AGE Flashcards

Question 1

Q

The Ageing Heart and Lungs by Dr Cheng

Ageing Heart Valves

*LOB: Describe the age-related structural and physiological changes in the cardiovascular and respiratory systems (and relate to their functional consequences)

Answer

A

Increased Thickness
Decreased Flexibility
Calcification

Question 2

Q

The Ageing Heart and Lungs by Dr Cheng

Ageing Heart Muscle

*LOB: Describe the age-related structural and physiological changes in the cardiovascular and respiratory systems (and relate to their functional consequences)

Answer

A

Increased Left Ventricular Wall Thickness
Increased Myocyte size
Fibrous Tissue deposits
Amyloid Desposits

Enlargement of Left Atrium
Slight enlargement/ hypertrophy of left ventricular cavity

Question 3

Q

The Ageing Heart and Lungs by Dr Cheng

Ageing Conduction Pathway

*LOB: Describe the age-related structural and physiological changes in the cardiovascular and respiratory systems (and relate to their functional consequences)

Answer

A

Reduced pacemaker cells (50-75% lost by ~50)
Fibrous tissue
AV node constant

Question 4

Q

The Ageing Heart and Lungs by Dr Cheng

Ageing Arteries

*LOB: Describe the age-related structural and physiological changes in the cardiovascular and respiratory systems (and relate to their functional consequences)

Answer

A

Lose elasticity and compliance
Lose stretch
More resistant to blood flow

Peripheral arteries less reilient
Calcifications in artery walls including aorta
Arteries stiffer and more difficult to dilate

Question 5

Q

The Ageing Heart and Lungs by Dr Cheng

Ageing Veins

*LOB: Describe the age-related structural and physiological changes in the cardiovascular and respiratory systems (and relate to their functional consequences)

Answer

A

Intima & muscular walls thicken and become less elastic
Dilate and stretch with less elasticity

Question 6

Q

The Ageing Heart and Lungs by Dr Cheng

Ageing Aorta

*LOB: Describe the age-related structural and physiological changes in the cardiovascular and respiratory systems (and relate to their functional consequences)

Answer

A

Dilated Elongated and rigid
Calcifications
May tortous
Reduced elastin, increased collagen
Increased stiffness, reduced compliance

Question 7

Q

The Ageing Heart and Lungs by Dr Cheng

Age Related Physiological Changes in CVS

*LOB: Describe the age-related structural and physiological changes in the cardiovascular and respiratory systems (and relate to their functional consequences)

Answer

A

Heart rate
Blood pressure
Myocardial function
Valvular function
Conduction pathways

Question 8

Q

The Ageing Heart and Lungs by Dr Cheng

Ageing Myocardial Function

*LOB: Explain the functional consequences to the cardiovascular and respiratory systems in relation to age-related changes

Answer

A

Reduced contractile strength & efficiency
Reduced cardiac output
Reduced cardiac reserve

Question 9

Q

The Ageing Heart and Lungs by Dr Cheng

Ageing Cardiac Function

PRELOAD

*LOB: Explain the functional consequences to the cardiovascular and respiratory systems in relation to age-related changes

Answer

A

PRELOAD
Early diastolic left ventricular filling rate, slows with age
Compensation with increased atrial contraction
increasing late diatsole filling

RESULT End diastolic volume (Pre-load) at rest remains the same

Question 10

Q

The Ageing Heart and Lungs by Dr Cheng

Ageing Cardiac Function

AFTERLOAD

*LOB: Explain the functional consequences to the cardiovascular and respiratory systems in relation to age-related changes

Answer

A

AFTERLOAD
Decrease in elasticity and lumen diamter within arterial tree
gradual increase systolic bp with age
Small arteries less responsive to vasodilator cues with age
increases peripheral resistance

INCREASED AFTERLOAD with age

Question 11

Q

The Ageing Heart and Lungs by Dr Cheng

Ageing Heart Rate

PRELOAD

*LOB: Explain the functional consequences to the cardiovascular and respiratory systems in relation to age-related changes

Answer

A

Reduced cardiac responsiveness with exercise
Longer to return to baseline
Decrease in maximal HR in exercise

If healthy, resting heart rate (supine) does not change)

