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Rob's RDA > Ageing > Flashcards

Ageing Flashcards

1
Q

Define ageing/senescence

A

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

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2
Q

Why do organisms age. 2 theories

A
  1. DAMAGE THEORY

2. PROGRAMMED AGEING THEORY

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3
Q

Outline damage theory of ageing

A

Accumulation of DNA damage. Loss of telomeres/oxidative damage. Ageing could be prevented if the damage could be repaired

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4
Q

Outline programmed ageing theory

A

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

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5
Q

Define population ageing

A

increasing age of an entire country, due to increasing life spans, and falling fertility rates.

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6
Q

How will UK population change

A

’s predicted there will be small increases in the number of younger people, but the largest increase will be in older people

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7
Q

Older patients are more likely to come with what presentation

A

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

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8
Q

Giants of geriatric medicine (the 5Is)

A

immobility, intellectual impairment, instability, incontinence and iatrogenic problems.

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9
Q

Why can old people have delayed treatment

A

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.

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10
Q

Frail definition

A

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.

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11
Q

Give an example of frailty

A

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.

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12
Q

What is the problem with drug treatment for older people

A

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.

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13
Q

What happens to the brain tissue with age

A
  1. Increased CSF, widened ventricles, gaps between the major gyri widen.
  2. White matter changes.
  3. Weight of brain changes
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14
Q

What happens to brain weight across life

A

maximum weight occurs at 20, stays until 40-50

Then reduces 2-3% each decade until 80, when you have 10% lower brain weight

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15
Q

t/f impairment of cognitive funciton is normal process associated with ageing

A

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.

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16
Q

Why have rates of dementia diagnosis been low historically

A
  1. Misinterpretation (thinking it’s normal for old people to have reduced cognition)
  2. Fatalism (there’s nothing we can do about it anyway)
  3. Social isolation of some older people, such that they have no one to notice any problems
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17
Q

What proportion of those with dementia have a diagnosis

A

70%

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18
Q

What is dementia and what are the main types

A

Dementia is a chronic, progressive, degenerative disease which causes a decline in cognition. The most common types of dementia (Alzheimer’s and vascular)

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19
Q

What is the progresion of dementia

A

Often start with memory problems, but over time will include all cognitive functions.

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20
Q

What is mild cognitive impairment

A

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

21
Q

Differentiate dementia with delirium

A

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)

22
Q

T/F there is no link between delirium and dementa

A

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.

23
Q

What could be a cause of delirium

A

infection or medication changes

24
Q

What test can help to distinguish dementia and delirium

A

Confusion Assessment Method (CAM) and 4AT are tools to help distinguish between delirium and dementia

25
Q

What is life expectancy

A

statistical measure of how

long a person can expect to live

26
Q

What is chronoloical age vs biological age

A

Chronological is how old you actually are
Biological is how old ur body is

Chronological ageing is inevitable but poor biological
ageing is not…

27
Q

Challenges for society of ageing populatin

A
  • 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
28
Q

What is compression of morbidity

A

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

29
Q

What is health span

A

Health span is the time before disease, and you want this to inrcrease

30
Q

What symptoms are old people more and less likely to have with PE and Acute coronary syndrome

A 
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

31
Q

What proportion of over 65s and over 75s have multiple morbidity

A

The majority of over-65s have 2 or more conditions, and the majority of over-75s have 3 or more
conditions

32
Q

-ve impacts of multimorbitity

A

– Worse QoL, more likely to be depressed
– Increased functional impairment
– Burden of treatment
– Polypharmacy

33
Q

Why do older people take more drugs

A
  • Multimorbidity
  • Guidelines/QOF/NICE
  • Undetected non adherence
  • Infrequent review
  • Poor communication
34
Q

What poor outcomes is polypharmacy associated with

A 
– Falls
– Increased length of stay
– Delirium
– Mortality
– Adverse drug reactions
35
Q

What is the biggest cause of hospital acquired complications for old frail people in hospital

A
  1. Medication related problem
36
Q

Give an example of a prescribing cascade

A
  1. Patient has high blood pressure
  2. They are given amlodipine
  3. That causes ankle swelling, which is mistaken for HF
  4. Furesomide given
  5. Patient becomes hypotensive and falls and has a fracture (Fall and Colles fracture)
37
Q

Why are old people at increased risk of harm

A
  • Reduced physiological reserve
  • Impaired compensation mechanisms
  • Comorbidities
  • Polypharmacy
  • Cognitive impairment
38
Q

What is the CGA

A 
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)

39
Q

What is rehabilitation

A

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)

40
Q

What is normal change in ageing, and what doesn’t usually change

A 
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)
41
Q

Components of higher brain function

A
    1. Level of consciousness
  • = Alertness
    1. Content of consciousness
  • = Cognition
42
Q

What is dementia with regard to higher brain function

A

Progressive decline in all domains of

cognition (alertness fine)

43
Q

What are the effects of dementia

A

– Loss of executive function
– Functional impairment
– Behavioural and psychological changes
– Lack of insight

44
Q

What is delirium

A

Acute brain failure

45
Q

What is 4AT

A

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

46
Q

What is the MOCA

A

SCREENING

Montreal Cognitive Assessment (MOCA)

Looks at different parts of cognition

Memory
Language etc

47
Q

Advantages of the MOCA

A

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

48
Q

General problems with cognitive tests

A

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

49
Q

What is AMT, MOCA, MMSE and CAM?

A

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

Rob's RDA (10 decks)

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