Ageing Flashcards
what is ageing/senescence?
biological process of growing old, with associated changes in physiology and increased susceptibility to disease and increased likelihood of dying.
what are the two theories that reason why organism age?
o Damage or error theories
– accumulation of damage to DNA, cells and tissue.
o Programmed ageing theories
– genetic, hormonal and immunological changes lead to the cumulative deficits we see as ageing.
examples of damage/errors leadings to ageing
loss of telomerases
oxidative damage
free radicals
DNA damage
how do they two theories of ageing differ?
Damage/error theory suggests that preventing these from happening can prevent ageing
the programmed aged theory suggests that ageing is inescapable
what is population ageing? what does it reflect?
increasing age of an entire country due to increasing life spans and decreasing fertility rates
successes of healthcare but brings extra burden to society
what is life expectancy?
the expected number of years a person can expect to live
can changes at different stages of life
what is chronological and biological age?
Chronological age is the number of years a person has been alive while biological age refers to how old a person seems.
Biological age, also referred to as physiological age, takes many lifestyle factors into consideration, including diet, exercise and sleeping habits,
what factors affect the rate at which people age?
- genetics
- health behaviours
- where they live
- social economic status
who are the “sandwich generation”?
those who look after older relatives while raising children of their own
how are older people more likely to present their symptoms of disease?
they have an atypical/non-specific presentation (not textbook)
symptoms of pathology don’t immediately link to the disease
symptom is attributed to another cause or “old age
what are some atypical symptoms of disease?
falls–> reduced mobility and delirium
what are the “Giants of geriatric medicine”?
1) immobility–> falls
2) intellectual impairment
3) instability
4) incontinence
5) iatrogenic (problems due to receiving healthcare) problems
6) recurrent infections
7) weight loss
what is frailty?
- the loss of functional reserve and resistance to stressors
- results from cumulative decline across multiple physiological systems
- among older people which leads to impairment of their ability to manage everyday activities
- increases the likelihood of adverse events and deterioration when faced with a minor stressor.
what effect does having atypical and non-specific symptoms (in the elderly)?
delays in treatment
they will need increased care e.g. hospitalisation
what factors contribute to frailty?
- genetic
- environment e.g. pollution, occupation
these contribute to the cumulative cellular damage
what are the problems faced in managing health in older patients?
1) delays in treatment due to atypical symptoms
2) co-morbidities: one condition affects the other. Treatment for one conditions affects treatment for the other
3) drug trial evidence using younger people means extrapolation is done for the treatment of older people , which may not be accurate always
4) drug treatments are increasingly dangerous due to changes in pharmacokinetics and pharmacodynamics
give an example of condition presents atypically in an older patient
pulmonary embolism
the patient may not show pleuritic chest pain and haemoptysis
what effect does co-morbidity and treating all the conditions have on the patient?
- decreased quality of life
- polypharmacy
- more likely to be depressed
What leads to polypharmacy?
- multiple morbidities
- NICE guidelines (designed for single conditions)
- undetected non-adherence
- infrequent review of meds
- poor communication of plans with meds
what is a prescribing cascade?
the process whereby the side effects of drugs are misdiagnosed as symptoms of another problem, resulting in further prescriptions and further side effects and unanticipated drug interactions, which itself may lead recursively to further misdiagnoses and further symptoms.
what is the effect of polypharmacy on an older patient?
- potentially inappropriate polypharmacy–> worse health outcomes
- adverse drug reactions are more likely
how is a prescribing cascade avoided?
when a med does not work, replace the med with another rather than give an additional drug on top
give examples of iatrogenic harm to older patients
- adverse drug reactions
- nosocomial conditions e.g. muscle atrophy/deconditioning
- falls
- psychological/cognitive damage
what are some age-related changes? how are they assessed?
- CSF within the surrounding brain increases
- ventricles enlarge
- neuronal connections and microglia lost
- sulci (grooves) become more prominent
- white matter change
- 2-3% decrease in brain mass from age 40/50 per decade
these are assessed with MRI and CT
changes are considered normal in the ageing brain
when is it obvious that the brain has not aged normally?
when there is significant cognitive impairment
why is dementia’s diagnosis rate poor?
o Misinterpretation
–belief that older people have worse memory anyway.
o Fatalism
– belief that nothing can be done about it so no reason to diagnose it.
o Social isolation
– no one notices it.
what is dementia?
chronic, progressive, degenerative; causing a decline in cognition
not just memory!
the condition progresses initially with memory issues but eventually all cognitive functions are affected
what is delirium?
acute episode of confusion, usually with a clear precipitant e.g. infection or medication change
this can be resolved unlike dementia and it more common in those with dementia
what are the most common types of dementia?
- vascular
- alzheimers
- mixed
what are some examples of cognitive assessment done on older patients?
o Abbreviated Mental Test (AMT) and clock drawing tests
o Montreal Cognitive Assessment (MOCA)
o Mini Mental State Examination (MMSE)
slightly outdated and less widely used.
o Confusion Assessment Method (CAM) and 4AT
what does the Abbreviated Mental Test (AMT) and clock drawing tests enable?
screen for cognitive impairment
what does the Montreal Cognitive Assessment (MOCA) enable?
detailed examination in wide general use
- brief
- used in translated versions
what does the Confusion Assessment Method (CAM) and 4AT enable?
tools to help distinguish between dementia and delirium.
what is the problem with using MOCA?
- level of education of the patient
- visual and/or hearing impairment
- physical impairment e.g. holding pencil
- basic cultural knowledge level
- not valid in acute illness
- depression misdiagnosed as dementia
what is social care in England?
- home carers
- sheltered housing
- care homes (nursing or residential)
- personal budgets
how do drug treatments cause older people harm?
change in pharmacokinetics and pharmacodynamics
this is why drug trials tend to be done on younger people, skewing treatment evidence
what are the age related changes to the brain?
- CSF volume increase
- ventricle enlargement
- major gyri gaps widen
- decrease in weight from age 40-45 onwards
what is a brief screening test for cognitive impairment?
- Abbreviated Mental Test (AMT)
- Clock Drawing Test
which test is more detailed and in wider general use?
Montreal Cognitive Assessment (MOCA)
what is the slightly outdated assessment, less widely used?
Mini Mental State Examination (MMSE)
what tools are used to distinguish between delirium and dementia?
Confusion Assessment Method (CAM) and 4AT
what are some advantages of using the Montreal Cognitive Assessment (MOCA)?
- covers variety of domains
- brief and quick to do
- validated
- translated versions available
what are some disadvantages of using the Montreal Cognitive Assessment (MOCA)?
- education level will affect results
- floor and ceiling effects
- language level affects results
- poorly administered
- practice/coaching effects
what factors need to be taken into consideration when administering a cognitive test to an elderly person?
- slow processing and reaction time
- shorter attention span
- hearing and visual impairments
- physical impairment e.g. holding pencil
- assumption of literacy