Question 12

Q

The Ageing Heart and Lungs by Dr Cheng

Ageing BP

*LOB: Explain the functional consequences to the cardiovascular and respiratory systems in relation to age-related changes

Answer

A

SYSTOLIC may rise disproportionately higher than diastolic

why? Increase in pre-load due to cardiac changes

Question 13

Q

The Ageing Heart and Lungs by Dr Cheng

Ageing Left Ventricle

*LOB: Explain the functional consequences to the cardiovascular and respiratory systems in relation to age-related changes

Answer

A

Weakened heart cant squeeze well, less blood pumped out = REDUCED Cardiac Output

Less blood fills ventricles, stiff heart cant relax= DIASTOLIC dysfunction

Question 14

Q

The Ageing Heart and Lungs by Dr Cheng

Ageing Ejection Fraction

*LOB: Explain the functional consequences to the cardiovascular and respiratory systems in relation to age-related changes

Answer

A

Reduced due to

Increased vascular resistance
Increased end diastolic volume
Reduced maximal myocardial contractility
Reduced contractility by adrenergic stimulation

Ejection fraction = stroke volume divided by end diastolic volume
End diastolic volume on exertion is increased in older age, whereas it is unchanged at rest

Question 15

Q

The Ageing Heart and Lungs by Dr Cheng

Ageing Valves

*LOB: Explain the functional consequences to the cardiovascular and respiratory systems in relation to age-related changes

Answer

A

Systolic and diastolic murmurs may result from thickened, calcified and malaligned valve leaflets

Question 16

Q

The Ageing Heart and Lungs by Dr Cheng

Ageing Conduction pathways

*LOB: Explain the functional consequences to the cardiovascular and respiratory systems in relation to age-related changes

Answer

A

Irritability of the myocardium may result in extra systoles, along with sinus arrhythmias & sinus bradycardia

Question 17

Q

The Ageing Heart and Lungs by Dr Cheng

Functional Implications

QOL

*LOB: Explain the functional consequences to the cardiovascular and respiratory systems in relation to age-related changes

Answer

A

Reduced response to stress
Activity intolerance
Orthostatic hypotension

INCREASED RISK FOR:
Hypertension
Ischaemic heart disease
Myocardial infarction
Heart failure
Arrhythmias
Stroke

Question 18

Q

The Ageing Heart and Lungs by Dr Cheng

Respiratory Ageing

*LOB: Describe the age-related structural and physiological changes in the cardiovascular and respiratory systems (and relate to their functional consequences)

Answer

A

Structural changes
Increase in size of alveolar space and air trapping
Loss of supporting structure of lung parenchyma
Decreased elasticity

Chest wall
Reduction in chest wall compliance
Reduced thickness of vertebral discs
Kyphosis

Question 19

Q

The Ageing Heart and Lungs by Dr Cheng

Respiratory Muscles

*LOB: Describe the age-related structural and physiological changes in the cardiovascular and respiratory systems (and relate to their functional consequences)

Answer

A

Generalised reduction in muscle strength with age
Diaphragm falls in height, thereby reducing its ability to generate force
Weakened cough reflex

The ventilatory response to lower oxygen tension or raised carbon dioxide tension is markedly impaired in older adults

Question 20

Q

The Ageing Heart and Lungs by Dr Cheng

Ageing Chest Wall

*LOB: Describe the age-related structural and physiological changes in the cardiovascular and respiratory systems (and relate to their functional consequences)

Answer

A

Chest wall compliance reduced
Stiffening of the thoracic cage from calcification of the rib cage
Age-related kyphosis
Arthritis of costovertebral joint

More muscular work is therefore required for ventilation (20% more at 60yrs vs 20yrs)-  work of breathing

Question 21

Q

The Ageing Heart and Lungs by Dr Cheng

Ageing Respiratory Muscles

*LOB: Describe the age-related structural and physiological changes in the cardiovascular and respiratory systems (and relate to their functional consequences)

Answer

A

Muscle atrophy
Decrease in fast twitch fibers

Predisposes individuals to diaphragmatic fatigue and ventilatory failure with increased ventilatory load

Respiratory muscle performance is impaired by the age related increase in functional residual capacity

