Ageing

Question 1

What is the definition of ageing?

Answer 1

Biological process of growing old with associated changes in physiology and increased susceptibility to disease and increased likelihood of dying

Question 2

What are the two broad categories for theory of why organisms age?

Answer 2

Damage or error theories- accumulation of damage to DNA, cells and tissues- loss of telomeres or oxidative damage. If we could prevent this damage, we could prevent ageing
Programmed ageing- Genetic, hormonal and immunological changes over the lifetime of an organism lead to cumulative defects we see as ageing. Inescapable biological timetable

Question 3

What does population ageing refer to?

Answer 3

Increasing age of an entire country due to increasing life spans and falling fertility rates- reflects the successes of public health policies, education and socioeconomic development but brings challenges for societies as they try to adapt

Question 4

What problems are caused by an ageing population?

Answer 4

Outdated and ageist beliefs/assumptions
Working life/retirement balance
Medical system designed for single acute diseases
Extending healthy old age not just life expectancy
Inadequate or absent services
Lack of accessibility for people with disabilities

Question 5

What is social care in England?

Answer 5

It is given based on a financial assessment and involves:
Home carers
Sheltered housing
Care home
Personal budgets

Question 6

What is life expectancy?

Answer 6

Statistical measure of number of years a person can expect to live- rising continuously for many years

Question 7

What is the life expectancy for a man and woman now?

Answer 7

Man- 79

Woman- 83

Question 8

What is predicted to be the outcome of the increasing life expectancy?

Answer 8

More young people but even more older people

Question 9

What does a non-specific presentation mean?

Answer 9

Presentations where the underlying pathology is not immediately obvious or clearly linked to the presentation. Falls, delirium and reduced mobility are all common reasons for older people seeking medical attention and can be due to variety of underlying problems including stroke, myocardial infarction, infections and changes to medication

Question 10

What are the giants of geriatric medicine?

Answer 10

Immobility
Intellectual impairment
Instability
Incontinence 
Iatrogenic problems

Question 11

What is the medical meaning of frailty?

Answer 11

Loss of functional reserve among older people which causes impairment of their ability to manage every day activities and increases likelihood of adverse events and deterioration when they are faced with a minor stressor.

Question 12

What can atypical and non-specific presentations lead to?

Answer 12

Delays in treatment when underlying problem isn’t recognised

Question 13

What happens to the brain with age?

Answer 13

CT and MRI has shown that volume of cerebral spinal fluid within surrounding brain increases with age, the ventricles enlarge and gaps between major gyri widen

Question 14

What percentage of normal elderly persons show some degree of white matter?

Answer 14

About 50%

Question 15

When does the brain attain its maximum weight?

Answer 15

Around 20 years old and it then remains at his weight until 40-50 after which it decreases

Question 16

What are normal cognitive changes that occur in older people?

Answer 16

Processing speed slows
Working memory slightly reduced
Simple attention ability preserved but reduction in divided attention
Executive functions generally reduced
No change in non declarative memory
No change in visuospatial abilities
No overall change in language

Question 17

Why have rates of dementia been low in the past?

Answer 17

Misinterpretation, fatalism (can’t do anything about it) and social isolation of older people- 70% of those with dementia have a diagnosis

Question 18

What is the definition of dementia?

Answer 18

Chronic, progressive, degenerative disease which causes a decline in cognition

Question 19

What are the most common types of dementia?

Answer 19

Alzheimer’s and vascular

Question 20

How does dementia commonly develop?

Answer 20

With memory problems and then over time all cognitive functions

Question 21

What is the definition of delirium?

Answer 21

Acute episode of confusion usually with a clear precipitant such as infection or medication changes

Question 22

Give examples of tests used for cognitive assessment?

Answer 22

Abbreviated mental test (AMT) and clock drawing tests are brief screening tests for cognitive impairment
Montreal cognitive assessment (MOCA) is a more detailed examination in wide general use
Mini mental state examination is a slightly outdated assessment which is less widely used than previously
Confusion assessment method and 4AT are tools to help distinguish between delirium and dementia

Question 23

What does an AMT consist of?

Answer 23

DOB
Age
Current place
Year
Dates of WW2
Monarch or PM
Count 20-1
Recognise 2 people
Remember 3 item address