Ageing Flashcards
What is the definition of ageing?
Process of growing older
biological, psychological/cognitive, social
What is life expectancy?
Life expectancy is a statistical measure of how long a person can expect to live
What are the changing natures of the older population?
Increasing numbers of BAME older people Increasing education of older people Reduction in poverty More people are working for longer More complex/nuanced retirement process
What are the two theories for ageing?
Programmed ageing
Damage or error theories
Described programmed ageing
Hayflick limit theory - Cells in culture divide and then stop dividing at one point. Our cells count the number of times they divide and stop dividing when they no longer have facilities to.
May be a protective measure for cancer
It’s programmed into DNA and telomeres shorten each division, telomeres cannot be replicated
Describe damage or error theories
All our cells accumulate damage over time
Free radical - oxidative stress due to reactive oxygen species exceeding antioxidant capacity
What are the take home messages from these theories?
They have no real clinical significance in relevance to how we treat etc.
People age at different rates, chemical v.s. biological age
Health behaviours influence biological ageing HEAVILY
Can ageing be prevented?
Start young
Health behaviours
What challenges does society face as a result of population ageing?
Working life/retirement balance - dependency ratio
Extending healthy old age not just life expectancy : life expectancy starting to lessen in deprived populations
Caring for older people, the sandwich generation : people who have to look after their kids and their parents, due to market fragility of care homes
Outdated and ageist beliefs/assumptions
Medical system designed for single acute diseases
Is health random?
No
Genetic, health behaviour, where we live and access to healthcare
What are the implications for health care services?
Increasing demand for primary, secondary and tertiary health care
Increasing complexity
Navigating the health and social care divide
What is frailty?
Loss of biological reserve across multiple organ systems, leading to vulnerability to physiological decompensation and functional decline after a stressor event
FOR EXAMPLE - more likely to have renal failure when older as you have far fewer nephrons following a relevant stressor event
Can frailty be prevented?
Once again health behaviour
How is frailty categorised?
Mild
Moderate
Severe - bed bound, home, nurse dependent
Can we treat frailty?
Exercise, nutrition, drugs(possibly)
Prevention is better
Treatment requires extreme motivation and few have the mentality to adhere
Describe a non-specific presentation
Falls Reduced mobility Recurrent infections Confusion Weight loss “Not coping” Iatrogenic harm
What is special about how older people present?
They have an altered presentation
EXAMPLE
In acute coronary syndrome patient is less likely to have chest pain AND more likely to have SOB
Give another example of an altered presentation
Pulmonary embolism
Less likely to have pleuritic chest pain(sudden and intense pain when inhaling/exhaling) and haemoptysis(coughing up blood)
More likely to have a syncope
What is multimorbidity?
two or more chronic conditions
Conditions impact on one another Treatment for one condition may impact on another Negative impacts Worse QoL, more likely to be depressed Increased functional impairment Burden of treatment Polypharmacy
Why do older people take more drugs?
Multimorbidity Guidelines/QOF/NICE Undetected non adherence Infrequent review Poor communication
What is potentially inappropriate polypharmacy?
Up to 40% of prescriptions are inappropriate
Polypharmacy is associated with bad outcomes
Falls
Increased length of stay
Delirium
Mortality
What is iatrogenic harm?
Harm caused by avoidable error or negligence on healer’s parts
Adverse reactions to medications Nosocomial conditions Infections Pressure sores Constipation Deconditioning Delirium Malnutrition Incontinence Falls Psychological/cognitive damage
What percentage of hospital admissions are from ADRs?
17
NSAIDs most likely cause
Why are older people at increased risk?
Reduced physiological reserve Impaired compensation mechanisms Comorbidities Polypharmacy Cognitive impairment
What is deconditioning?
Occurs in hospital beds
Loss of muscle mass
1kg in one week
What is the function of a comprehensive geriatric assessment?
Multidisciplinary assessment - medical, functional, social, psychology, problem list and plan
CGA in the community1 Reduce admissions to institutional care Reduce falls Most benefit in mild or moderate frailty CGA for frail inpatients2 Reduces inpatient mortality Reduces functional and cognitive decline Reduces admission to institutional care
What is rehabilitation?
Improving/restoring functionality
multidisciplinary
rehabilitate alongside acute illness - prevents deconditioning
Prehabilitation
What are the key changes in ageing brain?
Atrophy with age
enlarged ventricles
You lose neurons but loss of interconnecting neurons more important
More prominent gyri due to reduced brain mass
Decrease in both grey and white matter
What are the normal cognitive changes in older people?
Processing speed slows
Executive function generally reduced (problem solving)
Working memory slightly reduced
Simple attention ability preserved but not ability to divide attention
What are things that are retained in normal ageing?
No change in nondeclarative memory
No change in visuospatial abilities
No overall change in language (some reduction in verbal fluency)
What is dementia?
Decline in all cognitive functions, not just memory Impairment of function Progressive Degenerative Irreversible
LOADS, multiple tyes, Alzheimer’s more to do with memory loss and vascular is more to do with processing speed
What are the different screening tests?
Screening tests
AMT, clock drawing test, 4AT, GP COG, 6CIT…
Mini Mental State Examination (MMSE)
Montreal Cognitive Assessment (MOCA)
What are diagnostic tests?
Diagnostic tests
Addenbrooke’s Cognitive Examination (ACE)
Detailed neuropsychometric testing
What are the advantages of 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
What are the disadvantages of the MOCA?
Education level will affect results Language level will affect results Floor and ceiling effects Can be poorly administered Possibly practice/coaching effects
Problems with cognitive assessments in general?
Hearing and visual impairment may limit testing
Physical problems may limit testing
Most assume numeracy and literacy
Most assume some basic cultural knowledge
Depression can masquerade as dementia
Not valid in acute illness
Normal cognitive changes (slower processing speed, slower reaction times) may affect administration
NEED CONTEXT THOUGH
