Ageing

Question 1

Name the 2 theories of ageing

Answer 1

Programmed Ageing

Damage/ Error Theory

Question 2

Outline the Programmed Ageing theory of ageing

Answer 2

Cells have limited number of times they can divide due to genetic programming

Question 3

Outline the Damage/ Error theory of ageing

Answer 3

Mitochondrial generation of NO/ H2O2 free radicals damages mitochondira –> decreased respiration reactions –> cell death

Question 4

What is the stringest evidence for the Damage/ Error theory of ageing?

Answer 4

Ageing process accelerated in both smokers and those with inflammatory conditions

Question 5

What is the main reason for the ageing population?

Answer 5

Advances in public health that have prevented INFECTION SPREAD

Question 6

Recall 3 challenges faced by society on account of having an ageing population

Answer 6

1. Retirement/ pension is longer
2. Caring for older people
3. Extending HEALTHY age

Question 7

Define “frailty”

Answer 7

Loss of biological reserve across multiple organ systems, leading to vulnerability to physiological decompensation and functional decline after a stressor event

Question 8

What % of >85s are frail?

Answer 8

33-45%

Question 9

Recall 5 non-specific presentations of frailty

Answer 9

1. Falls
2. Weight loss
3. Confusion
4. Recurrent infection
5. Less “textbook” features of disease

Question 10

What are the 3 main spheres of difficulty in managing disease in older people?

Answer 10

Multimorbidity
Polypharmacy
Iatrogenic harm

Question 11

Recall 2 reasons for polypharmacy in the elderly

Answer 11

1. Undetected non-adherence

2. Infrequent review of meds

Question 12

What is inappropriate polypharmacy associated with increased risk of?

Answer 12

Falls

Delirium

Question 13

Give 3 examples of iatrogenic harm that the frail/ elderly are particularly vulnerable to

Answer 13

1. Giving bad drug combo eg amlodipine with frusemide
2. ADRs
3. Deconditioning

Question 14

Which drugs are most likely to cause ADRs?

Answer 14

NSAIDs

Question 15

Give 3 reasons that the elderly are at a particularly high risk of ADRs

Answer 15

1. Impaired physiological reserve
2. Impaired compensation mechanisms
3. Comorbidities

Question 16

What is a CGA?

Answer 16

Comprehensive Geriatric Assessment:

• MULTIdisciplinary
• Produces proble list and plan

Question 17

Recall 3 normal changes in the ageing brain

Answer 17

1. Very slight slowing in processing speed
2. Reduction in divided (but not simple) attention
3. Reduction in executive function

Question 18

Recall the key definitive features of dementia

Answer 18

Decline in ALL cognitive functions that is progressive, degenerative and irreversible

Question 19

How does dementia differ from delirium?

Answer 19

Unlike dementia, delirium is acute, fluctuates and alters conscious level

Question 20

What is the most useful form of cognitive assesment?

Answer 20

Montreal Cognitive Assessment

Question 21

What is assessed by the MCA?

Answer 21

Visuospatial funciton, naming, memory and attention

Question 22

Recall 4 advantages of the MCA

Answer 22

Covers a variety of domains
Brief
Available in translated versions
Widely-used

Question 23

Recall 4 disadvantages of the MCA

Answer 23

Affected by education level
Floor and ceiling effects
Can be poorly-administered
May have coaching/ practise effects

Question 24

Recall 3 general limitations of cognitive assesment tests

Answer 24

Affected by:
Hearing/ visual impairments
Assumption of numeracy and literacy
Acute illness

Question 25

Which cognitive test can be used diagnostically?

Answer 25

Addenbrooke’s Cognitive Examination