Ageing Flashcards
Define ageing/senescence
biological process of growing old, with associated changes in physiology and increased susceptibility to disease and increased likelihood of dying.
Why do organisms age. 2 theories
- DAMAGE THEORY
2. PROGRAMMED AGEING THEORY
Outline damage theory of ageing
Accumulation of DNA damage. Loss of telomeres/oxidative damage. Ageing could be prevented if the damage could be repaired
Outline programmed ageing theory
genetic, hormonal and immunological changes over the lifetime of an organism lead to the cumulative deficits –> ageing
part of an inescapable biological timetable, just as growth and puberty are programmed to occur
Define population ageing
increasing age of an entire country, due to increasing life spans, and falling fertility rates.
How will UK population change
’s predicted there will be small increases in the number of younger people, but the largest increase will be in older people
Older patients are more likely to come with what presentation
A non-specific presentation means presentations where the underlying pathology is not immediately obvious, or clearly linked to the presentation
e.g. alls, delirium and reduced mobility
Giants of geriatric medicine (the 5Is)
immobility, intellectual impairment, instability, incontinence and iatrogenic problems.
Why can old people have delayed treatment
they attribute symptoms to another cause or “old age”, and lead to delays in treatment.
Atypical and non-specific presentations can lead to delays in treatment when the underlying problem is not recognised.
Frail definition
loss of functional reserve among older people which causes impairment of their ability to manage every day activities, and increases the likelihood of adverse events and deterioration when they are faced with a minor stressor.
Give an example of frailty
young person with mild pneumonia may need treatment with antibiotics at home
frail, older person with mild pneumonia may end up in hospital because the pneumonia causes delirium and reduced mobility.
What is the problem with drug treatment for older people
Changes in pharmacokinetics and pharmacodynamics can make drug treatments in older people more likely to cause harm.
Many drug trials have low numbers of older people, so the evidence for treatment is often extrapolated from younger people. In the past it was common to exclude older people from drug trials altogether.
What happens to the brain tissue with age
- Increased CSF, widened ventricles, gaps between the major gyri widen.
- White matter changes.
- Weight of brain changes
What happens to brain weight across life
maximum weight occurs at 20, stays until 40-50
Then reduces 2-3% each decade until 80, when you have 10% lower brain weight
t/f impairment of cognitive funciton is normal process associated with ageing
F. Some aspects of cognition change as a person ages, but significant impairment of cognitive function is not normal, even in the oldest old, and indicates that there is a problem.
Why have rates of dementia diagnosis been low historically
- Misinterpretation (thinking it’s normal for old people to have reduced cognition)
- Fatalism (there’s nothing we can do about it anyway)
- Social isolation of some older people, such that they have no one to notice any problems
What proportion of those with dementia have a diagnosis
70%
What is dementia and what are the main types
Dementia is a chronic, progressive, degenerative disease which causes a decline in cognition. The most common types of dementia (Alzheimer’s and vascular)
What is the progresion of dementia
Often start with memory problems, but over time will include all cognitive functions.
What is mild cognitive impairment
a specific term used to refer to people who have mild problems which do not interfere with their day-to-day life and don’t meet the diagnostic criteria for dementia
Differentiate dementia with delirium
Dementia= chronic progresive degenerative disease
Delirium- acute episode of confusion, usually with a clear precipitant such as infection or medication changes.
Dementia just affects cognition i.e. content (not alertness), whereas delirium affects both level and content (i.e. alertness and cognition)
T/F there is no link between delirium and dementa
F
Delirium usually resolves, but can leave some people with residual problems (ie dementia). Delirium is much more common in people who already have dementia.