Question 22

Q

The Ageing Heart and Lungs by Dr Cheng

Respiratory Functional changes with age

*LOB: Explain the functional consequences to the cardiovascular and respiratory systems in relation to age-related changes

Question 23

Q

The Ageing Heart and Lungs by Dr Cheng

Spirometry Changes

*LOB: Explain the functional consequences to the cardiovascular and respiratory systems in relation to age-related changes

Answer

A

Decrease of FEV1 and FVC between 25 and 39, with more at over 65

Question 24

Q

The Ageing Heart and Lungs by Dr Cheng

Vascular Remodelling

*LOB: Explain the functional consequences to the cardiovascular and respiratory systems in relation to age-related changes

Answer

A

Increased pulmonary vascular stiffness

Increased vascular pressures and resistance

Decreased pulmonary capillary blood volume

Question 25

Q

The Ageing Heart and Lungs by Dr Cheng

Immunological changes

*LOB: Explain the functional consequences to the cardiovascular and respiratory systems in relation to age-related changes

Answer

A

Reduced Mucocillary transport
Blunted cough reflex
Increased swallowing error
Decreased no and funct T Cell, Mφ
Total exposure to pollutants over years

Therefore
chronic low-grade inflammation
Bronchoalveolar lavage has demonstrated increased levels of neutrophils, IL-1 and IL-8as well as neutrophil elastase

Question 26

Q

The Ageing Heart and Lungs by Dr Cheng

Respiratory Consequences

*LOB: Explain the functional consequences to the cardiovascular and respiratory systems in relation to age-related changes

Answer

A

Increased work of breathing

Decreased exercise tolerance

Increased risk of infection

Subsequent increased risk of a variety of respiratory diseases

VO2Mac decreases (quicker if sedentary)

Question 27

Q

Disease presentation in the older adult by Dr Hetherington

Events in Ageing

*LOB: Explain why disease presentations may be atypical in the older adult

Answer

A

Physiological decline happens across all body systems

Expending reserves to compensate for primary age changes

Reduced ability to maintain homeostasis when disturbed by physiological insult
(Also known as… frailty)

Question 28

Q

Disease presentation in the older adult by Dr Hetherington

What is Frailty?

*LOB: Explain why disease presentations may be atypical in the older adult

Answer

A

Dysregulation in multiple physiological systems (e.g. cardiac, respiratory, metabolic, renal, musculoskeletal etc etc) results in reduced reserve

Older age ≠ frailty

Question 29

Q

Disease presentation in the older adult by Dr Hetherington

What is Clinical Frailty Scale?

*LOB: Explain why disease presentations may be atypical in the older adult

Answer

A

1-9, scores slightly differently in dementia
Depends on active disease and activity
Includes terminal illness

Question 30

Q

Disease presentation in the older adult by Dr Hetherington

Homeostenosis

*LOB: Explain why disease presentations may be atypical in the older adult

Answer

A

Homeostasis + Stenosis
Homeostasis has a physiological limit
Physiologic reserve decreases with time
Stress (biologic) can overwhelm the reserve

Question 31

Q

Disease presentation in the older adult by Dr Hetherington

Pathology vs Ageing

*LOB: Explain why disease presentations may be atypical in the older adult

Answer

A

Pathology may be mistaken for ‘normal ageing’ (by patients, relatives or healthcare staff)
Fatigue, memory problems, incontinence et.c

Symptoms are often multifactorial in origin

Same symptoms can be caused by different disease processes
E.g. dyspnoea – COPD/ heart failure / anaemia

The same disease process can cause different symptoms in different patients.

Question 32

Q

Disease presentation in the older adult by Dr Hetherington

System Overlap

*LOB: Explain why disease presentations may be atypical in the older adult

Question 33

Q

Disease presentation in the older adult by Dr Hetherington

Atypical Presentation

*LOB: Describe the five most common atypical disease presentations

Answer

A

An older person may have the same presentation for varied underlying causes
* Dyspnoea (pneumonia, COPD, heart failure)
* Falls (infection, postural hypotension, arrhythmia)
* Fatigue (infection, anaemia, malignancy, MS)
* Delirium (almost anything you can think of)

