Ageing Flashcards
Define ageing
Ageing is the process of growing older:
- Biological
- Psychological/cognitive
- Social
Define life expectancy
Life expectancy is a statistical measure of how long a person can expect 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 eventually leads 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 explaining the programmed ageing theory?
- Genetic life-span theory
- Genetic predisposition theory
- Telomere theory
- Specific system theories (Neuroendocrine theory)
What are the theories explaining the damage/error theory of ageing?
- Wear and tear theory
- Rate of living theory
- Waste product accumulation theory
- Cross-linking theory
- Free radical theory
- Autoimmune theory
- Error theories
- Order to disorder theory
What challenges does society face as a result of population ageing?
- Working life/retirement balance - not saving enough
- Caring for older people, the sandwich generation
- Extending healthy old age not just life expectancy
- Inadequate or absent services - social care and housing
- Outdated and ageist beliefs/assumptions
- Medical system designed for single acute diseases
- Limited accessibility for those with disabilities
- loneliness and isolation
How does disease presentation change with age?
- Frailty
- Non-specific presentations
What are the difficulties with managing disease in older people?
- Multimorbidity
- Polypharmacy
- Iatrogenic harm (caused by medical examination or treatment)
- Comprehensive geriatric assessment
- 5Rehabilitation
What is frailty?
A physiologic syndrome characterized by decreased reserve and resistance to stressors, resulting from cumulative decline across multiple physiologic systems, and causing vulnerability to adverse outcomes
How does frailty develop?
- Genetic and environmental factors
- Time
- Cumulative molecular and cellular damage
- Reduced physiological reserve
- Physical activity and nutritional factors
- Frailty
What are the “geriatric syndromes”?
Non-specific presentations:
- Falls
- Delirium/confusion
- Fluctuating disability
- reduced mobility
- Weight loss
- Iatrogenic harm
- “Not coping”
Why is frailty a problem?
- Minor illnesses cause more pronounced changes in health
- Increased hospital admissions
- Increased duration of hospital stay
- Increased care needs and dependence
Can frailty be treated?
- Not really
- Prevention rather than sure is best
- Prevention through exercise, nutrition, lack of smoking and drinking is the best way
Using MI and PE as examples, what are the issues with the elderly’s non-specific presentation?
- A wide variety of diseases can present as the same thing i.e. falls
- Less likely to have the textbook symptoms e.g.
- MI - less likely yo have chest pain
- PE - less likely to have pleuritic chest pain or haemoptysis
- More likely to have other symptoms
- MI - more likely to be short of breath
- PE - more likely to have syncope
Why is multimorbidity an issue?
- Conditions impact on one another
- Treatment for one condition may impact on another
- Negative impacts
- Worse QoL - more likely to be depressed
- Increased functional impairment
- Burden of treatment
- Polypharmacy
Why is polypharmacy an issue?
- Associated with bad outcomes:
- Falls
- Increased length of stay
- Delirium
- Mortality
- Increased risk of adverse drug reactions
Why are older people at increased risk of harm?
- Reduced physiological reserve
- Impaired compensation mechanisms
- Comorbidities
- Polypharmacy
- Cognitive impairment
How can outcomes be improved for people with frailty?
- Comprehensive Geriatric Assessment (CGA)
- A multidimensional, interdisciplinary assessment that leads to an individualised, goal based plan
What are the benefits of CGA in the community and inpatients?
CGA in the community
- Reduce admissions to institutional care
- Reduce falls
- Most benefit in mild or moderate frailty
CGA for frail inpatients
- Reduces inpatient mortality
- Reduces functional and cognitive decline
- Reduces admission to institutional care
What are the physical changes that occur in the brain with ageing?
- Atrophy
- Cerebrovascular disease - furring up of the small vessels in the brain
What are the 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
What cognitive changes shouldn’t occur in normal people as they age?
- No change in nondeclarative/implicit memory (memory that doesn’t take conscious effort to remember)
- No change in visuospatial abilities
- No overall change in language (some reduction in verbal fluency)
What are the 2 components of higher brain function and which one does dementia effect?
- Level of consciousness - alertness
- Content of consciousness - cognition
- Affected by dementia
What are the features of 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
- Impairment of function
- Progressive
- Degenerative
- Irreversible
What are the main types of dementia?
Alzheimer’s
Vascular
What is delirium?
- An acute, global failure of higher brain function
- i.e. affecting level and content of consciousness
- i.e. alertness and cognition
- Acute Brain Failure = A medical emergency
How do you distinguish between dementia and delirium?
Patient history vital
Dementia:
- Chronic (months-years)
- Gradual progression
- No change in conscious level
- Irreversible
Delirium:
- Acute (hours-days)
- Fluctuating
- Main problem with alertness and attention
- Usually reversible
- Usually precipitated by something
What are the screening tests for cognitive impairment?
- 4AT score
- MOCA
What are the components of the 4AT score?
- Alertness
- AMT 4 (age, DOB, location, current year)
- Attention (months in backwards order)
- Acute changes/fluctuating course
Note:
The higher the score the more likely delirium
What are the advantages of the MOCA score?
- 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
What are the dis-advantages of the MOCA score?
- Education level will affect results
- Language level will affect results
- Floor and ceiling effects
- Can be poorly administered
- Possibly practice/coaching effects
