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Year 2 - LCRS - RDA > Ageing (10.03.2020) > Flashcards

Ageing (10.03.2020) Flashcards

1
Q

What is ageing?

A

Ageing is the process of growing older

Aspects:

  • 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

What is the life expectancy of a girl born in the UK today?

A

83

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4
Q

Asepcts of the changing nature of the older population.

A
  • Increasing numbers of BAME 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

Theories as to why people age?

A

Programmed ageing

  • ageing is build into DNA
  • cells will divide a certain number of times and then stop dividing
  • Telomere perform this counting function, they get shorter and shorter as the cell divides.
  • we age because they stop dividing and we cannot generate new cells.
  • That is to protect us from cancer
  • if we could alter our genes and improve telomerase we could perhaps expand or lifespan

Damage or error theories

  • cells accumulate damage
  • from variation, free radicals, oxygenation, DNA damage, DNAA disrepair.
  • e.g. calorie restriction in mice increases life span

=> no clinical applicability for this at the moment

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6
Q

Ageing take home messages

A
  • No proven specific anti-ageing therapies in humans
  • People age at different rates
    • Chronological age vs biological age (e.g. lifestyle can make you biological age older than your chronological age)
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7
Q

What challenges does society face as a result of population ageing?

A
  • Working life/retirement balance - dependency ratio
  • Extending healthy old age not just life expectancy (most people spend some time eat the end of their life having medical problems)
  • Caring for older people, the sandwich generation
  • Outdated and ageist beliefs/assumptions
  • Medical system designed for single acute diseases
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8
Q

What determines health at old age?

A
  • where you live - how much pollution
  • your job - how much stress
  • access to healthcare
  • genetics
  • lifestyle
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9
Q

What proportion of over 65s live in a care home?

A

3%

this is different to residential facilities

people are quite physically dependant in care homes

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10
Q

What are some of the problems with social care?

A
  • Means testing - it’s not like the NHS
  • catastrophic costs: selling homes to pay for care
  • unmet need: people going without the care and support they need
  • quality of care: 15-minute care visits and neglect
  • workforce pat and conditions: underpaid and overworked staff
  • market fragility: care home companies go out of business
  • disjointed care: delayed transfers of care and lack of integration with health
  • the postcode lottery: unwarranted variation in access and performance.

=> the whole system is a mess.

e.g. people that pay privately subsidise for the people paid by the council (the council does not pay enough to cover the cost)

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11
Q

Sandwich generation

A
  • 1.25m sandwich carers in the UK
    • caring for an older relative
    • whilst bringing up children
  • 68% women
  • 78% also in paid work
  • 88 000 (84% women) provide more than 35h of care/week (not paid to do this)
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12
Q

Implications of ageing for health care services

A
  • Increasing demand for primary, secondary and tertiary health care
  • Increasing complexity
  • Navigating the health and social care divide
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13
Q

Disease presentation in old age

A

Identify the altered presentation of disease with age

  • FRAILTY
  • Non-specific presentations

Summarise the difficulties in managing disease in older people

  • Multimorbidity
  • Polypharmacy
  • Iatrogenic harm
  • Comprehensive geriatric assessment
  • Rehabilitation

Recognize the social and multidisciplinary management of the ageing population

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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

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15
Q

Factors affecting fralty

A
  • environmental
  • genetic
  • cumulative molecular and cellular damage
  • reduced physiological reserve
  • physical and nutritional factors
  • due to a stressor event an older, frail person is more likely to develop problems (loss of lung capacity etc.)
  • e.g. UTI
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16
Q

Rockwood frailty scores

A
  • 1-3 is not frial
  • 4 is pre-frail
  • 5,6,7 mild, moderate severe frailty
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17
Q

Can we prevent frailty?

A

yes

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18
Q

Can we treat frailty?

A

yes (to some extent)
but it is hard to turn around and go back to mild frailty

  • Exercise
  • Nutrition
  • Drugs (possibly)

Prevention is better than cure!!!

19
Q

Non-specific presentations

A
  • Falls
  • Reduced mobility
  • Recurrent infections
  • Confusion (increased or new)
  • Weight loss
  • “Not coping”
  • Iatrogenic harm
20
Q

Non-specific presentations

A
  • Falls
  • Reduced mobility
  • Recurrent infections
  • Confusion (increased or new)
  • Weight loss
  • “Not coping”
  • Iatrogenic harm

=> these are presentations and not diagnoses

  • Older people are less likely to have common, “textbook” symptoms of disease
  • ACS - less likely to have chest pain; more likely to have SoB
  • PE: less likely to have pleuritic chest pain to haemoptysis; more likely to have syncope.

Getting the diagnosis and getting treatment is delayed.

21
Q

Multimorbidity

A
  • two or more chronic conditions

- more likely when you are older.

22
Q

Impact of multi morbidity

A
  • Conditions impact on one another
  • Treatment for one condition may impact on another
  • Negative impacts
    • Worse QoL, more likely to be depressed
    • Increased functional impairment
    • Burden of treatment
    • Polypharmacy *you might want to give drug A but you cannot give it because of drug B or because of a certain condition)
23
Q

How many people take more than 10 drugs

A

> 10% of older people are taking 10 or more medications

24
Q

Why do older people take more drugs?