Or the same disease may present in different ways in differnet patients

ATYPICAL is typical in older patients

Question 34

Q

Disease presentation in the older adult by Dr Hetherington

Geriatric Giants - the 5 Is

*LOB: Describe the five most common atypical disease presentations

Answer

A

Immobility

Instability

Intellectual impairment

Incontinence

(Iatrogenesis)

Question 35

Q

Disease presentation in the older adult by Dr Hetherington

Immobility

*LOB: Describe the five most common atypical disease presentations

Answer

A

Causes
Acute or chronic illness
Medication side effects
Pain
Delirium or dementia
Sarcopenia
Mood
Lack of mobility aid

Consequences
Pressure ulcers
Pneumonia
Increased dependence
Death

Question 36

Q

Disease presentation in the older adult by Dr Hetherington

Instability

*LOB: Describe the five most common atypical disease presentations

Answer

A

Causes
Age-related changes:
Gait, Sarcopenia, Visual impairment etc
Medical conditions
Environmental causes
Medications
Alcohol

Consequences
Fractures
Immobility
Fear of falling (FFF) and reduced confidence
Traumatic intracranial haemorrhage
Dependence
Death

Question 37

Q

Disease presentation in the older adult by Dr Hetherington

Iatrogenesis

*LOB: Describe the five most common atypical disease presentations

Answer

A

illness caused by medication
Polypharmacy
More than half of >65 take 3 medications
Increases ADR risk
Changes in pharmacokinetics/dynamis with age

Question 38

Q

Disease presentation in the older adult by Dr Hetherington

Atypical presentation in Covid

*LOB: Describe the five most common atypical disease presentations

Answer

A

Fever, cough, and dyspnoea may be absent despite respiratory disease

Only 20-30% of geriatric patients with infection present with fever

Delirium, falls, malaise, functional decline, conjunctivitis, dizziness, headache, rhinorrhoea, chest pain, haemoptysis, diarrhoea, nausea/vomiting, abdominal pain

May be covid positive when other plausible explanation for presentation (remember – often >1 cause for syndromes)

Older adults may present with mild symptoms that are disproportionate to the severity of their illness
Regional Geriatric Program of Toronto

Question 39

Q

Disease presentation in the older adult by Dr Hetherington

Reversible Causes of Incontinence

*LOB: Describe the five most common atypical disease presentations

Answer

A

DIAPPERS think diapers

Delirium
Infection - urinary (symptomatic)
Atrophic urethritis and vaginitis
Pharmaceuticals
Psychiatric disorders, especially depression
Excessive urine output (eg, from heart failure or hyperglycemia)
Restricted mobility
Stool impaction

Question 40

Q

Disease presentation in the older adult by Dr Hetherington

Incontinence

*LOB: Describe the five most common atypical disease presentations

Answer

A

Not a normal part of ageing
Urge, stress, mixed, functional

Consequence
Damage to skin
Infection
Embarrassment
Instability
Social isolation

Question 41

Q

Disease presentation in the older adult by Dr Hetherington

Precipitants of Delirium

*LOB: Describe the five most common atypical disease presentations

Answer

A

PINCH ME

Predisposing factors
Polypharmacy
Acute illness
Constipation
Electrolyte or fluid imbalance
Change in environment
Pain

Question 42

Q

Disease presentation in the older adult by Dr Hetherington

Instability

*LOB: Describe the five most common atypical disease presentations

Answer

A

Causes
Age-related changes:
Gait, Sarcopenia, Visual impairment etc
Medical conditions
Environmental causes
Medications
Alcohol

Consequences
Fractures
Immobility
Fear of falling (FFF) and reduced confidence
Traumatic intracranial haemorrhage
Dependence
Death

Question 43

Q

Disease presentation in the older adult by Dr Hetherington

Intellectual Impairment

*LOB: Describe the five most common atypical disease presentations

Answer

A

Causes
delirium
Delirium affects >25% of people in hospital

Disturbed consciousness, cognitive function or perception, which has an acute onset and fluctuating course

Consequences
Significant mortality (> cancer, #NOF, STEMI)
Instability
Immobility
Longer stay
Increased level of dependence (e.g. nursing home)
Poor PO intake
Death

Question 44

Q

Disease Presentations in the Older Adult

Skin

*LOB: Describe the age-related changes to the structure and function of the skin and the functional consequences

