Ageing Flashcards
Define ageing
Process of growing older
Define life expectancy
Statistical measure of the number of years a person can expect to live
How is the older population changing? Why?
Living longer
Better public health
What challenges does society face as a result of population ageing?
Working life/retirement balance
Caring for older people “sandwich generation”
Extending healthy old age, not just life expectancy
Inadequate or absent services
Outdated + ageist beliefs/assumptions
Medical system designed for single acute diseases
How does disease presentation change with age?
Non-specific presentation
Less likely to present with “textbook” symptoms
Multi-morbidity
Frailty
What are the difficulties in managing disease in older people?
Multimorbidity Polypharmacy Iatrogenic harm Comprehensive geriatric assessment Rehabilitation
What are the key physical changes associated with the ageing brain?
Neurones shrink Decreased connections between neurones Ventricles enlarge Gaps between major gyri widen More CSF surrounding brain Decrease in grey + white matter
What are the key issues associated with cognitive assessment of alder adults?
Most assume numeracy + literacy + basic cultural knowledge Physical problems may limit testing Not valid in acute illness Not all cover all cognitive functions Need tests in many different languages Education + language levels Practice/coaching effects Floor + ceiling effects e.g. if highly educated may score high Blind/deaf
How is the demography of society changing?
Population is ageing
Increase in average life expectancy (due to better public health)
Fertility rates are dropping
What are the key cognitive changes associated with the ageing brain?
Slight decrease in problem solving ability
Decreased processing speed
Slight decrease in working memory
Decrease in divided attention
Decrease in executive functions: plan, adapt
No change in nondeclarative memory, visuospatial abilities, language (some reduction in verbal fluency)
What are some non-specific signs/symptoms of frailty in the elderly?
Falls Reduced mobility Weight loss Confusion "Not coping" Iatrogenic harm Recurrent infections
What are programmed ageing theories?
Describe how genetic, hormonal + immunological changes over lifetime lead to cumulative deficits we see as ageing
Suggest this is part of an inescapable biological timetable, just as growth + puberty are programmed to occur
Hayflick limit to no. of divisions (telomeres + telomerase counts)
Allows cell to divide if it needs to (prevents cancer)
What is frailty?
Loss of biological reserve across multiple organ systems
Leads to vulnerability to physiological decompensation + functional decline after a stressor event
What are damage or error ageing theories?
Describe accumulation of damage to DNA, cells + tissues, e.g. loss of telomeres or oxidative damage, as cause for ageing
Suggest if we could prevent or repair damage we could prevent ageing
Free radicals, radiation, smoking, HIV etc cause DNA damage/ misrepair
What 4 health behaviours are thought to slow ageing and possibly prevent frailty and dementia?
Exercise
Diet
Limiting Alcohol
Not Smoking
Why is multimorbidity difficult to manage?
Conditions may impact each other
Treatments may impact on each other
Increased likelihood of depression
Increased burden of treatment
Why do old people take more drugs?
Multimorbidity Guidelines (only addressing a single condition) Undetected non adherence Infrequent review Poor communication
Why are older people at increased risk of adverse drug reactions?
Reduced physiological reserve Impaired compensation mechanisms Comorbidities Polypharmacy Cognitive impairment
Give 4 examples of iatrogenic harm common in the elderly
Adverse drug reactions
Nosocomial conditions e.g. constipation, deconditioning
Falls
Psychological/ cognitive damage
What is reduced by employing a comprehensive geriatric assessment?
Hospital admissions
Falls
Inpatient mortality
Functional + cognitive decline
What areas are assessed in a CGA?
Medical
Functional
Social
Psychological/ psychiatric
What is Dementia? What characterises it?
decrease in all cognitive functions, not just memory Impairment of function Progressive Degenerative Irreversible
What are the 2 main types of dementia?
Alzheimers
Vascular
List 4 screening tests used in cognitive assessment
AMT: 10 point test
Clock drawing test
Mini mental state examination (MMSE): rarely used
Montreal Cognitive Assessment (MOCA)
List 2 diagnostic tests used in cognitive assessment
Addenbrooke’s Cognitive Examination (ACE)
Detailed neuropsychometric testing
What are the advantages of the MOCA?
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- can compare changes
What are the disadvantages of MOCA?
Education level affects results Language level affects results Floor + ceiling effects Can be poorly administered Possibly practice/coaching effects