A
  • Multimorbidity (how you manage conditions together might be different to how you treat conditions on their own)
  • Guidelines/QOF/NICE (guidelines usually only take one single condition into account)
  • Undetected non-adherence (can be up to 60%; you have to ask!!)
  • Infrequent review (e.g. at around 80 the BO starts going down again so you might want to take them off meds, frequent review is very helpful!)
  • Poor communication
25
Q

PIP

A

Potentially inaproppraite polypharmacy

  • Up to 40% of prescriptions are inappropriate
  • Polypharmacy is associated with bad outcomes
    • Falls
    • Increased length of stay
    • Delirium
    • Mortality
26
Q

Iatrogenic harm

A
  • Adverse reactions to medications
  • Nosocomial conditions
    • Infections
    • Pressure sores
    • Constipation
    • Deconditioning (huge problem: e.g. muscle mass loss (you can loose 1kg of muscle mass in a week of bed rest), loss in BMD etc. so when you are ill you should continue moving and doing the things you generally do if possible)
    • Delirium
    • Malnutrition
    • Incontinence
  • Falls
  • Psychological/cognitive damage

e.g. antipsychotics can cause drug induced Parkinson’s -> you shouldn’t treat with levodopa but stop the meds that are causing it.

  • 2 – 36% of inpatients
  • Half probably avoidable
27
Q

Colles fracture

A

A Colles Fracture is a complete fracture of the radius bone of the forearm close to the wrist resulting in an upward (posterior) displacement of the radius and obvious deformity.

28
Q

ADRs

A

= adverse drug reactions

  • Up to 17% of hospital admissions are due to drug reactions
  • The more medications taken, the greater the risk
29
Q

Which drug is most likely to be the cause of a hospital admission?

NSAIDS, opioids, warfarin, digoxin, antidepressants..?

A
  • NSAID 30%
  • Opioid 6%
  • Warfarin 10%
  • Digoxin 3%
  • Antidepressant 7%
30
Q

Why are older people at increased risk of harm from drugs?

A
  • Reduced physiological reserve
  • Impaired compensation mechanisms
  • Comorbidities
  • Polypharmacy
  • Cognitive impairment
31
Q

CGA - why is it useful?

A
  • Comprehensive geriatric assessment (CGA)

CGA in the community

  • Reduce admissions to institutional care
  • Reduce falls
  • Most benefit in mild or moderate frailty

CGA for frail inpatients

  • Reduces inpatient mortality
  • Reduces functional and cognitive decline
  • Reduces admission to institutional care
  • reduces death after being sent home from the hospital
32
Q

CGA - how?

A

Multidisciplinary assessment

  • Medical
  • Functional
  • Social
  • Psychological/psychiatric

Problem list
Plan

(much more assessment than e.g. with an ED admission)

33
Q

Rehanilitation

A
  • Aim is to restore or improve functionality
  • Multidisciplinary
  • Rehabilitation alongside acute illness
    • Preventing deconditioning
  • Prehabilitation
34
Q

Disease presentation in older age

A

Identify the altered presentation of disease with age
Frailty
Non-specific presentations
Summarise the difficulties in managing disease in older people
Multimorbidity
Polypharmacy
Iatrogenic harm
Comprehensive geriatric assessment
Rehabilitation
Recognize the social and multidisciplinary management of the ageing population

35
Q

Changes in the ageing brain

A
  • grey matter reductions (daily in size not in number)
  • you lose connections between neurones
  • white matter reductions
  • atrophy
  • ventricles enlarge
36
Q

Normal cognitive changes in older people

A
  • Processing speed slows (e.g. it may take longer to respond and think things true, less white matter)
  • Working memory slightly reduced (e.g. remembering telephone numbers)
  • Simple attention ability preserved, but reduction in divided attention
  • Executive functions generally reduced (incl. reduction in problem solving abilities, this actually starts at 45)
  • No change in nondeclarative memory (e.g. how to cook a meal)
  • change in short term memory is not normal! It is a sign of cognitive impairment.
  • No change in visuospatial abilities
  • no change in autobiographical memory, even in people with dementia they seem to remember this
  • No overall change in language (some reduction in verbal fluency e.g. not being able to find the right word)
37
Q

What is dementia?

A
  • Decline in all cognitive functions, not just memory
  • Impairment of function
  • Progressive
  • Degenerative
  • Irreversible
38
Q

Can we prevent dementia?

A
  • yes (lifestyle, foods exercise, no smoking, less alcohol)
39
Q

Types of dementia

A
  • alzheimers (memory problems more profound)
  • vascular (processing speed slower)
  • levy-body
40
Q

Cognitive assessments

A
  • Screening tests
    • AMT, clock drawing test
    • MMSE (mini mental state examination, not used in clinical practice anymore because of problems incl. copyright bought some years ago and more used for Alzheimer’s)
    • MOCA (montreal cognitive assessment)
  • Diagnostic tests
    • ACE (Addenbrooke’s Cognitive Examination)
    • Detailed neuropsychometric testing
41
Q

Advantages of MOCA

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
42
Q

Disadvantages of MOCA

A
  • Education level will affect results (you cane add one point if someone had less than 12y of education however it might actually take away more points if you are not educated)
  • Language level will affect results
  • Floor and ceiling effects (if you are very educated you may be demented but still score well)
  • Can be poorly administered (you have to do training now, but it is short)
  • Possibly practice/coaching effects
43
Q

Problems with cognitive assessments in general

A
  • Hearing and visual impairment may limit testing
  • Physical problems may limit testing
  • Most assume numeracy and literacy
  • Most assume some basic cultural knowledge
  • Depression can masquerade as dementia
  • Not valid in acute illness (e.g. if acutely confused)
  • Normal cognitive changes (slower processing speed, slower reaction times) may affect administration

=> interpret them in context

44
Q

Summary

A
  • Ageing mechanisms and societal consequences
  • Frailty
  • Multimorbidity and polypharmacy
  • Non specific presentations and the geriatric giants
  • Comprehensive geriatric assessment
  • Cognitive changes and assessment in older people

Year 2 - LCRS - RDA (11 decks)

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