Answer

A

Changes:
Thinning of the epidermis (outer layer)
Decreased collagen and elastin in the dermis (middle layer)
Reduction in subcutaneous fat (bottom layer)
Reduced sweat and oil gland activity

Structure:
Thinner, less elastic skin
Less cushioning from fat
Reduced moisture

Function:
Weaker barrier against external damage
Lower ability to retain moisture
Decreased temperature regulation

Consequence:
Increased risk of skin injuries and infections
Dry, itchy skin
Slower wound healing
Greater susceptibility to temperature extremes

Question 45

Q

Disease Presentations in the Older Adult

Pituitary Gland

*LOB: Describe the age-related functional changes to the pituitary, thyroid, and adrenal glands and how these may alter disease presentations

Answer

A

Changes:
Reduced hormone production (e.g., growth hormone)
Altered hormone release patterns

Structure:
Degeneration of gland tissue
Reduced cell function

Function:
Lowered growth hormone levels affect muscle mass and fat distribution
Altered hormone levels influence overall metabolism and stress response

Consequence:
Decreased muscle mass and strength
Increased body fat
Slower metabolism
Potential for disrupted sleep and energy levels

Question 46

Q

Disease Presentations in the Older Adult

Thyroid Gland

*LOB:Describe the age-related functional changes to the pituitary, thyroid, and adrenal glands and how these may alter disease presentations

Answer

A

Changes:
Decreased production of thyroid hormones (T3 and T4)
Increased incidence of thyroid nodules

Structure:
Gland may become nodular or atrophic

Function:
Slowed metabolism
Altered body temperature regulation

Consequence:
Increased risk of hypothyroidism (fatigue, weight gain, cold intolerance)
Potential for hyperthyroidism if nodules produce excess hormones

Question 47

Q

Disease Presentations in the Older Adult

Adrenal Gland

*LOB: Describe the age-related functional changes to the pituitary, thyroid, and adrenal glands and how these may alter disease presentations

Answer

A

Changes:
Decreased production of adrenal hormones (e.g., cortisol, aldosterone)
Altered response to stress

Structure:
Degeneration of adrenal cortex
Reduced gland size

Function:
Lowered ability to respond to physical and emotional stress
Reduced blood pressure regulation

Consequence:
Increased susceptibility to stress-related disorders
Potential for low blood pressure and electrolyte imbalances

Question 48

Q

Disease Presentations in the Older Adult

Increased Susceptibility to Infection in Older Adults

Explain why older people are more prone to infection

Answer

A

Changes:
Decline in immune system function (immunosenescence)
Reduced production of immune cells

Structure:
Thinner skin and mucous membranes
Weakened barriers against pathogens

Function:
Slower immune response
Reduced ability to recognize and attack pathogens

Consequence:
Higher risk of infections (e.g., pneumonia, urinary tract infections)
Slower recovery from illnesses
Increased severity of infections

Question 49

Q

Falls and Their Consequences by Dr Godfrey

Risk for Falls

*LOB Identify common risk factors for falls in the older population

Answer

A

Syncope
Stroke
STEMI
Trip Stumble
Difficulty raising foot
Foot catching furniture/ other foot
Tripped by another person
Loss of external support
Hit or bump
Loss of Conciousness

Question 50

Q

Falls and Their Consequences by Dr Godfrey

Why Falls?

*LOB Identify common risk factors for falls in the older population

Answer

A

Ageing Neurological BALANCE BRADYKINESIA
Brain atrophy, neurone loss, reduced synaptic transmission leading to slower processing speed, loss of proprioception, impaired vestibular system

Ageing Muscles
Sarcopenia, and asymmetrical changes

Ageing posture

Gait
Reduced stride, speed, fleion and extension, less strength in “pushing off”

Co Mobidities

Extrinsic
Lighting, pets, headroom, clothing, shoes

Question 51

Q

Falls and Their Consequences by Dr Godfrey

Comorbidities effecting Falls

*LOB Identify common risk factors for falls in the older population

Answer

A

Ageing Hearing/ Presbycusis
With each 10dB of hearing loss, risk increases by 140%
Less Spatially Aware, less resource for balance

