50 - Ageing and Frailty Flashcards
Rectangularisation of survival curves
More people now live into seventies and eighties, then there is a steep decline in percentage surviving.
A definition of ageing
Ageing defined as total of all changes an organism undergoes from conception to death
Cellular senescence
Cells lose the ability to divide
Organismal senescence
Ageing of whole organisms
Successful ageing
Changes due solely to the ageing process, unaffected by disease, environmental or lifestyle factors
Usual ageing
Changes associated with the combined effects of the ageing process, disease and adverse environment and lifestyle factors
Frailty
Characterised by multisystem dysregulations leading to a loss of dynamic homeostasis, decreased physiologic reserve, and increased vulnerability for subsequent morbidity and mortality
Two models of frailty
Phenotype model
Deficit model
Phenotype model of frailty
A group of patient characteristics which if present can predict poorer outcomes
Deficit model of frailty
An accumulation of deficits which can occur with ageing and and which combine to increase the “frailty index” which in turn will increase the of risk of an adverse outcome
Frailty phenotype 1 2 3 4 5
- Unintentional weight loss
- Weakness
- Exhaustion
- Slow walking speed
- Low physical activity
• Pre-frail 1 or 2 criteria
• Frail ≥ 3 criteria
Canadian clinical frailty scale 1 2 3 4 5
–70 item index of accumulated deficits including detailed physical examination
–Includes diseases, physical and cognitive impairments, psychological risk factors, and common geriatric syndromes other than frailty
–Strong correlation with need for institutional care and mortality
–Spectrum from independence to complete dependency
–Gold standard but more of a research tool than clinically applicable
Important driver of frailty
Chronic inflammation
Molecular factors that increase with frailty 1 2 3 4
- Neopterin
- Interleukin (IL)-6
- CRP
- Tumour necrosis factor-α
Cellular factors that change with increasing frailty 1 2 3 4 5
- Total white cell count
- Neutrophils
- Monocytes
- T-lymphocyte sub-populations
- anti-CMV (cytomegalovirus) immunoglobulin G titres suggesting chronic infection
Hormonal changes with increasing frailty 1 2 3 4 5 6 7
• Decreased oestrogen • Decreased testosterone • Decreased dihydroepiandosterone • DecreasedIGF-1 • Decreased growth hormone • Decreased vitamin D • Changes in cortisol – Increasedevening cortisol –Increased 24 hour mean cortisol – Blunted diurnal variation
Sarcopenia
1
2
3
- Loss of muscle mass and strength
- Commences after 50 year old but more rapid > 60 year old
- Accelerated by chronic disease
Contributors to sarcopaenia 1 2 3 4 5 6 7
– Changes in α-motor neurones – Type 2 muscle fibres – Muscular atrophy – Poor nutrition – Low physical activity – Decreased growth hormone – Decreased sex-steroid levels
Muscle changes with sarcopaenia
More fast twitch loss than slow twitch loss.
Definition of co-morbidity
Concurrent presence of ≥ 2 chronic disease
Definition of disability
Physical or mental impairment that limits ≥ 1 major ADL
Effect of morbidity of function
Most useful intervention for frailty in old age
Exercise
Possible outcomes of a pre-frail person encountering a minor illness
Can become frail, unable to live independently and then return to health, or remain frail
What is a geriatric syndrome?
The accumulated effect of impairments in multiple domains that together result in a particular adverse outcome.
One symptom or a complex of symptoms with high prevalence in geriatrics, resulting from multiple diseases and multiple risk factors.
Common geriatric syndromes
Falls Incontinence Delirium Pressure ulcers Functional decline
All lead to frailty
