Ageing Flashcards
• Define Ageing/senescence?
Biological process of growing old, with associated changes in physiology and increased susceptibility to disease & increased likelihood of dying
Why do organisms age?
2 main categories of thought:
(1) Damage of error theories
• accumulation of damage to DNA, cells & tissue
• e.g. loss of telomerases OR oxidative damage
• suggests we can prevent ageing IF we can prevent this damage
(2) Programmed ageing
• genetic, hormonal and immunological changes lead to cumulative deficits we see as ageing
• suggests ageing is part of an inescapable/programmed process
NO single theory explains all that we know about ageing
Define populating ageing
Increasing age of an entire country due to
• increasing life spans
AND
• decreasing fertility rates
Challenges faced by society as a result of populating ageing
x Working life/retirement balance
• dependency ratio
x Extending healthy old age not just life expectancy
x Caring for older people, the sandwich generation
x Outdated & ageist beliefs
x Medical system designed for single acute diseases
Define fraility
The loss of functional reserve among older people which leads to impairment of their ability to manage everyday activities and increases the likelihood of adverse events and deterioration when faced with a minor stressor.
Example of frailty
Mild pneumonia
In young person:
• recover fine when given AB treatment
In elderly people:
• may end up in hospital as causes delirium & reduces mobility
How do older people normally present with a disease?
More likely to have an: • ATYPICAL & • NON-SPECIFIC presentation
What is meant by non-specific presentation of disease?
Symptom is attributed to another cause or “old age”
• delays in treatment
What does non-specific presentations include?
o Falls o Reduced mobility o Recurrent infections o Confusion o Weight loss o “Not coping” o Iatrogenic harm – illnesses caused by retrieving healthcare treatements
Many of these presentations can be due to a huge variety of underlying problems
– this can cause confusion in the healthcare of frail patients
Can we prevent fraility?
- Exercise
- Nutrition
- Drugs (possibly)
- Prevention is better than cure
Issue of drug treatment with elderly people?
Changes in pharmacokinetics and pharmacodynamics can make drug treatments more dangerous in older people
Many drug trials have low numbers of older people, so the evidence for treatment is often extrapolated from younger people which may not always be accurate.
What is CGA?
Comprehensive Geriatric Assessment
• MDT assessment
Riccardo notes!
What are age-related changes assessed with?
Assessed with MRIs and CTs:
• CSF within the surrounding brain increases
• Ventricles enlarge
• Gaps between major gyri widen
• 50% of normal elderly people show a degree of white matter change
2-3% decrease in brain mass from age 40/50 per decade eventually reaching 10% below maximum brain mass by around age 80.
Define and explain dementia
Dementia – chronic, progressive, degenerative; causing a decline in cognition.
Explain dementia
Most common types (Alzheimer’s and vascular) start with:
• memory problems
and progress to include all cognitive functions
More common with increasing age
Mild cognitive impairment
– people that have MILD cognitive impairment, not enough to warrant a dementia diagnosis.
Define and explain delirium
Delirium
– acute episode of confusion, usually with a clear precipitant (i.e. infection)
Usually resolves but can progress to dementia
Much more common in people that already have dementia
Rates of dementia have been low historically - why is this?
o Misinterpretation
– older people have worse memory anyway
o Fatalism
– can’t do anything about it so no reason to diagnose it
o Social isolation
– so no one notices it
Describe NORMAL cognitive changes in older people
- Processing speed slows
- Working memory slightly reduced
- Simple attention ability preserved, but reduction in divided attention
- Executive functions generally reduced – ability to organise reduced, less able to make a new plan on the spot
BUT
- No change in nondeclarative memory (ability to remember how to do tasks)
- No change in visuospatial abilities (don’t get lost)
- No overall change in language (some reduction in verbal fluency)
What are the different types of Cognitive Assessments?
o Abbreviated Mental Test (AMT) and clock drawing tests
– screen for cognitive impairment
o Montreal Cognitive Assessment (MOCA)
– detailed examination in wide general use
o Mini Mental State Examination (MMSE)
– slightly outdated and less widely used
o Confusion Assessment Method (CAM) and 4AT
– tools to help distinguish between dementia and delirium.
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 seed, slower reaction times) may affect administration
