costs linked with age?
What is the burden of disease linked with?
What are 4 factors that affect the burden of disease?
- Health and social care costs rise with increasing age
- The burden of disease links to deprivation index
- 4 factors that affect the burden of disease:
1) Smoking
2) Alcohol
3) Diet and obesity
4) Housing
What are 4 things realistic medicine is about?
- 4 things realistic medicine is about:
1) Holistic approach Involving the patient in decisions
2) Health literacy eg risks/benefits
3) Decision making
4) Potential for harm in over- or under investigation and treatment
What are 4 parts of a comprehensive geriatric assessment?
- 4 parts of a comprehensive geriatric assessment:
1) Functional capacity
2) Psychological assessment
3) Balance assessment of falls risk
4) Medical and medication review
What is frailty?
- Frailty is:
- “a clinically recognizable state of increased vulnerability resulting from aging associated decline in reserve and function across multiple physiologic systems such that the ability to cope with everyday or acute stressors is comprised”
Describe the phenotype model of frailty (in picture)\?
What 5 factors can potentially make up frailty (in picture)?
- 5 factors can potentially make up frailty (in picture):
1) Unintentional weight loss
2) Low energy expenditure
3) Exhaustion
4) Reduced muscle strength
5) Slow walking speed
What are 4 assessments for Frailty?
- 4 assessments for Frailty:
1) PRISMA 7 questions
* Are you more than 85?
* Male?
* Are you limited by health problems?
* Do you need someone to help you on a regular basis?
* Do your health problems require you to stay at home?
* If needed, is someone available to help you?
* Do you use a walking aid?
1) Edmonton frail-scale
* 9 aspects assessed (see resources)
2) TUG test
* “timed up and go”- rise from a chair, walk 3m, return to chair - ideally <10sec
3) Gait speed
* 4m in < 5 seconds
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