ageing Flashcards
what is ageing
process of growing older, involving biological, psychological/cognitive and social aspects
what is life expectancy
statistical measure of how long a person can expect to live
what is population ageing
increasing average life expectancy (happening almost everywhere in world)
5 changes of nature of older population
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
5 reasons why are people living longer
better nutrition, better public health, less violence, advances in medicine, better education
2 reasons why people age
programmed ageing, damage or error theories
describe programmed ageing
due to Hayflick limit, causing cells to stop dividing (due to presence of telomeres), protecting against cancer
describe damage or error theories of ageing
all cells accumulate damage from radiation or free radical oxidative stess
2 types of age
chronological age and biological age (if live poorly, accumulate more damage, so biologically older than chronological age)
how to prevent ageing
no specific anti-ageing therapies, but start young with healthy lifestyle (exercise most important)
challenges society faces due to population ageing
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ratio), extending healthy old age not just life expectancy, caring for older people, the sandwich generation, outdated and ageist beliefs/assumptions, medical system designed for single acute diseases
describe working life/retirement balance (dependency ratio)
number of dependence in society compared to number of people in work (relevant to pensions), hence increase in pension age and retirement nuances
describe extending healthy old age not just life expectancy
want to increase both life and healthy life expectancies (compress morbidity towards end of life); influenced by health behaviour, environment, job etc., and genetics
describe caring for older people
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
implications of ageing population on healthcare
increased demand for primary, secondary and tertiary healthcare; increased complexity; navigate health and social care divide
define frailty
loss of biological reserve across multiple organ systems, leading to vulnerability to physiological decompensation and functional decline after a stressor event
2 classes of factors affecting frailty
genetic, acquired (e.g. pollution, job, etc.)
effect of frailty on organs
more likely to become infected or diseased, and fail if minor stresser event (e.g. UTI)
3 divisions of frailty
mildly frail (still able to get out, independent) -> moderate -> severe (bed-bound or in hospital)
how to treat frailty (prevention is better)
exercise (increase physiological reserve), nutrition
% of >80s who are frail
30%
7 non-specific presentations of frailty (less likely to have common symptoms of disease)
falls, reduced mobility, recurrent infections, confusion, weight loss, “not coping”, iatrogenic harm
consequence of frail patients being less likely to have common symptoms of disease
delayed diagnosis
what is multimorbidity
2 or more chronic conditions (increases with age)
impacts of multimorbidity
conditions and treatment impact on one another; worse quality of life, increased depression, increased functional impairment, burden of treatment, polypharmacy (increased number of medications)
why do older people take more drugs
multimorbidity, guidelines (QOF, NICE), undetected non-adherence, infrequent review, poor communication
4 outcomes of polypharmacy (40% of prescriptions are inappropriate)
falls, increased length of stay, delirium, mortality
describe iatrogenic harm
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
5 reasons why older people are at increased risk of iatrogenic harm
reduced physiological reserve, impaired compensation systems, comorbidities, polypharmacy, cognitive impairment
nosocomial conditions causing iatrogenic harm
infections, pressure sores, constipation, deconditioning (lose muscle mass and bone density due to bed rest), delerium, malnutrition, incontinence
2 other causes of iatrogenic harm
falls, psychological/cognitive damage
what is a comprehensive geriatric assessment
multidisciplinary assessment (medical, functional, social, psychological/psychiatric), problem list, plan
describe importance of rehabilitation
aims to restore or improve functionality, multidisciplinary; either alongside acute illness (e.g. prevent deconditioning), or prehabilitation (before surgery etc.)
changes in ageing brain
lose connections between neurones (atrophy of grey and white matter), enlarged ventricles
normal cognitive changes in older people
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
3 abnormal cognitive changes in older people
changes in nondeclarative memory, visuospatial abilities and language
what is dementia
decline in all cognitive functions (not just memory); impairs function, progressive, degenerative, irreversible
majority types of dementia
Alzheimer’s (early memory changes), vascular (early processing speed changes), mixed
cognitive assessments: screening tests
AMT, clock-drawing test, MMSE, MOCA
cognitive assessments: diagnostic tests
ACE, detailed neuropsychometric testing
advantages of MOCA over MMSE
covers variety of domains of cognitive function, brief, available in translated versions, widely used, validated in range of populations
disadvantages of MOCA
affected by education and language levels, floor and ceiling effects, can be poorly administered, possibly practice/coaching effects
general problems with cognitive assessments in general (interpret in context)
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
