Ageing and Frailty Flashcards
Why are more people living longer?
Social engineering changes - better accommodation, sanitisation, clean water, better nutrition
What is the progression of ageing in 1st world vs 3rd world countries?
1st world countries are doubling the % population above 65 in about 100 years; 3rd world countries in only 25
What is compression of mortality?
More people are living out their natural life expectancy, not more people living longer - rectangularization of the survival curve; tf more people are getting to old age
What is compression of morbidity?
Delaying the onset of disability as we increase life expectancy so as to prevent people living longer but doing so in disability/using health care resources
What is frailty?
Diminished ability to carry out the important practical and social activities of daily living; excess demand imposed on a reduced capacity; easily perturbed; at risk for adverse health outcomes; unable to integrate responses in the face of stress
What are the biomarkers of frailty?
low-grade chronic activation of the immune system (eg CRP elevated, increased cytokines eg IL-6 and TNFa) with abnormalities of the endocrine and coagualtion systems
What is the relationship of IL-6 and frailty?
higher levels associated with mortality and associated with poor survival in institutionalized; associated with lower muscle mass and strength; predictive of functional decline independent of disease states
What is the relationship of TNFa to frailty?
higher levels with ageing; marker of mortality in very old
What is sarcopenia?
Ageing skeletal muscle due to altered CNS and PNS innervation (neuronal loss of anterior horn cells and ventral root fibres), hormonal status, inflammatory effects (IL1, IL6), diet and disuse
What molecular & disease changes are associated with ageing?
oxidative stress; mitochondrial deletions; shortened telomeres; DNA damage; cell senescence; gene variation; inflammatory disease
What are the criteria for frailty?
unintentional weight loss; weakness; exhaustion; slow walking speed; low physical activity (1-2 pre frail, +3 frail)
What is co-morbidity?
Concurrent presence of 2 or more chronic diseases
What is disability?
Physical or mental impairment that limits one or major activities of daily living
What are the implications of co-morbidity on medical care?
polypharmacy & poor coordination (many doctors treating each disease); disease interaction can lead to adverse outcomes
What are the implications of disability on medical care?
focus on rehab and social integration, reducing dependency; potential for prevention of other morbidites
