Ageing: SAP

Question 1

what changes to the CV system are associated with ageing?

Answer 1

decreased heart rate
increased size of hear
thickening of capillaries
increased hart workload

Question 2

what changes to the respiratory system are associated with ageing?

Answer 2

weakened diaphragm
change in shape of rib cage
change in shape of alveoli
airways close easier

Question 3

what changes to the musculoskeletal system are associated with ageing?

Answer 3

decreased bone mass density 
osteoporosis 
arthritis 
muscle atrophy 
loss of strength and flexibility

Question 4

what changes to the urinary system are associated with ageing?

Answer 4

bladder becomes less elastic
weakening of bladder muscles- loss of bladder control
enlarged prostate

Question 5

what changes to the GI tract are associated with ageing?

Answer 5

change in taste/ smell
change in oseophageal motility- dysphagia
changes to hormone and enzyme production
increased constipation

Question 6

what changes to the skin are associated with ageing?

Answer 6

skin becomes thinner and less elastic
easy bruising
drying of skin- less oil production

Question 7

what changes to the immune system are associated with ageing?

Answer 7

slower to respond
autoimmune disorders can develop
slower healing
decreased detection of cell defects- cancer

Question 8

what changes to the senses are associated with ageing?

Answer 8

reduced sensation
eyes- decreased acuity, less able to tolerate glare, floaters
ears- hearing loss, particularly high frequency or when there is background noise
taste and smell- decline in number of taste buds, dry mouth, decreased sense of smell

Question 9

what is frailty?

Answer 9

a state of diminished strength, endurance and reduced physiological function that increases and individuals vulnerability to deterioration in health and/ or death

Question 10

what are the changes to male reproductive health with ageing?

Answer 10

testosterone and sperm production decrease
prostate enlarges
erectile dysfunction

Question 11

what impact does the ageing population have on healthcare?

Answer 11

increased elderly people- more people with multi morbidity, increased people with support needs
increased costs
shortage of healthcare professionals

Question 12

what changes to the healthcare system need to be made to improve healthcare for the older population?

Answer 12

change to healthcare structure to better cope with multimorbitidy
increase research and guidelines involving older people and multimorbidity
increase service integration between health and social care

Question 13

what are the polices aimed at improving healthcare for older people?

Answer 13

kings fund- more preventative/ supportive care, improve integration, CGA
CGA- comprehensive geriatric assessment- use of MDT to provide a person centred approach making use of multiple settings
NHS long term plan- community MDT teams, integration of health and social care
workforce planning- more generalised training rather than specialty based

Question 14

what are the ethical issues relating to older people in clinical practice?

Answer 14

consent and capacity
end of life care and resuscitation
when to investigate and when to palliate (risk/benefit)

Question 15

what is multimorbidity?

Answer 15

the presence of 2 or more long term health conditions

Question 16

what are the implications of multi morbidity for the patient?

Answer 16

lots of appointments
seeing multiple specialists
lack of co-ordinated care
poly pharmacy

Question 17

what are the challenges of multimorbidity?

Answer 17

lack of guidance related to multimorbidity
possible drug interactions
unusual disease presentation

Question 18

what are the approaches used to manage multimorbidity?

Answer 18

identify the patients priorities and goals of care- what will most improve their life
establish the disease and treatment burden
agree on an individual plan

Question 19

what conditions can present with falls?

Answer 19

vertigo 
parkinsons 
orthostatic hypertension
visual impairment
osteoarthritis 
dementia 
drug adverse effects 
peripheral neuropathy

Question 20

what are the types of dizziness and the conditions associated with them?

Answer 20

light headed- usually vascular, cardiac or autonomic
disquilibrium/unsteadiness- peripheral neuropathy
vertigo- illusion of movement, vestibular causes

Question 21

what are the clinical features of osteoporosis?

Answer 21

back pain
loss of height over time
stooped posture
bones which break easily

Question 22

what is the pathogenesis of osteoporosis?

Answer 22

uncoupling of normal balance between bone formation and resorption

Question 23

what are the risk factors for osteoporosis?

Answer 23

female 
smoking and alcohol 
immobilisation 
corticosteroid use 
FH- of fragility fracture

Question 24

what is DEXA screening?

Answer 24

dual energy X-Ray Absorptiometry (DEXA)
gives a measure of bone mass density so is useful in diagnosing or assessing risk for osteoporosis
also useful for before starting treatments that may affect BMD

Question 25

what is the pathogenesis of osteomalacia/rickets?

Answer 25

inadequate mineralisation of new bone matrix/osteoid

rickets occurs in children

Question 26

what are the causes of osteomalacia/rickets?

Answer 26

deficient intake or absorption of vitamin D, inadequate sun exposure
defective 1 alpha hydroxylation- vit D dependant rickets type I
primary renal PO4 wasting
inhibitors of mineralisation- high levels of fluoride and aluminium, metabolic acidosis
defective vit D receptors- vit D dependant rickets type II

Question 27

what are the clinical features of rickets?

Answer 27

at birth- craniotabes- softened occipital bones, flat parietal bones
early years- widened epiphyses, frontal bossing, groove in rib cage
older children- lower limb deformity, myopathy, lumbar lordosis and bowing of legs

Question 28

what are the clinical features of osteomalacia?

Answer 28

usually asymptomatic 
proximal muscle weakness 
bone pain- worse on weight bearing 
insufficiency fracture
waddling gait

Question 29

what are the main causes of hypercalcaemia?

Answer 29

primary hyperparathyroidism

malignant disease

Question 30

how does primary hyperparathyroidism cause hypercalcaemia?

Answer 30

excess PTH secreted causing increased bone resorption, increased formation of 1,25-DHCC, increased intestinal Ca absorption and increased renal Ca reabsorption

Question 31

how does malignant disease cause hypercalcaemia?

Answer 31

malginant metastases in bone cause destruction of the bone and release Ca.
cane be sue to direct tumour invasion or due to local secretion of osteoclast activating factors

Question 32

what are the main causes of hypocalcaemia?

Answer 32

hypoparathyroidism
pseudohypoparathyroidism
vitamin D deficiency and dependency
renal disease

Question 33

how does hypoparathyroidism cause hypocalcaemia?

Answer 33

inadequate response of the PTH-vitamin D axis to hypocalcaemic stimuli
can occur in autoimmune disease, accidental removal or damage

Question 34

how does renal disease cause hypocalcaemia?

Answer 34

causes abnormal renal loss of calcium and decreased conversion of vitamin D to 1,25-DHCC

Question 35

how does pseudohypoparathyroidism cause hypocalcamia?

Answer 35

target organ resistance to PTH

Question 36

what is the FRAX score?

Answer 36

a tool developed to evaluate fracture risk. it calculates the 10 year risk percentage of a major osteoporotic fracture and the 10 year risk percentage of hip fracture