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Year 2 LCRS RDA > 7: prospectives on Ageing > Flashcards

7: prospectives on Ageing Flashcards

1
Q

What is Ageing?

A

Ageing is the process of growing older

It has 3 different main domains:

  • Biological
  • Psychological/cognitive
  • Social
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2
Q

What is Life expectancy?

A

Life expectancy is a statistical measure of how long a person can expect to live

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3
Q

Why did life expectancy increase in the past 100 years

A

Many factory but mainly

  1. better public health (sanitation, hygene etc) but also:
    1. better nutrition
    2. less violence
    3. adnancaes in medicine and
    4. better education
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4
Q

How does the nature of the ageing population changes?

A
  • Increasing numbers of BAME (black asian, minority ethnicity) older people
  • Increasing education of older people
  • Reduction in poverty
  • More people are working for longer
  • More complex/nuanced retirement process
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5
Q

What are the two main groups of Ageing theories?

A
  1. Programmed ageing
  2. Damage or error theories

But:

  • no know theory/application there are no anti-ageing treatments in medicine
  • people age at different rates
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6
Q

Explain the main thesis of “programmed ageing” theory

A

Aged because it is programmed in DNA

  • e.g. telomers get shorther
  • –> cells count the number they are deviding and at some point stop deviding
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7
Q

Explain the “Damage of error theories” as a rationale behind ageing

A

In theory: could live forever but cells get damage appears that cause ageing

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8
Q

What are the big challanges for society in a ageing population?

A
  • Working life/retirement balance - dependency ratio
  • Extending healthy old age not just life expectancy
  • Caring for older people, the sandwich generation
  • Outdated and ageist beliefs/assumptions
  • Medical system designed for single acute diseases
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9
Q

Explain the role of the dependency ration as a challenge of ageing

A

Working life/retirement balance - dependency ratio

  • number of depemdance of people in society (older people in pansion and children)
  • vs number of people that work
    • being able to pay pansion to people!
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10
Q

Explain the role of extending healthy old age not just life expectancy in a challange of ageing

A

Extending healthy old age not just life expectancy

  • aim: to reduce disease time and increase life expectancy
    • but currently: mainly life expectancy went up but disease free time did not
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11
Q

Which factors influence health and (disease free) life expectancy?

A
  • where we live (e.g. pollution)
  • genetic
  • health behaviour
  • access to healthcare
  • who we are (gender etc.)
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12
Q

Explain the challenge of Caring for older people, the sandwich generation

A

3% of over 65 live in a carehome

  • is expensive for working “sandwich” generation
    • caring for an older relative
    • whilst bringing up children
  • not paied by government for vast majority of people
  • leading to
    • decreased workforce and
    • underpaied workers, delayed and worse care
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13
Q

Explain the consequences of the increased age on the healthcare system

A
  • Increasing demand for primary, secondary and tertiary health care
  • Increasing complexity
  • Navigating the health and social care divide
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14
Q

What is frailty?

A

Loss of biological reserve

  • across multiple organ systems
  • leading to vulnerability to physiological decompensation and
  • functional decline

after a stressor event

–> having decreased resources to deal with a stressor event so that a minor stressor (e.g. mild infection) have a big impact (need for care afterwards, admission to long-term care and hospital

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15
Q

Which factors influence Frailty?

A

It is dependant on

  • Environmental and
  • Genetic factors
  • Leading to
    • accumulative damage to cells and molecular damage (Ageing)
    • reduced physilogical reserve (in all organ systems)
      • influenced by nutritional status and exercise
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16
Q

What does a stressor event in a fragile person lead to?

A

It leads to (more) severe response/effects like

  1. falls
  2. Delirium
  3. Fluctuating disability

Leading to

  • increased care needs
  • admission to hospital
  • admission to long-term care
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17
Q

What are the characteristics of

  • mild
  • severe frailty
A
  • Mild
    • living on their own, dependant on some help
  • severe
    • dependant on others and help of others (often living in care home)
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18
Q

Can frailty be prevented?

A

Yes, with lifestyle choices

  • exercise
  • nutrition
  • no smoking
  • no drinking
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19
Q

Can frailty be treated?

A

Yes but it is difficult

  • Exercise
  • Nutrition
  • Drugs (possibly)

Prevention is better than cure

20
Q

What are the non-specific presentations of fraiglty?

A
  • Falls
  • Reduced mobility
  • Recurrent infections
  • Confusion
  • Weight loss
  • “Not coping”
  • Iatrogenic harm

–> Not diagnosis but syndromes that make people come into hospital

21
Q

How does presentation of a disease in old people change?

A

They are less likely to have a “textbook presentation” of symptoms but are more likely to show additional symptoms

  • ACS
    • Less likely to have chest pain
    • More Likely to have SOB
  • PE
  • Less likely to have pleuritic chest pain
  • Less likely to have haemoptysis
  • More likely to have syncope
22
Q

What is the impact of multimorbidity in age?

A

Because: conditions of conditions impact on one another

  1. directly
  2. viat the treatment of one condition
  3. Leading to
    • Worse Quality of Life, more likely to be depressed
    • Increased functional impairment
    • Burden of treatment
    • Polypharmacy
23
Q

Why do older people take more drugs?

