Ageing Flashcards
What is ageing/senescence
Process of growing old
2 theories behind ageing
- accumulation of damage to DNA for example loss of telomeres or oxidative damage
- programmed ageing describe how immunological, genetic and hormonal changes over time lead to ageing
Main difference between 2 ageing theories
DNA theory suggests that ageing could be reversed
What does population ageing refer to
Increasing age of a whole country due to increasing life spans and falling fertility rates
Define life expectancy
Statistical measure of the number of years a person can expect to live
What is the challenge of an elderly persons presentation
Very often is atypical and there is a non-specific presentation of disease
What does a non-specific presentation mean
Underlying pathology is not immediately or clearly linked to the presentation. Falls, delirium and reduced mobility are very common reasons for elderly people seeking medical attention but underlying problems can actually be the cause
What are the giants of geriatric medicine
Immobility Intellectual impairment Instability Incontinence Iatrogenic problems
Problems with the giants of geriatric medicine
Mislead patients and doctors as they attribute symptoms to old age which can delay treatment
What is frailty in medical terms
Loss of functional reserve among older people causing impairment of their ability to manage everyday activities. Increases the likelihood of adverse events and deterioration when faced with minor stressor
What is special about medicine for the elderly
Multidisciplinary team consisting of doctors, nurses, therapists and social workers etc
Need for multidisciplinary team in medicine for elderly
Most of the time present with a large range of symptoms
Problems associated with drug treatments for the elderly
Changes in pharmacodynamics and pharmacokinetics can make drug treatments in the elderly more likely to harm them- doctors have to think twice about prescribing them
Most drug trials have few elderly people in so evidence for their effects on the elderly are very understudied
What changes does the brain undergo in ageing
Increased volume of CSF
Widening of ventricles
Widened major gyri
Changes in the size of brain throughout life
Reaches maximum weight around 20 years of age and remains at this weight until40-50years. Decreases by 2-3%/decade following this
What is abnormal about cognitive development in the elderly
Changes in cognitive ability are normal but severe impairment indicates a problem
Reason for low rates of dementia diagnosis
Combination of misinterpretation- its normal for the elderly to have memory problems
Fatalism- we cant do anything about it so no point diagnosing it
Social isolation- no one is around them to notice
Difference between dementia and delirium in terms of onset
Dementia chronic and progressive
Delirium is acute
Difference between dementia and delirium in terms of cause
Dementia- alzheimers and vascular (can be unclear)
Delirium- infection or medication changes (normally a clear precipitant)
What group of people is delirium common in
Dementia sufferers- delirium can also lead to dementia
Progression of dementia
Starts with memory issues then leads to include all cognitive functions
Name given to condition where people dont quite meet the dementia criteria
Mild cognitive impairment- have mild problems but dont yet impair their day to day life
2 tests for cognitive impairment
Clock drawing
Abbreviated mental test
Tools used to distinguish between dementia and delirium
Confusion assessment method
4AT
What is 4AT test
Clinical test used to rapidly diagnose delirium
What is name given to more detailed cognitive assessment test
Montreal Cognitive Assessment
Outated assessment test that is used much less
Mini Mental State Examination
Changing nature of elderly population
Increased education of eldery people
Reduction of poverty
More people work for longer
More complex retirement process
Challenges facing society from ageing population
Balance between working life/retirement
Healthy old age is extended
Have to care for older people- sanwich generation where have to care for older relative and raise children at same time
Outdated ageist beliefs
Medical system designed for single acute diseases
Problems facing health care services
Increasing demand for all degrees of healthcare
Increasing complexity of disease
Navigating health and social care divide
Ways to improve frailty
Exercise
Nutrition
Drugs
Problems of multimorbidity
Conditions and their treatments impact on one another Negatives on patient - worse QOL - depressed -functional impairment - burden of treatment - polypharmacy
What is causing polypharmacy
Multimorbidity Guidelines for treatment Non-adherence Infrequent reviews Lack of communication
What is potentially inappropriate polypharmacy
Up to 40% of prescriptions are inappropriate which can lead to bad outcomes Falls Increased length of stay Delirium Mortality
What are normal changes to observe in older peoples cognitive ability
Slowed processing speed
Working memory reduced
Reduction in divided ability
Executive functions reduced
What changes shouldnt be observed in cognitive ability
Nondeclarative memory
Visuospatial abilities
Lanuage
Advantages of montreal cognitive assessment
Variety of cognitive domains Brief Translated versions Widely used Validated widely
Disadvantages of montreal cognitive assessment
Education level a factor Language level a factor Can be carried out poorly Possible coaching for it Floor and ceiling effects
