Ageing and Frailty

Question 1

What is fraility?

Answer 1

• Frailty is effectively progressive dyshomeostasis (reduction in ability to deal with an environmental challenge)

Question 2

Frailty results in ‘frailty syndromes’, what are these?

Answer 2

• Falls
• Delirium
• Immobility
• Incontinence

Question 3

How is the average age of the population changing?

Answer 3

Ongoing demographic shift, meaning population of world is getting older (developed and developing world):

• Fertility rates falling
• Life expectancy increasing
• Therefore aging population

Question 4

Why is life expectancy increasing?

Answer 4

• Increased resources
• Better economic conditions
• Improved screening with earlier diagnosis and treatment
• Better outcomes following major events
  
  • Cardiac, stroke, surgery

Question 5

What are the different theories of ageing?

Answer 5

Different theories:

• Stochastric theory
  
  • Accumulate damage due to micro damage and free radicals which builds over time
• Programmed
  
  • Predetermined, changes in gene expression during various stages

These things cause homeostatic failure, less reserve to deal with damage

Question 6

What are examples of physiological changes in ageing?

Answer 6

Affects every organ system, affecting individuals differently:

• Renal
  
  • GFR falls
• CVS
  
  • BP increases (systolic increases but diastolic falls)
  • CO falls
• Respiratory
  
  • Vital capacity decreases

Question 7

How do the following change in ageing:

• GFR
• BP
• CO
• vital capacity

Answer 7

GFR - falls

BP - increases (systolic increases but diastolic decreases)

CO - falls

Vital capacity - decreases

Question 8

What are examples of reduced homeostasis in the elderly?

Answer 8

• Reduced baroreceptor reflex for low blood pressure
• During cold stress less peripheral vasoconstriction and metabolic heat production
• During heat stress reduced sweat gland output, reduced skin blood flow, smaller increase in CO, less redistribution of blood from renal and splanchnic circulations

Question 9

Are clinical features the same in the old and young?

Answer 9

Medical conditions might have different presenting signs and symptoms in people with frailty

Question 10

What is known about drug efficacy and safety for patients 80+?

Answer 10

• Little evidence on drug efficacy and safety for patients 80+