ageing

Question 1

what is ageing

Answer 1

process of growing older, involving biological, psychological/cognitive and social aspects

Question 2

what is life expectancy

Answer 2

statistical measure of how long a person can expect to live

Question 3

what is population ageing

Answer 3

increasing average life expectancy (happening almost everywhere in world)

Question 4

5 changes of nature of older population

Answer 4

increasing numbers of BAME older people, increasing education of older people (protective against dementia), reduction in poverty, more people are working for longer, more complex/nuanced retirement process

Question 5

5 reasons why are people living longer

Answer 5

better nutrition, better public health, less violence, advances in medicine, better education

Question 6

2 reasons why people age

Answer 6

programmed ageing, damage or error theories

Question 7

describe programmed ageing

Answer 7

due to Hayflick limit, causing cells to stop dividing (due to presence of telomeres), protecting against cancer

Question 8

describe damage or error theories of ageing

Answer 8

all cells accumulate damage from radiation or free radical oxidative stess

Question 9

2 types of age

Answer 9

chronological age and biological age (if live poorly, accumulate more damage, so biologically older than chronological age)

Question 10

how to prevent ageing

Answer 10

no specific anti-ageing therapies, but start young with healthy lifestyle (exercise most important)

Question 11

challenges society faces due to population ageing

Answer 11

working life/retirement balance (dependency ratio), extending healthy old age not just life expectancy, caring for older people, the sandwich generation, outdated and ageist beliefs/assumptions, medical system designed for single acute diseases

Question 12

describe working life/retirement balance (dependency ratio)

Answer 12

number of dependence in society compared to number of people in work (relevant to pensions), hence increase in pension age and retirement nuances

Question 13

describe extending healthy old age not just life expectancy

Answer 13

want to increase both life and healthy life expectancies (compress morbidity towards end of life); influenced by health behaviour, environment, job etc., and genetics

Question 14

describe caring for older people

Answer 14

3% of >65s live in care home; due to loss of budgets, less spent on social care (means tested); “sandwich generation” are people working, bringing up children and looking after elderly parents

Question 15

implications of ageing population on healthcare

Answer 15

increased demand for primary, secondary and tertiary healthcare; increased complexity; navigate health and social care divide

Question 16

define frailty

Answer 16

loss of biological reserve across multiple organ systems, leading to vulnerability to physiological decompensation and functional decline after a stressor event

Question 17

2 classes of factors affecting frailty

Answer 17

genetic, acquired (e.g. pollution, job, etc.)

Question 18

effect of frailty on organs

Answer 18

more likely to become infected or diseased, and fail if minor stresser event (e.g. UTI)

Question 19

3 divisions of frailty

Answer 19

mildly frail (still able to get out, independent) -> moderate -> severe (bed-bound or in hospital)

Question 20

how to treat frailty (prevention is better)

Answer 20

exercise (increase physiological reserve), nutrition

Question 21

% of >80s who are frail

Answer 21

30%

Question 22

7 non-specific presentations of frailty (less likely to have common symptoms of disease)

Answer 22

falls, reduced mobility, recurrent infections, confusion, weight loss, “not coping”, iatrogenic harm

Question 23

consequence of frail patients being less likely to have common symptoms of disease

Answer 23

delayed diagnosis

Question 24

what is multimorbidity

Answer 24

2 or more chronic conditions (increases with age)

Question 25

impacts of multimorbidity

Answer 25

conditions and treatment impact on one another; worse quality of life, increased depression, increased functional impairment, burden of treatment, polypharmacy (increased number of medications)

Question 26

why do older people take more drugs

Answer 26

multimorbidity, guidelines (QOF, NICE), undetected non-adherence, infrequent review, poor communication

Question 27

4 outcomes of polypharmacy (40% of prescriptions are inappropriate)

Answer 27

falls, increased length of stay, delirium, mortality

Question 28

describe iatrogenic harm

Answer 28

caused by medical examination or treatment e.g. adverse drug reactions to medications (increases with polypharmacy), with NSAIDs being most likely to cause hospital admission

Question 29

5 reasons why older people are at increased risk of iatrogenic harm

Answer 29

reduced physiological reserve, impaired compensation systems, comorbidities, polypharmacy, cognitive impairment

Question 30

nosocomial conditions causing iatrogenic harm

Answer 30

infections, pressure sores, constipation, deconditioning (lose muscle mass and bone density due to bed rest), delerium, malnutrition, incontinence

Question 31

2 other causes of iatrogenic harm

Answer 31

falls, psychological/cognitive damage

Question 32

what is a comprehensive geriatric assessment

Answer 32

multidisciplinary assessment (medical, functional, social, psychological/psychiatric), problem list, plan

Question 33

describe importance of rehabilitation

Answer 33

aims to restore or improve functionality, multidisciplinary; either alongside acute illness (e.g. prevent deconditioning), or prehabilitation (before surgery etc.)

Question 34

changes in ageing brain

Answer 34

lose connections between neurones (atrophy of grey and white matter), enlarged ventricles

Question 35

normal cognitive changes in older people

Answer 35

reduction in problem solving ability (reduced executive functions in frontal lobe), slow processing speed (atrophy of white matter), slightly reduced working memory, reduction in divided attention

Question 36

3 abnormal cognitive changes in older people

Answer 36

changes in nondeclarative memory, visuospatial abilities and language

Question 37

what is dementia

Answer 37

decline in all cognitive functions (not just memory); impairs function, progressive, degenerative, irreversible

Question 38

majority types of dementia

Answer 38

Alzheimer’s (early memory changes), vascular (early processing speed changes), mixed

Question 39

cognitive assessments: screening tests

Answer 39

AMT, clock-drawing test, MMSE, MOCA

Question 40

cognitive assessments: diagnostic tests

Answer 40

ACE, detailed neuropsychometric testing

Question 41

advantages of MOCA over MMSE

Answer 41

covers variety of domains of cognitive function, brief, available in translated versions, widely used, validated in range of populations

Question 42

disadvantages of MOCA

Answer 42

affected by education and language levels, floor and ceiling effects, can be poorly administered, possibly practice/coaching effects

Question 43

general problems with cognitive assessments in general (interpret in context)

Answer 43

limited by hearing/visual/physical impairment, assumption of literacy, numeracy and basic cultural knowledge, not valid in acute illness, depression masquerades as dementia, normal cognitive changes may affect administration