Ageing Sight
Deterioration in acuity, opaque lens, pupil rigid, slower light reaction, reduced sensitivity

Medications
Exposure to anticholinergic associated in 60% increase

Question 52

Q

Falls and Their Consequences by Dr Godfrey

Posture and Gait Changes

*LOB Identify the changes to posture and gait in normal ageing

Answer

A

Posture Changes:
Increased thoracic kyphosis
Decreased lumbar lordosis
Height loss
Forward head position
Shoulders more rounded and stooped

Functional Consequences of Posture Changes:
Balance issues
Back pain
Breathing difficulties

Gait Changes:
Decrease in stride length
Reduction in walking speed
Widening of the stance
Decreased arm swing
Joint stiffness

Functional Consequences of Gait Changes:
Increased fall risk
Reduced mobility
Fatigue

Question 53

Q

Falls and Their Consequences by Dr Godfrey

Hip Fracture Management

*LOB: Briefly describe key steps in the management of hip fracture in the elderly, appreciating both surgical and non-surgical aspects

Answer

A

Initial Assessment and Stabilization:
Pain Management
Imaging
Medical Stabilization

Surgical Management:
Type of Surgery
Internal Fixation
Hemiarthroplasty
Total Hip Arthroplasty
Timing

Post-Surgical Care:
Pain Management
Antibiotics
Anticoagulation

Non-Surgical Management:
Rehabilitation
Weight-Bearing
Assistive Devices

Comprehensive Care:
Nutritional Support
Bone Health
Multidisciplinary Approach

Follow-Up:
Monitoring
Adjustments

Question 54

Q

Frailty and Multiple Morbidity

Caveats to Frailty

*LOB: Outline the concepts of frailty and multiple morbidity

Answer

A

Not living with multiple long-term health conditions.
Someone living with frailty may have no other diagnosed health conditions
Not a disability

Question 55

Q

Frailty and Multiple Morbidity

Frailty

*LOB: Outline the concepts of frailty and multiple morbidity

Answer

A

“a distinctive health state related to the ageing process in which multiple body systems gradually lose their in-built reserves”

Question 56

Q

Frailty and Multiple Morbidity

Pathogenesis of Frailty

*LOB: Describe the pathogenesis of frailty

Answer

A

Aetiology, Mechanisms, Phenotype and Outcome

Question 57

Q

Frailty and Multiple Morbidity

Screeing Frailty: Rockwood

*LOB: Identify the screening tools to detect frailty

Question 58

Q

Frailty and Multiple Morbidity

Screening Frailty: Edmonton

*LOB: Identify the screening tools to detect frailty

Question 59

Q

Frailty and Multiple Morbidity

Management

*LOB: Describe the management of the frailty syndrome

Answer

A

Comprehensive Geriatric Assessment (CGA)
Interdisciplinary, multi-component process, focused on medical, psychological and functional capabilities to develop an integrated plan for treatment and long term follow up
NNT is only 17
Can be used in hospitals or in the community

Question 60

Q

Introduction to Ageing and Disease

Ageing is….

*LOB: Define ageing

Answer

A

the time-related deterioration of the physiological functions necessary for survival and fertility.

Question 61

Q

Pharmacology and Older People by Dr Cheng

Distribtution in Age

*LOB: Describe how pharmacokinetics and pharmacodynamics can be affected in old age

Answer

A

Increased Body fat
Decreased body water, lean body mass, plasma albumin

Can increase Vd for lipophilic drugs, increasing halflife
Decreases Vd for hydrophilic
Less albumin = unbound drug = toxicity risk

Question 62

Q

Pharmacology and Older People by Dr Cheng

Metabolism in Age

*LOB: Describe how pharmacokinetics and pharmacodynamics can be affected in old age

Answer

A

Decreased hepatic blood flow and volume with age
Decreased activity of Hepatic enzymes
first-pass metabolism are most likely to be affected

Phase 1 reactions (oxidation, reduction & hydrolysis) are more significantly affected than Phase 2 reactions (conjugation & glucorinidation)

Question 63

Q

Pharmacology and Older People by Dr Cheng

Excretion in Age

*LOB: Describe how pharmacokinetics and pharmacodynamics can be affected in old age

