9 - ageing

Question 1

define ageing

Answer 1

process of growing old associated with physiological changes increased susceptibility to illness and increased likelihood of dying

Question 2

define life expectancy

Answer 2

stastitical measure of how long a person can live

Question 3

define health

Answer 3

the state of complete physical, mental and social wellbeing

Question 4

define disability

Answer 4

a physical or mental impairment that affects ones ability to do daily activities

Question 5

2 theories of ageing and summarise

Answer 5

programmed ageing - we have a biological clock. Hayflick limit - theres a limited number of times a cell can divide before it stops as telomeres shorten with each division

Damage/error theories - accumulation of damage to DNA e.g. loss of telomeres/ oxidative damage causes ageing

Question 6

What is population ageing and what are its challenges to society

Answer 6

increases age of an entire country (increasing expectancy) and decreased fertility rates

• outdated ideals
• working life/ retirement balance
• life expectancy increased bu not healthy old age
• medical system designed for acute illness
• lack of accessibility for people with disabilities

Question 7

disease presentation in old people

Answer 7

atypical / non-specific presentation of disease not clearly linked to underlying cause e.g. falls, delirium, instability, immobility, incontinence

causes a delay in treatment

Question 8

what is frailty

Answer 8

loss of functional reserve which impairs ability to do day to day activities — increases chance of adverse events and deterioration when minor stressors occur

Question 9

what is multimorbiidty and why is it bad

Answer 9

have 2 or more chronic conditions

• adverse reactions
• decreases QOL
• more likely to be depressed
• burden of treatment
• poly pharmacy asoaicated with bad outcomes e.g. falls, increases admission, delirium and death

Question 10

why more likely to have polypharmacy

Answer 10

comorbidities
undetected non-adherence
infrequent review
poor communication

Question 11

physical and cognitive changes in ageing brain

Answer 11

physical

increase volume of CSF around brain
ventricles enlarge 
wider gaps between major gyri
decreased white matter
decreased size and number of connections between neurones in grey matter

cognitive
decreased working memory
decreased processing speed
decreased executive function
decreased divided attention but same simple attention
non change in non declarative memory ( e.g. how to get places)
no change in visuospatial
no change in language

Question 12

diffenrece between dementia and delirium

Answer 12

dementia is a chronic degenerative disease the is irreversible – decrease in cognition

delirium - acute episode of confusion usually with a clear cause e.g. infection that usually resolves - can lead to dementia, and is more common in dementia patients

Question 13

name 4 cognitive assessments

Answer 13

abbreviated mental test (AMT)
montreal cognitive assessment (more detailed than AMT)
mini mental state exam
confusion assessment method (distinguish dementia and derlirium)

Question 14

why using the AMT is limited

Answer 14

floor and ceiling effects
assumes numeracy
assumes literacy
assumes cultural knowledge
orientation focussed (some is preserved in some dementias)
no time limit for countdown 20-1
may be poorly administered