50 - Ageing and Frailty

Question 1

Rectangularisation of survival curves

Answer 1

More people now live into seventies and eighties, then there is a steep decline in percentage surviving.

Question 2

A definition of ageing

Answer 2

Ageing defined as total of all changes an organism undergoes from conception to death

Question 3

Cellular senescence

Answer 3

Cells lose the ability to divide

Question 4

Organismal senescence

Answer 4

Ageing of whole organisms

Question 5

Successful ageing

Answer 5

Changes due solely to the ageing process, unaffected by disease, environmental or lifestyle factors

Question 6

Usual ageing

Answer 6

Changes associated with the combined effects of the ageing process, disease and adverse environment and lifestyle factors

Question 7

Frailty

Answer 7

Characterised by multisystem dysregulations leading to a loss of dynamic homeostasis, decreased physiologic reserve, and increased vulnerability for subsequent morbidity and mortality

Question 8

Two models of frailty

Answer 8

Phenotype model

Deficit model

Question 9

Phenotype model of frailty

Answer 9

A group of patient characteristics which if present can predict poorer outcomes

Question 10

Deficit model of frailty

Answer 10

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

Question 11

Frailty phenotype 
1
2
3
4
5

Answer 11

1. Unintentional weight loss
2. Weakness
3. Exhaustion
4. Slow walking speed
5. Low physical activity
   • Pre-frail 1 or 2 criteria
   • Frail ≥ 3 criteria

Question 12

Canadian clinical frailty scale 
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2
3
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5

Answer 12

–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

Question 13

Important driver of frailty

Answer 13

Chronic inflammation

Question 14

Molecular factors that increase with frailty
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2
3
4

Answer 14

• Neopterin
• Interleukin (IL)-6
• CRP
• Tumour necrosis factor-α

Question 15

Cellular factors that change with increasing frailty 
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2
3
4
5

Answer 15

• Total white cell count
• Neutrophils
• Monocytes
• T-lymphocyte sub-populations
• • anti-CMV (cytomegalovirus) immunoglobulin G titres suggesting chronic infection

Question 16

Hormonal changes with increasing frailty 
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2
3
4
5
6
7

Answer 16

• 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

Question 17

Sarcopenia
1
2
3

Answer 17

• Loss of muscle mass and strength
• Commences after 50 year old but more rapid > 60 year old
• Accelerated by chronic disease

Question 18

Contributors to sarcopaenia 
1
2
3
4
5
6
7

Answer 18

– Changes in α-motor neurones
– Type 2 muscle fibres
– Muscular atrophy
– Poor nutrition
– Low physical activity
– Decreased growth hormone
– Decreased sex-steroid levels

Question 19

Muscle changes with sarcopaenia

Answer 19

More fast twitch loss than slow twitch loss.

Question 20

Definition of co-morbidity

Answer 20

Concurrent presence of ≥ 2 chronic disease

Question 21

Definition of disability

Answer 21

Physical or mental impairment that limits ≥ 1 major ADL

Effect of morbidity of function

Question 22

Most useful intervention for frailty in old age

Answer 22

Exercise

Question 23

Possible outcomes of a pre-frail person encountering a minor illness

Answer 23

Can become frail, unable to live independently and then return to health, or remain frail

Question 24

What is a geriatric syndrome?

Answer 24

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.

Question 25

Common geriatric syndromes

Answer 25

Falls
Incontinence
Delirium
Pressure ulcers
Functional decline 

All lead to frailty