1 - Frailty

Question 1

why do more specialties practice geriatric medicine?

Answer 1

the population is getting older

Question 2

give 4 reasons for people living longer?

Answer 2

Increased resources availability

Better economic conditions

Improved screening programs with earlier diagnosis and treatment

Better outcomes following major events - e.g. stroke

Question 3

what is a consequence of people getting older?

Answer 3

More people have several co-morbid conditions

Question 4

describe the stochastic theory of ageing?

Answer 4

idea that we accumulate damage due to micro trauma and free radicals, occurs randomly

Question 5

describe the programmed theory of ageing?

Answer 5

idea that death is predetermined and is expressed in changes in gene expression during various stages

Question 6

what is the result of ageing, whether its stochastic or programmed?

Answer 6

homeostatic failure

Question 7

how does physiology of ageing vary between people?

Answer 7

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

Question 8

what can be measured and used to show the ageing of the kidney?

Answer 8

creatinine clearance - it dramatically drops the older we get

Question 9

how does systolic BP tend to change as we get older?

Answer 9

it usually increases

Question 10

how does diastolic BP change after 60 years old?

Answer 10

usually decreases

Question 11

what is the risk associated with treating elderly patients for increasing systolic BP?

Answer 11

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

Question 12

effect of ageing and cardiac output?

Answer 12

CO decreases as we get older (generally)

Question 13

effect of ageing on the lungs?

Answer 13

total lung capacity remains the same, but the ‘useful’ bit (vital capacity) decreases

Question 14

what is the relationship between frailty and dyshomeostasis?

Answer 14

frailty = progressive dyshomeostasis

Question 15

define frailty?

Answer 15

A susceptibility state that leads to a person being more likely to lose function in the face of a given environmental challenge

Question 16

name 4 frailty syndromes?

Answer 16

Falls

Delirium

Immobility

Incontinence

Question 17

describe the basics of -ve feedback control of maintaining blood pressure?

Answer 17

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

Question 18

describe 2 factors which make this -ve feedback control of BP in elderly more challenging?

Answer 18

decreased baroreflex sensitivity

decreased cardiac output

Question 19

name 2 possible consequences for elderly patients if they cannot control their BP effectively?

Answer 19

blackouts

falls

Question 20

name 2 difficulties for frail patients in terms of temperature and cold stress?

Answer 20

less likely to vasoconstrict

reduced metabolic heat production

Question 21

name 2 difficulties for frail patients in terms of temperature and heat stress?

Answer 21

reduced sweat gland output

reduced skin blood flow

Question 22

define social dyshomeostasis?

Answer 22

Difficulty caused by environmental insults not only bio-medical

Question 23

describe 4 symptoms associated with classic presentation of hyperthyroidism?

Answer 23

Tremor

Anxiety

Weight loss

Diarrhoea

Question 24

name 6 symptoms associated with frailty presentation of hyperthyroidism?

Answer 24

Depression

Cognitive impairment

Muscle weakness

Atrial fibrillation

Heart failure

Angina

Question 25

in terms of medications, what is the increased risk with frail/ elderly individuals?

Answer 25

statistically they are on more and often multiple medications - therefore drug-drug interactions, adverse drug reactions are more of a risk etc.