A
  • more conditions (multimorbidity)
  • infrequent review
  • guidelines
    • only on single condition and not on multimoriditions that might be treated differently
  • undetected non-adherence
  • poor communication
24
Q

What is the result of Potentially inappropriate polypharmacy (PIP) ?

A

E.g. Long-term perscription of opioids,

  • Falls
  • Increased length of stay
  • Delirium
  • Mortality
25
Q

What is the iatrogenic harm?

A

Harm caused by the medical treatment

iatrogenic illness or death caused purposefully or by avoidable error or negligence on the healer’s part

26
Q

What are the possible effects of iaterogenic harm?

A
  • Adverse reactions to medications
  • Nosocomial conditions
    • Infections
    • Pressure sores
    • Constipation
    • Deconditioning
      • in hosptial e.g. moving too little in Hospital Bed
    • Delirium
    • Malnutrition
    • Incontinence
  • Falls
  • Psychological/cognitive damage
27
Q

Why are older people more suspectible to ADRs?

A
  • Reduced physiological reserve
  • Impaired compensation mechanisms
  • Comorbidities
  • Polypharmacy
  • Cognitive impairment
28
Q

What is a CGA?

A

Comprehensive geriatric assessment

29
Q

How is a CGA made?

A
  • It is a Multidisciplinary assessment of
    • Medical
    • Functional
    • Social
    • Psychological/psychiatric needs
  • Then: coming up with a Problem list and a
  • Treatment Plan
30
Q

What are the advantages of a CGA?

A

In the community

  • reduces hospital admissions
  • and falls
    • benefit in mild or moderate frailty

In hospital:

  • reduces mortality
  • reduced functional and cognitive decline
  • reduces hospital/care home admission
31
Q

What are the goals of Rehabilitation?

A
  • Aim is to restore or improve functionality
  • Multidisciplinary
  • Rehabilitation alongside acute illness
  • Preventing deconditioning
  • Prehabilitation
32
Q

What are the biological changes in the brain that occur with ageing?

A
  • Enlargement of the ventricles
  • loss of supporting matter + connection between neurons
    • in grey+ white matter
33
Q

What are the normally cognitive functions that decline with age?

A

Reduction of

  • cognitive speed, working memory
  • executive function e.g. probling solving abilits
  • devided attention
34
Q

Name some cognitive abilities that do not physiologically change with age?

A

No change (decline) in

  1. simple (on one thing) attention
  2. nondeclerative memory
  3. visuospatial abilities
  4. language (some reduction in verbal fluency)
35
Q

What is dementia?

A

•Decline in all cognitive functions, not just memory

  • Impairment of function
  • Progressive
  • Degenerative
  • Irreversible
36
Q

Can dementia can be prevented?

A

YES (at least lifestle has some influence)

  • stop smoking
  • exercise
  • diet
  • alcohol
37
Q

What is the AMT?

A

It is a brief assessment (10 point) of cognitive function

The Abbreviated mental test score (AMTS)

38
Q

What are possible screening test cognitive function?

A
  • AMT–> 10 point questions used in clinical practice
  • Clock drawing test (try the patients to show time with their fingers)
    • both used tas brief screening for cognitive impairment
  • MMSE (Minimal Mental Stater Examination) not used in clincal practice anymore
  • MOCA (Montreal Cognitive Assessment) –> has replaced MMSC as brief screening test (screening test that is a bit more detailed thatn first two)
39
Q

What are possible diagnositc test that can test cognitive function?

A
  1. Addenbrooke’s Cognitive Examination (ACE)
    1. 100 qestions, 20-50 mins
  2. Detailed neuropsychometric testing
    1. hours, done by psychology
40
Q

Explain the process of testing the MOCA test

A

MOCA= Montreal Cognitive Assessment

–> normally 30 min for exam (realistically 15-20)

41
Q

What are the adantages of a MOCA screeming test?

A
  • Covers a variety of domains of cognitive function
  • Brief to administer (10 mins)
  • Validated in a range of populations
  • Available in translated versions
  • Widely used –> good comparisons available
42
Q

What are the disadvantages of the MOCA test?

A
  • Education level will affect results
  • Language level will affect results
  • Floor and ceiling effects
    • with good education –> education but still dement and high score
  • Can be poorly administered (if people don’t have the training)
  • Possibly practice/coaching effects
43
Q

What are general problems with cognitive tests?

A

Just interpret test in the context of the patient!

  • Physical problems may limit testing
    • also hearing + seeing
    • e.g. can’t hold a pen
  • Education may limit testing
    • most need: numeracy and literacy
    • and some basic cultural knowledge
  • Depression can masquerade as dementia
  • Not valid in acute illness (acute confusion)
  • Normal cognitive changes (slower processing speed, slower reaction times) may affect administration
44
Q

What are the implications of the two main theories of ageing on treatment?

A
  1. Damage theories
    • if damage could be prevented/ repaired this could stop ageing
  2. Programmed ageing theories
    • if genetic modification
45
Q

What are the “giants of geriatric medicine”?

A

The reasons why old people come into hospital

  • immobility
  • intellectual impairment
  • instability
  • incontinence
  • iatrogenic problems.
46
Q

What are possibilities to differentiate between dementia and delirium?

A

Confusion Assessment Method (CAM)

4AT

are tools to help distinguish between delirium and dementia

Year 2 LCRS RDA (11 decks)

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