Ageing Flashcards
what are the main concepts in ageing?
Frailty
multi-morbidity
polypharmacy
non-specific
presentations and the geriatric giants
comprehensive geriatric assessment
multidisciplinary working
what is ageing?
the process of growing older:
- social
- psychological/cognitive
- biological
what is life expectancy?
statistical measure of how long a person can except to live
what are the biological theories of ageing?
programmed ageing - the idea that ageing is genetically programmed to occur with time and this process of deterioration will eventually lead to death.
Damage or error theories - the idea that external or environmental forces gradually damage cells and organs leading to ageing and death.
what are the theories in programmed ageing?
genetic life-span
genetic pre-disposition
telomere theory
specific system theories (neuroendocrine theory)
what are the damage or error theories?
wear and tear
rate of living
waste product accumulation
cross linking
free radical
autoimmune
error
order to disorder
why do people age at different age?
chronical age vs biological age
can we prevent ageing?
No but we can promote healthy eating:
- healthy diet
- exercise
- no smoking
- no alcohol
what is the Uk’s population?
this is an ageing population
the over 85 group is increasing most rapidly.
not just in UK it is all over the world.
why are people living longer?
better support
better lifestyles
better medical intervention
what challenges does society face as a result of ageing?
working life/retirement balance - huge disparity in that group.
caring for older people- lots of the elderly live alone.
extending healthy old age and not just life expectancy- health age is not random but determined
inadequate or absent services - housing is a big issue.
outdated and ageist beliefs/assumptions -frail and dependant are common stereotypes.
medical system designed for single acute diseases
access and connectivity- due to loss of mobility. this leads to loneliness and isolation.
what is the sandwich generation?
people in the 30’s and 40’s who have to look after children and parents –> they are under a large amount of pressure.
what is delayed transfer of care?
when someone is stuck in hospital because they cannot be transported home.
what is frailty?
a physiological syndrome characterized by a decreased reserve and resistance to stressors, resulting from cumulative decline across multiple physiological system and causing vulnerability to adverse outcomes.
how does frailty develop?
genetic and environmental factors which leads to damage to the molecular and cellular system .
as you get older physical activity and nutritional factors play a large role.
if you become frail and you undergo a stressor event you will develop the geriatric giants and this will lead to increased care needs + admission to hospital.
what are the geriatric giants?
falls
delirium
fluctuating disability
can you treat frailty?
exercise
nutrition
drugs (not really at the moment)
prevention is better than cures
what are non-specific presentations in the elderly?
Falls
reduced mobility
confusion
weight loss
not coping
iatrogenic harm
older people are less likely to present with textbook symptoms for common diseases.
why is multi-morbidity important?
conditions impact one another
treatment of one condition may impact on another
worse quality of life - more likely to be depressed
increased functional impairment
burden of treatment
polypharmacy - multiple medication
why do older people take more drugs?
multi-morbidity
guidelines/QOF/NICE - clinical trials do not usually don’t include elderly
undetected non-adherence
infrequent review
poor communication
what is potentially inappropriate prescribing?
Giving drugs that they may not need.
polypharmacy will lead to:
- falls
- increased length of stay
- delirium
- mortality
there can be adverse drug reactions
prescribing cascade
why are older people at increased risk of harm?
reduced physiological reserve
impaired compensation mechanisms
comorbidities
polypharmacy
cognitive impairment.
how do we make things for people with frailty?
comprehensive geriatric assessment:
-a multidimensional interdisciplinary assessment that leads to an individualised, goal based plan.
looking at:
- physical health
- mental health
- functional ability
- social circumstances
- environment
can be done in the community: reduces falls and admissions to institutional care.
what is rehabilitation?
this aims to restore or improve functionality
alongside acute illness this is to prevent de-conditioning
prehabilitation
what are the changes in the ageing brain?
atrophy - lose cells
cerebral vascular disease
very common in the elderly.
processing speed slows
working memory is reduced
reduced divided attention
executive functions generally reduced.
NO changes in:
- non-declarative memory
- visuospatial abilities
- overall change in language
what are issues associated with the common presentation of confusion?
can be many things
delirium
dementia
dysphasisa, deafness???
what are the components of higher brain function?
1- level of consciousness = alertness
2- content of consciousness = cognition
what is dementia?
progressive decline in all domains of cognition.
not just memory impairment:
-loss of executive function
- functional impairment
- behavioural and psychological changes
- lack of insight
PROGRESSIVE
DEGENERATIVE
IRREVERSIBLE
What is delirium?
an acute global failure of higher brain function.
alertness and cognition
= acute brain failure
differences between dementia and delirium?
dementia:
chronic
gradual progression
no change in
consciousness level
irreversible
delirium:
acute
fluctuating
alertness and attention problem
usually reversible
precipitated by something
what are the cognitive tests which are used?
screening tests:
4AT :
alertness
AMT (age, name, DOB and place).
attention (Months of the year in backward order)
acute or fluctuating
4 or above = delirium
MOCA is another test that is used - can see which are is impaired the most BUT education level will affect results
what are problems of cognitive assessments?
hearing and visual impairment
physical problems
most assume basic cultural knowledge
depression can masquerade as dementia
not valid in acute illness and there are normal cognitive changes which must be accounted for.
