Ageing and disease Flashcards
What is ischaemic heart disease and what are the symptoms?
Caused by ischaemia of the cardiac muscle – results from obstruction to arteries to heart wall muscle (coronary arteries), due to atherosclerosis ± thrombus formation
A common comorbidity with ischaemic stroke
Most common symptom is angina = tight or crushing pain in the centre of the chest, sometimes also involving the throat or jaw, left shoulder or arm, or the back. Reversible ischaemia
Typically comes on with exertion and is relieved by rest - may occur at rest in more severe disease
Complete obstruction of a coronary artery results in myocardial (“heart muscle”) infarction
Irreversible ischaemic damage to cardiac muscle
Can be fatal
How is ischemic heart disease treated?
Drug treatment
Medication that dilates blood vessels, lowers blood pressure and reduces cardiac workload - low blood pressure and dizziness are common medication side effects
Antiplatelet drugs (e.g. aspirin) to prevent thrombus formation
Interventional treatment
Angioplasty – insertion of a catheter into a coronary artery to stretch open a narrowing
Stenting of coronary arteries
Surgical treatment
Coronary artery bypass grafting – use of a blood vessel from elsewhere in the body to “bypass” the narrowed coronary artery
Cerebral ischaemia is a potential common complication of cardiac bypass surgery – either a discrete stroke or global ischaemia
Mild/subtle cognitive deficits not uncommon
What are the consequences of ischemic heart disease?
Common consequences of heart muscle ischaemia or infarction include:
Arrhythmias
May cause symptoms of palpitations (sensation of fast or irregular heartbeat) and light-headedness
Treated with medication and/or a pacemaker
Congestive heart failure - occurs when heart muscle function is compromised so that blood is not pumped effectively
Left-sided heart failure results in a build-up of fluid (oedema) in the lungs → shortness of breath and cough (especially with exertion or when lying flat), reduced exercise tolerance and fatigue
Right-sided heart failure results in gravity-dependent oedema in the extremities – most commonly the feet and ankles (gravity)
Heart failure is treated with medication to increase fluid excretion via the kidneys (diuretics) and improve cardiac efficiency – low blood pressure, dizziness, dry mouth are common side effects
What is COPD?
Respiratory condition characterised by breathing difficulties, may present with one or both of these components:
Emphysema – damage to alveoli in the lungs = reduced surface area, interferes with exchange of O2 and CO2; causes shortness of breath and dry cough
Chronic bronchitis – persistent inflammation of the airways; causes shortness of breath, wheezing, moist cough, ↑ mucus production, frequent chest infections
Causes of pneumonia in older adults
Caused by inflammation of the lung tissue due to infection or chemical irritation
Common causes
Viral pneumonia
Bacterial pneumonia
Aspiration pneumonia – typically a combination of chemical irritation of lung tissue by aspirated food/fluids/stomach contents, and superadded bacterial infection
Multiple factors may contribute to increased frequency of pneumonia in older adults:
Reduced immune system function
Reduced lung clearance mechanisms, including weaker cough
Increased frequency of comorbidities associated with aspiration
Consequences and treatment of pneumonia
Infection results in an inflammatory immune response:
Mucus production obstructs bronchi and fills alveoli
Oedema of alveolar walls impedes gas exchange (walls are thicker)
If enough lung tissue is affected, can’t maintain adequate O2 levels in the bloodstream
Treatment
Antibiotics for bacterial pneumonia
Supplemental 02 if hypoxic
What is diabetes?
A group of disorders related to problems with insulin, a hormone that helps to transport glucose out of the bloodstream and into cells (used as energy source)
Type 2 diabetes more common in older age
Pancreas produces enough insulin but insulin is less effective at transporting glucose into cells (insulin resistance)
inability of insulin to “push” glucose into cells results in high blood glucose levels
Associated with obesity
Treatment of diabetes
Treatment of Type 2 diabetes depends on severity
Mild – treated with diet, weight loss and exercise – may go into remission
Moderate – treated with oral hypoglycaemic medications
Severe – may require subcutaneous insulin injections
Type 1 diabetes = autoimmune disorder associated with pancreatic failure → no insulin produced → high blood sugar levels
Type 1 always requires treatment with insulin – otherwise leads to very high blood glucose levels and a potentially fatal condition called ketoacidosis
↑ numbers of people with Type 1 diabetes now survive into older age
What are the long term complications of diabetes?
Long-term complications of Type 1 (or severe type 2 diabetes) relate to
vascular damage by chronically high levels of glucose in the bloodstream
More common if diabetes is poorly controlled (but can also occur in those with good control)
Includes ischaemic stroke and ischaemic heart disease
Peripheral vascular disease
Impaired circulation in the limbs due to atherosclerosis of arteries in the legs
Symptoms include pain, poor wound healing, leg ulcers
Increased risk of infection/ulcers/gangrene, sometimes necessitates amputation
Retinopathy
Damaged retinal vasculature results in retinal ischaemia and haemorrhage
Common cause of sight loss in longstanding diabetes
Kidney failure
Due to ischaemic damage due to impaired renal blood supply
May require dialysis (artificial filtering of waste products, salts and excess water from blood)
Haemodialysis = blood circulates through a machine
Peritoneal dialysis = special fluid introduced into the abdominal cavity
What are the most common cancer types in older adults?
half of all cancers are diagnosed in people 70+
prostate most common in males and breast cancer most common in females aged 50+
In older adults, both these types of cancer may be slowly progressive rather than very aggressive – “living with” vs “dying from”
Other common cancers in older adults include skin cancer (typically remain localised, apart from melanoma), lung cancer and bowel cancer
Oral cancer has risen in incidence by 37% over the last decade; laryngeal cancer incidence has fallen by 7%
TNM staging for cancer
Stage 1 - usually a small tumour confined to the organ of origin
Stage 2 - usually a larger tumour +/- some positive lymph nodes
Stage 3 – usually a larger tumour with some growth into surrounding tissue + positive lymph nodes
Stage 4 – any primary tumour + metastases in other parts of the body
Other common health issues in older adults
osteoarthritis, falls, incontinence, confusion, dehydration, pressure sores, DVT
