3. Ageing well, or Not so Well Flashcards
What is demographics?
Demographics is the study of populations based on factors such as age, race and gender
Demographic data - socioeconomic information expressed statistically, e.g. income, education etc.
What are population demographics
- Populations are not static
- birth
- death
- migration
- All are measureable
- Balance of factors at any time affects population demographic
- Populations change due to changes in birth rates, death rates and immigration/emmigration rates.
Factors influencing population growth
What are the five stages of the demographic transition
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Stage 1 - preindustrial
- high birth and death rates, population size fairly constant
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Stage 2 - modern medicine
- lower death rates esp. among children, birth rates remain high
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Stage 3 - birth rates gradually decrease
- improved economic conditions and contraception
- Stage 4 - population stabliises as birth rates and death rates lower
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Stage 5 - future
- lower fertility rates
- elderly population > younger
What has a big impact on life expectancy
Deprivation - e.g. difference between Glashow City and Highlands
Where someone lives has a profound impact on their morbidity and mortality
Life expectancy and health life expectancy are linked - deprivation has a significant impact on both
What 7 factors comprise the Scottish Index of Multiple Deprivation (SIMD)?
Deprivation is broad and complex
- Income
- Education
- Employment
- Health
- Access to services
- Crime
- Housing
Top 5 leading causes of death in Scotland in 2018
- IHD
- Dementia and AD
- Lung canceer
- CVD
- Chronic lower respiratory disease
Five impacts of an aging population
- Need for health and social care
- Increased spending on pensions
- Increase in dependency ratio*
- Housing needs
- Workforce shortages
What is the dependency ratio?
The ratio of those not working to those working and therefore paying tax
(increased dependency ratio seen in an aging population)
Summarise some aspecets of the physiology of ageing
- Decline
- Loss of cells
- Loss of function
- Across body systems
- Less ability to respond to metabolic stress
- Less reserve capacity
- Less ability to recover
Affects can be seen across all many body systems, e.g. reduced lung volumes in respiratory system
Define multimorbidity
The presence of two or more long term conditions
- Linked with reduced QoL, higher mortality etc.
- Most deprived experience multimorbidity earlier than least deprived
- Commonest multimorbid condition in deprivation is mental health
- Multiple symptoms, medications etc. Complex
- Multimorbidity often results in polypharmacy
Define polypharmacy
Definitions vary: 4-9 or >10 drugs
- Multiple medicines introduced for each condition
- appropriate vs. inappropriate polypharmacy*
- Increased treatment burden and likelihood of interactions
- Reduced ability of patients to adhere to treatment
Appropriate vs. Inappropriate polypharmacy
Appropriate - balance of benefit and risks
Inappropraite - adding in all the time and not taking a step back and reviewing
Complexity of situtation: drugs tested isolation, and can interact with one another.
Issues of complexity for caring for patients with multimorbidity
- Guideline based treatments focus on single diseases.
- Medications are tested in isolation.
- Drugs often interact with one another.
- Drugs that help one system hinder another.
- Multimorbidity – frailty – less reserve – higher likelihood of harm.
What caring options are available for the elderly population
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Care services
- family/friends living with at home
- formal care - visits
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Sheltered housing
- warden available during the day
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Very sheltered housing
- warden available during the day and evening
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Care home
- 24hr care in supported environment
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Nursing home
- Care home + nursing staff
Four key impacts of caring on carers
- Physical health impact
- Mental health impact
- Social impact
- Financial impact
Overview of demographics of caring
- 17% of Scottish adult population are carers
- 4% of children under 16 are carers
- 59% carers are children
- Many work while also caring
Describe briefly what anticipatory care plans are
- Advance and anticipatory care planning promotes discussion in which individuals, their care providers and often those clsoe to them, make decisions with respect to their future health or personal and practical aspects of care.
- Performed continuously, when appropriate
- Shared through key information summaries, with the out of hours team or through other communication
Examples of legal aspects of anticipatory care planning
Legal
- Welfare power of attorney
- Financial power of attorney
- Guardianship
Examples of personal aspects of anticipatory care planning
- Statement of wishes regarding treatment/advance directive
- Next of kin
- Consent to pass on information to relevant others
- Preferences and priorities regarding treatment
- Who else to consult/inform
- Preferred place of death
- Religious and cultural beliefs re death
- Current level of support e.g. family/carers
Examples of medical aspects of anticipatory care planning
- Potential problems
- Home care package
- Wishes re DNA CPR
- Scottish Palliative Care Guidelines
- Communication which has occurred with other professionals + Electronic care summary
- Details of “just-in-case” medicines
- Assessment of capacity/competence
- Current aids and appliances (helps assess current functional level)