Answer

A

Decreased renal blood flow, kidney size and functioning nephrons
Reduced eGFR (calculation may not show change)

Poor renal blood flow 2’ to arterial disease (+ RF of diabetes, HTN)
Loss of nephrons by focal glomerular sclerosis

Most important for medications with a narrow therapeutic range which rely on renal clearance – digoxin, gentamicin, lithium
May stay in body longer = longer affects, higher risk of toxicity

Question 64

Q

Pharmacology and Older People by Dr Cheng

Prescribing in Ageing

*LOB: Describe principles for safe prescribing in the older patient

Answer

A

Polypharmacy
Typically defined as a taking 5 or more medications
Increasing prevalence in part due to increasing rates of multimorbidity and treatment options
Prescribing cascade -> HTN -> Amlodipine -> Ankle swelling -> Furosemide -> incontinence -> Tamsulosin -> Constipation -> Laxatives

Anticholinergic Burden calculator
https://www.acbcalc.com/

What is this patient’s anticholinergic burden? (Answer: 7)
(3+ is associated with increased mortality)
Chlorphenamine (3)
Prednisolone (1)
Amitriptyline (3)
Aspirin (0)

ADR
A: adverse reaction from an exaggeration of a drug’s expected actions

Answer 61

A

Complex regimens
Multiple prescribers
Medication storage / formulation issues
Multimorbidity
Cognitive impairment
Increased risk of ADRs

Start low and go slow

Answer 62

A

Increased Demand for Geriatric Care:

More elderly individuals require specialized medical services, long-term care, and management of chronic conditions.

Strain on Healthcare Resources:

Higher healthcare costs and resource allocation challenges due to the rising number of older patients with complex needs.

Expansion of Healthcare Workforce:

Need for more healthcare professionals trained in geriatric medicine, nursing, and allied health services to cater to the aging population.

Growth in Preventive and Community-Based Services:

Emphasis on preventive healthcare, home care services, and community-based support to manage aging in place and reduce hospital admissions.

Policy and Infrastructure Changes:

Development of policies and healthcare infrastructure to support aging populations, including increased funding, age-friendly facilities, and integrated care models.

Answer 63

A

By delaying the onset of disabling diseases to later ages when intrinsic ageing has raised fatality by reducing adaptability, the average duration of disability before death will be shortened. In brief, we will spend a longer time living and a shorter time dying
J Grimley Evans 1997

Answer 64

A

Brain Shrinking
Neurodegeneration
Ventricular Enlargement
Volume loss
Sulcal Swelling
Hippocampal Atrophy
Cortical Thinning

Answer 65

A

Brain Shrinking
Neurodegeneration
Ventricular Enlargement
Volume loss
Sulcal Swelling
Hippocampal Atrophy
Cortical Thinning

Answer 66

A

Large vessel disease
Ischaemic and haemorrhagic strokes

Small vessel disease
Cerebral arteriosclerosis and atherosclerosis
Cerebral amyloid angiopathy
Lacunar infarcts

Answer 67

A

Syndrome caused by a number of brain disorders which cause memory loss, decline aspects of cognition, and difficulties with activities of daily living.

Cognitive impairment
Psychiatric or behavioural disturbances
Difficulties with activities of daily living

Answer 68

A

Healthy Ageing: some impairment, doesnt affect daily living
MCI: memory loss, difficulty speaking, disorientation, but does not interfere with normal daily functions and routines

Dementia: severe cognitive dysfunction affecting daily life, completing tasks or learning new things

Answer 69

A

Risk Factors: Apolipoprotein E4
Aetiology: Extracellular beta-amyloid plaques, intracellular neurofibrillary tangles (Tau)
Clinical Evolution: Progressive decline
Neuropsychological changes: Short-term memory
Imaging: Medial temporal lobe atrophy
Management: Acetylcholinesterase inhibitors, NMDA receptor antagonistis

Answer 70

A

Risk Factors: HTN, DM, Stroke, TIA, AF, smoking
Aetiology: Infarction, leukoaraiosis, haemorrhage
Clinical Evolution: Step-wise decline
Neuropsychological changes: Executive function
Imaging: infarcts, small vessel disease, white matter changes
Management: Reduce cardiac risk factors

