Ageing Flashcards
What is the definition of ageing?
The process of growing older, and considers biological, psychological/cognitive and social concepts of getting old.
What is the definition of life expectancy?
A statistical measure of how long a person can expect to live.
What has been happening to the size of the ageing population across the world?
Life expectancy is increasing in almost every single country. The number of people aged 60 or older will rise from 900 million to 2 billion between 2015 and 2050 (moving from 12% to 22% of the total global population).
What reasons explain the growing ageing population? (x5)
Better nutrition, better public health, less violence, advances in medicine and better education.
How is the make-up of the ageing population changing? (x4)
Increasing numbers of BAME older people, increasing education of older people (which is protective against disease like dementia – it is for this reason that dementia rates haven’t been increasing at the same levels as the ageing population), reduction in poverty, and more people are working for longer.
What are the two main theories that explain why people age?
Programmed ageing AND damage/error theories.
What is the programmed ageing theory of ageing?
□ Ageing is genetic. □ Evidence is provided by Hayflick limit observations where cells in culture would only undergo a certain number of divisions then stop. □ The theory believe that TELOMERES determine this – they SHORTEN with each division. □ We age to protect us from cancer which is we are more susceptible to the more times our cells divide.
What is the damage/error theory of ageing?
□ Theory postulates that we age because our cells/DNA accumulate damage. □ This includes damage from radiation, oxidative stress due to reactive oxygen species etc. □ The theory also bases its conclusions on: Mitochondria contain their own DNA repair mechanisms but are less robust than nuclear ones. Eventually, DNA becomes damaged beyond repair, mitochondria die, and so cells die. □ Other sources include macrophages, peroxisomes, Cytochrome P450, some support from the fact that people with chronic inflammation or chronic infections clinically age more rapidly.
Why is reduced calorie intake seen as a route to long life, in relation to the damage theory of ageing?
Calorie restriction was very fashionable for a while as it was thought to increase life span. The reason for this belief is because, by reducing amount of energy available to mitochondria, less free radicals would be produced – less free radicals means less DNA damage to mitochondria and cell. Seems to work in rodents, recent studies in monkeys are mixed; however, there is no evidence that this works in humans.
What is the difference between chronological and biological age?
Chronological age describes your age in relation to time e.g. 80 years old. Biological age describes your age in relation to someone who would not have carried out your bad behaviours e.g. a 60-year-old smoker with obesity would have a biological age of around 80.
What challenges does society face as a result of population ageing? (x5)
□ RETIRING POPULATION BURDEN ON TAXPAYER: as the population ages, the dependency ratio gets higher. In other words, the number of dependents (i.e. those retired) vs. those who are still in work goes up. So, the relative burden of pensioners on the tax system (state pension scheme) goes up when the population ages.
□ EXTENDING HEALTHY OLD AGE NOT JUST LIFE EXPECTANCY: now, we have been increasing life expectancy by prolonging diseases in the elderly (through better management). What we need to do is extend life by extending HEALTHY lifespan rather than extending lifespan of a disease – see photo. This can be achieved through changing health behaviours, access to healthcare and changing living conditions e.g. air pollution.
□ SOCIAL CARE: ageing population puts greater demands on social care. Many elderly are cared for by their family, so demands on these people are higher also. NB: the sandwich generation describes individuals who are caring for an older relative while bringing up their children.
□ Outdated and ageist beliefs/assumptions.
□ MEDICAL SYSTEM DESIGNED FOR SINGLE ACUTE DISEASES: elderly population puts increased demands on primary, secondary and tertiary healthcare, and with increasing complexity of the health of the elderly, this makes demands even higher.
What is the definition of frailty?
Loss of biological reserve across multiple organ systems (e.g. loss of neurones, endocrine cells, loss of lung capacity…) leading to vulnerability to physiological decompensation and functional decline after a stressor event e.g. a fall or delirium.
What are the clinical presentations of frailty? (x6)
□ These are NON-SPECIFIC presentations. □ Falls. □ Reduced mobility. □ Reduced infections. □ Confusion. □ Weight loss. □ Iatrogenic harm (from medical examination or treatment e.g. amlodipine for high blood pressure can lead to ankle swelling; furosemide can lead to postural hypotension –> falls etc.).
How do elderly patients present with common disease? Give two examples?
□ Less likely to have common ‘textbook’ symptoms. □ For example, they are unlikely to present with a heart attack and crushing chest pain. They are more likely to complain of shortness of breath. □ Similarly, in pulmonary embolisms, they are less likely to present with pleuritic chest pain and haemoptysis, and more likely to have syncope.
What is multimorbidity?
Patient has two or more chronic conditions.
What happens with multimorbidities with age?
As you get older, you are more likely to have more than one condition.
What changes in the brain with age?
Lose connections between neurones, some of the supporting cells of the brain are lost, there is atrophy, and the ventricles have enlarged. There is a reduction in both the grey and white matter.