What could be a cause of delirium
infection or medication changes
What test can help to distinguish dementia and delirium
Confusion Assessment Method (CAM) and 4AT are tools to help distinguish between delirium and dementia
What is life expectancy
statistical measure of how
long a person can expect to live
What is chronoloical age vs biological age
Chronological is how old you actually are
Biological is how old ur body is
Chronological ageing is inevitable but poor biological
ageing is not…
Challenges for society of ageing populatin
- Working life/retirement balance
- Caring for older people, the sandwich generation
- Extending healthy old age not just life expectancy
- Inadequate or absent services
- Outdated and ageist beliefs/assumptions
- Medical system designed for single acute diseases
- Limited accessibility for those with disabilities
What is compression of morbidity
As life expectancy increased, people were getting ill at the same point and just living with morbidity for longer
That changed so that now people get ill later and live longer, so there is less time spent ill
What is health span
Health span is the time before disease, and you want this to inrcrease
What symptoms are old people more and less likely to have with PE and Acute coronary syndrome
Acute Coronary Syndrome • Less likely to have chest pain – Pulmonary Embolism • Less likely to have pleuritic chest pain • Less likely to have haemoptysis
– Acute Coronary Syndrome
• More likely to have shortness of breath
– Pulmonary Embolism
• More likely to have syncope
What proportion of over 65s and over 75s have multiple morbidity
The majority of over-65s have 2 or more conditions, and the majority of over-75s have 3 or more
conditions
-ve impacts of multimorbitity
– 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
What poor outcomes is polypharmacy associated with
– Falls – Increased length of stay – Delirium – Mortality – Adverse drug reactions
What is the biggest cause of hospital acquired complications for old frail people in hospital
- Medication related problem
Give an example of a prescribing cascade
- Patient has high blood pressure
- They are given amlodipine
- That causes ankle swelling, which is mistaken for HF
- Furesomide given
- Patient becomes hypotensive and falls and has a fracture (Fall and Colles fracture)
Why are old people at increased risk of harm
- Reduced physiological reserve
- Impaired compensation mechanisms
- Comorbidities
- Polypharmacy
- Cognitive impairment
What is the CGA
Comprehensive Geriatric Assessment (CGA) • A multidimensional, interdisciplinary assessment that leads to an individualised, goal based plan
Community (reduce admissions, falls, benfit family) or for frail patients (reduce mortality, cognitive decline)
What is rehabilitation
Aim is to restore or improve functionality
Prevent deconditioning
Prehabilitation (optimise patient before surgery so to prevent deconditioning after i.e get them as fit and prepared as possible)
What is normal change in ageing, and what doesn’t usually change
NORMAL: • Processing speed slows • Working memory slightly reduced • Simple attention ability preserved, but reduction in divided attention • Executive functions generally reduced
No change in nondeclarative/implicit memory • No change in visuospatial abilities • No overall change in language (some reduction in verbal fluency)
Components of higher brain function
- Level of consciousness
- = Alertness
- Content of consciousness
- = Cognition
What is dementia with regard to higher brain function
Progressive decline in all domains of
cognition (alertness fine)
What are the effects of dementia
– Loss of executive function
– Functional impairment
– Behavioural and psychological changes
– Lack of insight
What is delirium
Acute brain failure
What is 4AT
SCREENING
4AT
Alertness
AMT4 (abreviated mental test, i.e 4 simple questions)
Attention (months of year backwards, can do it in dementia but not in delirium)
Acute
What is the MOCA
SCREENING
Montreal Cognitive Assessment (MOCA)
Looks at different parts of cognition
Memory
Language etc
Advantages of the MOCA
Good because tests lots of domains of cognition, brief to administer (10mins), validated in a range of populations, widely used and available in translated versions
Disadvantage: education level affects results, language level affects results, can be poorly administered, practice/coaching effects
General problems with cognitive tests
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
Normal cognitive changes (slower processing
speed, slower reaction times) may affect
administration
What is AMT, MOCA, MMSE and CAM?
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 (MMSE) is a slightly outdated assessment which is less widely used that previously.
Confusion Assessment Method (CAM) and 4AT are tools to help distinguish between delirium and dementia
