1 - Frailty Flashcards
why do more specialties practice geriatric medicine?
the population is getting older
give 4 reasons for people living longer?
Increased resources availability
Better economic conditions
Improved screening programs with earlier diagnosis and treatment
Better outcomes following major events - e.g. stroke
what is a consequence of people getting older?
More people have several co-morbid conditions
describe the stochastic theory of ageing?
idea that we accumulate damage due to micro trauma and free radicals, occurs randomly
describe the programmed theory of ageing?
idea that death is predetermined and is expressed in changes in gene expression during various stages
what is the result of ageing, whether its stochastic or programmed?
homeostatic failure
how does physiology of ageing vary between people?
Marked inter-individual variability in both development and magnitude of changes, these changes get greater as we get older
e.g. 2 85 year olds will be more physiologically different than 2 25 year olds
what can be measured and used to show the ageing of the kidney?
creatinine clearance - it dramatically drops the older we get
how does systolic BP tend to change as we get older?
it usually increases
how does diastolic BP change after 60 years old?
usually decreases
what is the risk associated with treating elderly patients for increasing systolic BP?
treating systolic BP with antihypertensives to try and lower it, also runs the risk of lowering diastolic BP (which is already decreased in elderly) - therefore needs to be a balancing act
effect of ageing and cardiac output?
CO decreases as we get older (generally)
effect of ageing on the lungs?
total lung capacity remains the same, but the ‘useful’ bit (vital capacity) decreases
what is the relationship between frailty and dyshomeostasis?
frailty = progressive dyshomeostasis
define frailty?
A susceptibility state that leads to a person being more likely to lose function in the face of a given environmental challenge
name 4 frailty syndromes?
Falls
Delirium
Immobility
Incontinence
describe the basics of -ve feedback control of maintaining blood pressure?
lower blood pressure is detected by pressure sensitive receptor in carotid
this sends nerve signals to the hindbrain (integrative centre) to calculate the error term
sympathetic nervous system acts and produces increased cardiac output
this raises blood pressure
describe 2 factors which make this -ve feedback control of BP in elderly more challenging?
decreased baroreflex sensitivity
decreased cardiac output
name 2 possible consequences for elderly patients if they cannot control their BP effectively?
blackouts
falls
name 2 difficulties for frail patients in terms of temperature and cold stress?
less likely to vasoconstrict
reduced metabolic heat production
name 2 difficulties for frail patients in terms of temperature and heat stress?
reduced sweat gland output
reduced skin blood flow
define social dyshomeostasis?
Difficulty caused by environmental insults not only bio-medical
describe 4 symptoms associated with classic presentation of hyperthyroidism?
Tremor
Anxiety
Weight loss
Diarrhoea
name 6 symptoms associated with frailty presentation of hyperthyroidism?
Depression
Cognitive impairment
Muscle weakness
Atrial fibrillation
Heart failure
Angina
in terms of medications, what is the increased risk with frail/ elderly individuals?
statistically they are on more and often multiple medications - therefore drug-drug interactions, adverse drug reactions are more of a risk etc.
