Ageing Flashcards
define ageing
biological process of growing old,
with associated changes in physiology and increased susceptibility to disease and increased likelihood of dying.
Theories why organisms
age:
Damage or error theory
- accumulation of damage to DNA,
Programmed ageing theoriy
give some examples of damage or error and what the theory could mean for ageing
loss of telomeres or oxidative damage as the cause of ageing.
If
we could prevent or repair this damage, we could prevent ageing.
describe Programmed ageing theories and what the theory could mean for ageing
genetic, hormonal and immunological
changes over the lifetime of an organism lead to the cumulative deficits we see as
ageing.
inescapable biological
timetable
define Life expectancy
statistical measure of the number of years a person can expect to live.
Rising continuously for many year
Challenges society face due to ageing population:
Outdated and ageist beliefs/ assumptions
Working life/ retirement balance
Medical system designed for single acute diseases
Extending healthy old and not just life expectancy
Inadequate or absent services
what does an ageing population reflect
the successes of public health policies, education
and socioeconomic development,
Social care in England includes…..
home carers, sheltered housing, care homes (residential and
nursing), personal budgets.
identify the altered presentation of disease with age
Older people are more likely to have an atypical or non-specific presentation of disease;
where the underlying pathology is not immediately obvious or clearly linked to the
presentation.
what are common reasons or old
people to seek medical attention
falls, delirium and reduced mobility
may be due to a variety of underlying problems
such as stroke, MI or infection.
what is an issue with these non specific presentations
can lead to delays in treatment when
the underlying problem is not recognised.
what are Iatrogenic problems
illnesses caused by healthcare treatments and are more common in
older people.
include mistakes in providing care, and known complications of
treatment.
ADRs + cognitive damage
define frailty
loss of functional reserve which causes and resistance to stressors resulting from
cumulative decline
what is the significance of frailty give example
increases the likelihood of adverse events
and deterioration when faced with a minor stressor
example: a frail, older person with
mild pneumonia may end up in hospital because the pneumonia causes delirium and
reduced mobility.
what is another difficulty of presentation with elderly people (number of problems…..)
often present with multiple problems which all need to be managed
simultaneously (multi-morbidity).
conditions/treatment may impact one another
Negative impacts of Multimorbidity
-Worse QoL, more likely to be depressed
– Increased functional impairment
– Burden of treatment
– Polypharmacy
Why do older people take more drugs?
Multimorbidity • Guidelines/QOF/NICE • Undetected non adherence • Infrequent review • Poor communication
Polypharmacy is associated with bad
outcomes……
Falls – Increased length of stay – Delirium – Mortality - ADRs
why is treatment evidence not always applicable to older people
Drug trials tend to use younger people
Changes in pharmacokinetics and pharmacodynamics can make drug treatments in older
people cause harm.
what assessment can be used to make things better for people with frailty
Comprehensive Geriatric
Assessment (CGA)
multidimensional interdisciplinary assessment that leads to an individualised goal based plan
requires MDT
– Medical – Functional – Social – Psychological/psychiatric • Problem list • Plan
Changes in the ageing brain
Volume of CSF within the surrounding brain increases with age, the ventricles enlarge and
the gaps between the major gyri widen.
how does brain size change over lifetime
Brain reaches a maximum weight at around 20 years and remains the same till around 40-45 years, after which it decreases in weight at a rate of 2-3% per decade.
Normal cognitive changes in older people
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/implicit memory
- No change in visuospatial abilities
- No overall change in language (some reduction in verbal fluency)
define Alertness
Level of consciousness
define Cognition
Content of consciousness •
what is dementia
chronic, progressive, degenerative disease which cause a decline in cognition.
what do most common types fo dementia start withy symptom wise
The most common types (Alzheimer’s and vascular) often start with memory problems, but over time include all cognitive functions
Loss of executive function
– Functional impairment
– Behavioural and psychological changes – Lack of insight
what us delirium and what are consequences
an acute episode of confusion/ brain failure, usually with a clear precipitant such as infection or medication changes.
It usually resolves, but can leave people with residual problems such as dementia
affects alertness and cognition
in which group of people is delirium more likely to occur
much more common in people who already heave dementia.
give 2 examples of Cognitive assessments
Mini Mental State Examination (MMSE)
Montreal Cognitive Assessment (MOCA)
dvantages of the MOCA
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
problems with cognitive assessments in general
Hearing and visual impairment limit testing
- Physical problems may limit testing
- Most assume numeracy/ literacy/cultural knowledge
- Normal cognitive changes (slower processing speed, slower reaction times) may affect administration
- Depression can masquerade as dementia
- Not valid in acute illness
What are the disadvantages of the MOCA?
Education level will affect results • Language level will affect results • Floor and ceiling effects • Can be poorly administered • Possibly practice/coaching effects
