Ageing

Question 1

Define Ageing/senescence?

Answer 1

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

Question 2

 Why organisms age – two main categories of thought?

Answer 2

o Damage or error theories – accumulation of damage to DNA, cells and tissue.
 E.G. loss of telomerases or oxidative damage.
 This theory suggests that we can prevent ageing IF we can prevent this damage.

o Programmed ageing theories – genetic, hormonal and immunological changes lead to the cumulative deficits we see as ageing.
 These theories suggest ageing is part of an inescapable/programmed process.

Question 3

What is population ageing ?

Answer 3

Increasing age of an entire country due to increasing life spans and decreasing fertility rates.

Question 4

What does population ageing reflect and negatives?

Answer 4

o This reflects the successes of healthcare but brings extra burden to society – e.g. cost.

Question 5

Define life expectancy?

Answer 5

 Life expectancy – the expected number of years a person can expect to live.

Question 6

Impact of increased life expectancy with respect to age of population?

Answer 6

 The graph shows the impact of increased life expectancy.
o It is predicted there will be SMALL increases in the number of young people but the largest increase will be in the elderly.

Question 7

Presentation of disease in elderly?

Answer 7

 Older people are more likely to have an atypical or non-specific presentation of a disease.

Question 8

Atypical disease presentation?

Answer 8

Atypical – symptoms of pathology don’t immediately link to the disease – i.e. falls, delirium.

Question 9

Non-specific disease presentations?

Answer 9

Non-specific presentations – symptom is attributed to another cause or “old age” = delays in treatment.

Question 10

“Giants of geriatric medicine what type of disease presentation is this referring to and what are the giants?

Answer 10

Giants of geriatric medicine = example of Atypical disease presentation.

“Giants of geriatric medicine” – immobility, intellectual impairment, instability, incontinence, iatrogenic (problems due to receiving healthcare) problems.

Question 11

Define Frailty and give an example?

Answer 11

Frailty (in medical language) – the loss of functional reserve among older people which leads to impairment of their ability to manage everyday activities and increases the likelihood of adverse events and deterioration when faced with a minor stressor.
o E.G. young person with mild pneumonia may need AB treatment at home but will recover fine.
o E.G. old person with mild pneumonia may end up in hospital because pneumonia causes delirium and reduces mobility [adverse effects]

Question 12

Disease Management in Older People - why can delay treatment in these individuals?

Answer 12

Atypical & non-specific presentations can lead to delays in treatment.

Question 13

Why is it difficulty to manage the elderly?

Answer 13

 Older people often present with multiple problems which all need to be managed simultaneously.

Question 14

Drug treatments more dangerous in older people - why?

Answer 14

 Changes in pharmacokinetics and pharmacodynamics can make drug treatments more dangerous in older people.
 Many drug trials have low numbers of older people, so the evidence for treatment is often extrapolated from younger people which may not always be accurate.

Question 15

Age-related changes of brain – assessed with MRIs and CTs - what are they?

Answer 15

o Ventricles enlarge.
o CSF within the surrounding brain increases.
o Gaps between major gyri widen.
o 50% of normal elderly people show a degree of white matter change.
cus [2-3% decrease in brain mass from age 40/50 per decade eventually reaching 10% below maximum brain mass by around age 80].

Question 16

Rates of dementia diagnosis have been low historically due to – only 70% of those with dementia are diagnosed - why?

Answer 16

o Misinterpretation – older people have worse memory anyway.
o Fatalism – can’t do anything about it so no reason to diagnose it.
o Social isolation – so no one notices it.

Question 17

Dementia vs. delirium?

Answer 17

o Dementia – chronic, progressive, degenerative; causing a decline in cognition.
 Most common types (Alzheimer’s and vascular) start with memory problems and progress to include all cognitive functions.
 More common with increasing age.

o Delirium – acute episode of confusion, usually with a clear precipitant (i.e. infection).
 Usually resolves but can progress to dementia.
 Much more common in people that already have dementia.

Question 18

Mild cognitive impairment?

Answer 18

 Mild cognitive impairment – people that have MILD cognitive impairment, not enough to warrant a dementia diagnosis.

Question 19

Types of cognitive assessment - 2 examples?

Answer 19

o Mini Mental State Examination (MMSE)

o Abbreviated Mental Test (AMT) and clock drawing tests – screen for cognitive impairment.

Question 20

Tools to help distinguish between dementia and delirium?

Answer 20

Confusion Assessment Method (CAM)