Ageing

Question 1

What is the definition of ageing?

Answer 1

Process of growing older

biological, psychological/cognitive, social

Question 2

What is life expectancy?

Answer 2

Life expectancy is a statistical measure of how long a person can expect to live

Question 3

What are the changing natures of the older population?

Answer 3

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

Question 4

What are the two theories for ageing?

Answer 4

Programmed ageing

Damage or error theories

Question 5

Described programmed ageing

Answer 5

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

Question 6

Describe damage or error theories

Answer 6

All our cells accumulate damage over time

Free radical - oxidative stress due to reactive oxygen species exceeding antioxidant capacity

Question 7

What are the take home messages from these theories?

Answer 7

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

Question 8

Can ageing be prevented?

Answer 8

Start young

Health behaviours

Question 9

What challenges does society face as a result of population ageing?

Answer 9

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Outdated and ageist beliefs/assumptions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

Question 10

Is health random?

Answer 10

No

Genetic, health behaviour, where we live and access to healthcare

Question 11

What are the implications for health care services?

Answer 11

Increasing demand for primary, secondary and tertiary health care
Increasing complexity
Navigating the health and social care divide

Question 12

What is frailty?

Answer 12

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

Question 13

Can frailty be prevented?

Answer 13

Once again health behaviour

Question 14

How is frailty categorised?

Answer 14

Mild
Moderate
Severe - bed bound, home, nurse dependent

Question 15

Can we treat frailty?

Answer 15

Exercise, nutrition, drugs(possibly)
Prevention is better
Treatment requires extreme motivation and few have the mentality to adhere

Question 16

Describe a non-specific presentation

Answer 16

Falls
Reduced mobility
Recurrent infections
Confusion
Weight loss
“Not coping”
Iatrogenic harm

Question 17

What is special about how older people present?

Answer 17

They have an altered presentation
EXAMPLE
In acute coronary syndrome patient is less likely to have chest pain AND more likely to have SOB

Question 18

Give another example of an altered presentation

Answer 18

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

Question 19

What is multimorbidity?

Answer 19

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

Question 20

Why do older people take more drugs?

Answer 20

Multimorbidity
Guidelines/QOF/NICE
Undetected non adherence
Infrequent review
Poor communication

Question 21

What is potentially inappropriate polypharmacy?

Answer 21

Up to 40% of prescriptions are inappropriate
Polypharmacy is associated with bad outcomes
Falls
Increased length of stay
Delirium
Mortality

Question 22

What is iatrogenic harm?

Answer 22

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

Question 23

What percentage of hospital admissions are from ADRs?

Answer 23

17

NSAIDs most likely cause

Question 24

Why are older people at increased risk?

Answer 24

Reduced physiological reserve
Impaired compensation mechanisms
Comorbidities
Polypharmacy
Cognitive impairment

Question 25

What is deconditioning?

Answer 25

Occurs in hospital beds
Loss of muscle mass
1kg in one week

Question 26

What is the function of a comprehensive geriatric assessment?

Answer 26

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

Question 27

What is rehabilitation?

Answer 27

Improving/restoring functionality
multidisciplinary
rehabilitate alongside acute illness - prevents deconditioning
Prehabilitation

Question 28

What are the key changes in ageing brain?

Answer 28

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

Question 29

What are the normal cognitive changes in older people?

Answer 29

Processing speed slows
Executive function generally reduced (problem solving)
Working memory slightly reduced
Simple attention ability preserved but not ability to divide attention

Question 30

What are things that are retained in normal ageing?

Answer 30

No change in nondeclarative memory
No change in visuospatial abilities
No overall change in language (some reduction in verbal fluency)

Question 31

What is dementia?

Answer 31

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

Question 32

What are the different screening tests?

Answer 32

Screening tests
AMT, clock drawing test, 4AT, GP COG, 6CIT…
Mini Mental State Examination (MMSE)
Montreal Cognitive Assessment (MOCA)

Question 33

What are diagnostic tests?

Answer 33

Diagnostic tests
Addenbrooke’s Cognitive Examination (ACE)
Detailed neuropsychometric testing

Question 34

What are the advantages of MOCA?

Answer 34

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

Question 35

What are the disadvantages of the MOCA?

Answer 35

Education level will affect results
Language level will affect results
Floor and ceiling effects
Can be poorly administered
Possibly practice/coaching effects

Question 36

Problems with cognitive assessments in general?

Answer 36

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