Age and Ageing Flashcards
What is realistic medicine
shared decision making
personalised approach to care
reduce harm and waste- over investigation/treatment
reduce unnecessary variation in practice and outcomes
manage risk better
HOLISTIC
HEALTH LITERACY (patients more aware of how their disease will behave)
NOT:
RATIONING
AGEISM
CAPPING
PARTY POLITICAL IDEAS
what is included in multifactorial decision ,aking
clinical judgement
relevant scientific evidence
patient values and preferences
what is the theory of MOLECULAR aging
age related programmed genetic regulation by EPIGENETIC MODIFICATIONS
gene methylation (genes off)
histone modification
accumulation of mutations
what is epigenetic modification
modifications to DNA that regulate whether genes are turned on or off.
don’t change the building blocks of DNA sequencing
what is the CELLULAR theory of ageing
Chromosomal level
-telomere shortening- progressive loss of chromosome caps
-free radical damage to DNA
-apoptosis- programmed cell death
what is the theory of ENVIRONMENTAL and EVOLUTIONARY ageing
-wear and tear– inability to regenerate damaged tissue
-cumulative UV and ionising radiation damage
-“disposable soma”– no evolutionary advantage in survival beyond reproduction and rearing children
what happens to organ function with age
PHYSIOLOGICAL PROCESS- age related decline in every organ/system
-not life limiting but declining reserves
-eg. cardiac output, maximal energy output, renal function
-acute temporarily dips into insufficient organ function but bounce back (old might not be able to bump back)
what is the impact of increasing disease incidence with age
-many with have several chronic conditions
-diseases become more common
-each condition might have several medications prescribed- POLYPHARMACY
-meds might be for symptoms/ risk reduction
-relative vs absolute risk reduction
-hard to measure benefit for one individual
what is the difference between relative and absolute risk
relative looks better (eg. for drug companies as percentages are bigger)
Relative risk reductions give a percentage reduction in one group compared to another. These can be misleading and over-exaggerate how helpful something is. – Absolute risk reductions give the actual difference in risk between one group and another.
what is the effect on health costs from age
what is money spent on
rise with increasing age
burden of disease links to deprivation index
-smoking
-alcohol
-diet and obesity
-housing
pushes cost to the left (more expensive sooner)
MONEY ON:
hospital and community health services
family health services
pharmaceutical services
capital spending
total health spending
What is holistic approach
whole person- physical, psychological, social, functional well being
what is involved in a comprehensive geriatric assessment
-balance assessment of falls risk
-psychological assessment
-functional capacity
-environmental hazards
-medical and medication review
what is frailty
clinically recognizable state of increased vulnerability resulting from aging-associated decline in reserve and function across multiple physiologic systems
ability to cope with everyday or acute stressors is compromised
moving from independent to dependent functional abilites
NOT DEPENDENT ON REACHING A CERTAIN AGE
what are some characteristics of frailty/ phenotype
unintentional weight loss
slow walking speed
reduced muscle strength
exhaustion
low energy expenditure
what are the PRISMA 7 questions
more than 85?
male?
limited by health problems?
do you need help on a regular basis?
do your health problems require you to stay at home?
if needed, is someone available to help?
walking aid?
