Ageing and frailty

Question 1

How will Australian population have changed in 20 years time?

Answer 1

Ageing population

Many more people above the ages of 65 and 80

Increased pressure on healthcare services

Question 2

Briefly describe factors that have led to the compression of mortality over time?

PICTURE SLIDE 7

Answer 2

Many medical factors: immunisation, combatting childbirht mortality

Many environmental factors: altering the resources available, conditions in which people live

Question 3

Describe why compression of morbidity is just as important as compression of mortality?

Answer 3

Don’t want people living longer with disabilities and poor health outcomes

So, need to delay onset of disability as well as mortality

Quality of life vs quantity of life

Question 4

Define ageing?

Answer 4

Total of all changes an organism undergoes from conception to death

Question 5

Define cellular and organismal senescence?

Answer 5

Cellular senescence: phenomenon where cells lose their ability to divide

Organismal senescence: the ageing of whole organisms

Question 6

How can disease and deconditioning affect ageing?

Answer 6

Accelerate the ageing process

Question 7

Describe how we cope with responding to challenges during ageing?

Answer 7

Decreased reserve to respond to challenges

Question 8

Describe the difference between successful ageing and usual ageing?

Answer 8

Successful ageing: changes due solely to the ageing process, unaffected by disease, environmental or lifestyle factors

Usual ageing: changes associated with the combined effects of the ageing process, disease and adverse environment and lifestlye factors

Question 9

What is frailty?

Answer 9

Concept only

Distinct clinical syndrome with underlying biological processes that are not yet well understood

Question 10

Which biomarkers are associated with frailty?

Answer 10

Frailty is associtaed with chronic, low-grade activation of the immune system

So, biomarkers such as IL6, TNFa and CRP are associated with frailty

Question 11

Describe the factors which contribute to the development of sarcopenia?

Answer 11

Altered CNS and PNS innervation

Altered hormonal status

Inflammatory effects

Altered caloric and protein intake

Disuse

Question 12

Describe the effect of sarcopenia?

Answer 12

Decline in strength of muscles, especially limbs

Huge muscle loss and weakness

Question 13

Which muscle fibres are most affected by sarcopenia?

Answer 13

Type 2 fibre loss > Type 1 fibre loss

(Type 2 = fast twitch)

Question 14

Describe Fried’s criteria for diagnosing frailty?

Answer 14

1) Unintentional weight loss
2) Weakness
3) Exhaustion
4) Slow walking speed
5) Low physical activity

Pre-frail: 1-2 criteria

Frail: >3 criteria

Question 15

Describe the difference between co-morbidity, disability and frailty?

How do they overlap?

Answer 15

Co-morbidity: concurrent presence of 2 or more chronic diseases (refers to how many chronic diseases a person has)

Disability: physical or mental impairment that limits 1 or more major ADL (what a person cannot do, limitations)

Frailty: stage of high vulnerability for adverse health outcomes

Question 16

Describe the health care implications for co-morbidity?

Answer 16

Complexity of treating concurrent diseases

Potential for preventing diseases or minimising severity

Fragmentation of services

Minimise risk of disability and frailty

Question 17

Describe the health care implications for disability?

Answer 17

Rehabilitation

Social integration and community services

Aim to decrease dependency

Potential for primary, secondary and tertiary prevention

Question 18

Describe the health care implications for frailty?

Answer 18

Vulnerable to stressors

Risk of geriatric syndrome

Treat concomitant issues

Progressive but potnetial for primary and secondary prevention

Question 19

What is a geriatric syndrome?

How does it differ from a medical syndrome?

Answer 19

Accumulated effect of impairments in multiple domains that together result in a particular adverse outcome

Question 20

What are the ‘giants of geriatric medicine’?

Answer 20

Incontinence

Immobility

Impaired balance

Impaired cognition

Iatrogenic illness