Answer 71

A

NeuroneDecreased synaptic function
Microglia Accumulation of insoluble material, pro inflammatory, decreased surveilling
Oligodendrocyte Decreased myelination, release myelin debris, shorter internodes
Astrocyte Reactivity features, decreased neuronal synaptic suport, enhanced immune response

Answer 72

A

Brain Shrinking
Neurodegeneration
Ventricular Enlargement
Volume loss
Sulcal Swelling
Hippocampal Atrophy
Cortical Thinning

Answer 73

A

Infection
Constipation
Urinary retention
Medications (e.g. anticholinergics, opiates, benzodiazepines)
Medication/drug withdrawal
Pain
Post-operative

Hypoxia
Electrolyte abnormalities
Hormonal imabalances (e.g. thyroid)
Thiamine deficiency
B12 deficiency
Trauma
Post-ictal

Answer 74

A

Delirium is an acute, fluctuating syndrome characterized by disturbed consciousness, attention, cognition, and perception

Subtypes:
Hypoactive
Hyperactive
Mixed

Answer 75

A

View organisms as machines that wear out over time.
Example: Elephant’s teeth wear down, leading to difficulties in feeding.
Limitation: Some animals, like sea anemones, do not exhibit ageing.

Answer 76

A

Ageing is a result of evolution and natural selection, advantageous for species but not for individuals.
Prevents old and worn-out individuals from competing with younger, more vital individuals.
Limitation: Ageing is rarely observed in natural populations.

Answer 77

A

Mutation Accumulation
Natural selection weakens with age, allowing deleterious mutations to accumulate.
Ageing is due to a collection of late-acting, harmful genes.
Limitation: Lacks experimental support.

Antagonistic Pleiotropic Genes
Genes beneficial early in life can have adverse effects later, contributing to ageing.
Example: Drosophila studies showing increased early fecundity but reduced longevity.

Answer 78

A

Organisms allocate resources between reproduction and body maintenance.
Limited investment in maintenance leads to ageing as repair mechanisms eventually fail.

Answer 79

A

specific genes that either promote longevity or contribute to the ageing process.
“geronto-genes”
longevity assurance genes in various organisms.

Example:
Telomeres and Telomerase: ends of chromosomes that protect them from deterioration. Each time a cell divides, telomeres shorten. When they reach a critical length, the cell can no longer divide

Answer 80

A

maintenance of DNA integrity over time.
As organisms age, the ability to repair DNA damage declines, leading to an accumulation of genetic errors that contribute to the ageing process.

Example:
Free Radical Theory:
reactive oxygen species (ROS) produced during cellular metabolism can damage DNA, proteins, and lipids. Over time, the accumulation of such damage leads to genomic instability and contributes to ageing. Enzymes like superoxide dismutase (SOD) and catalase help mitigate this damage, but their efficacy decreases with age.

Answer 81

A

At the cellular level, ageing manifests through processes such as cell senescence, where cells lose their ability to divide and function properly, contributing to tissue dysfunction.

Examples:

Cell Senescence: Senescent cells cease to divide and can secrete inflammatory cytokines, growth factors, and proteases, collectively known as the senescence-associated secretory phenotype (SASP). This can disrupt tissue structure and function and promote age-related diseases. For instance, increased senescent cell numbers are observed in osteoarthritis and pancreatic dysfunction.

Hayflick Phenomenon: Normal somatic cells have a limited capacity for division, known as the Hayflick limit. After a certain number of divisions, cells enter a state of senescence due to telomere shortening.

Answer 82

A

At the systems level, ageing can be viewed through the decline in the function of entire organ systems and the interactions between them.

Examples:

Neuroendocrine Theory: This theory suggests that ageing is regulated by the decline in neuroendocrine function, particularly involving the hypothalamic-pituitary-adrenal axis. For instance, decreased pulsatile secretion of growth hormone and gonadotropin-releasing hormone (GnRH) is associated with ageing. Experimental interventions such as hypothalamectomy followed by hormone replacement have shown increased lifespan in rats.

Immune System Decline: The efficiency of the immune system decreases with age, a process known as immunosenescence. This contributes to increased susceptibility to infections, reduced response to vaccination, and a higher incidence of autoimmune diseases in the elderly.

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