Ageing

Question 1

• Define Ageing/senescence?

Answer 1

Biological process of growing old, with associated changes in physiology and increased susceptibility to disease & increased likelihood of dying

Question 2

Why do organisms age?

Answer 2

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

Question 3

Define populating ageing

Answer 3

Increasing age of an entire country due to
• increasing life spans
AND
• decreasing fertility rates

Question 4

Challenges faced by society as a result of populating ageing

Answer 4

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x Outdated & ageist beliefs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

Question 5

Define fraility

Answer 5

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.

Question 6

Example of frailty

Answer 6

Mild pneumonia

In young person:
• recover fine when given AB treatment

In elderly people:
• may end up in hospital as causes delirium & reduces mobility

Question 7

How do older people normally present with a disease?

Answer 7

More likely to have an:
 • ATYPICAL
&
 • NON-SPECIFIC
presentation

Question 8

What is meant by non-specific presentation of disease?

Answer 8

Symptom is attributed to another cause or “old age”

• delays in treatment

Question 9

What does non-specific presentations include?

Answer 9

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

Question 10

Can we prevent fraility?

Answer 10

• Exercise
• Nutrition
• Drugs (possibly)
• Prevention is better than cure

Question 11

Issue of drug treatment with elderly people?

Answer 11

 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.

Question 12

What is CGA?

Answer 12

Comprehensive Geriatric Assessment
• MDT assessment

Riccardo notes!

Question 13

What are age-related changes assessed with?

Answer 13

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.

Question 14

Define and explain dementia

Answer 14

Dementia – chronic, progressive, degenerative; causing a decline in cognition.

Question 15

Explain dementia

Answer 15

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.

Question 16

Define and explain delirium

Answer 16

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

Question 17

Rates of dementia have been low historically - why is this?

Answer 17

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

Question 18

Describe NORMAL cognitive changes in older people

Answer 18

• 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)

Question 19

What are the different types of Cognitive Assessments?

Answer 19

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.

Question 20

Problems with cognitive assessments in general?

Answer 20

• 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