Ageing and Frailty Flashcards
Why are more people living to later life?
Mostly because of social engineering Medicine helped in - Childbirth - Perinatal health - Immunisations
For how long do people tend to have severe disability and high utilisation of services?
2-3 yrs before death, no matter what age you die at
What is compression of morbidity?
Decreasing disability before death
Define ageing
Total of all changes an organism undergoes from conception to death
What is cellular senescence?
Cells lose ability to divide
What do cells do in response to DNA damage, including shortened telomeres?
Senesce
Apoptose
What is organismal senescence?
Ageing of whole organism
What is the physiology of ageing?
Decline due to normal ageing
Exaggerated/accelerated by disease and deconditioning
Decreased reserve to respond to challenges
Do all body parts age at the same rate?
No
What is deconditioning?
Decreased physical activity
What is successful ageing?
Changes due solely to ageing process, unaffected by disease, environmental, or lifestyle factors
What is usual ageing?
Changes associated with combined effects of ageing process, disease, and adverse environment and lifestyle factors
What is frailty?
Multi-system dysregulations > loss of dynamic homeostasis, decreased physiological reserve, and increased vulnerability for subsequent morbidity and mortality
What is frailty associated with?
Low-grade, chronic activation of immune system with abnormalities of endocrine and coagulation systems
What is the phenotype model of frailty?
Group of patient characteristics which if present can predict poorer outcomes
What is the deficit model of frailty?
Accumulation of deficits that can occur with ageing > combine to increase frailty index > increases risk of adverse outcome
What are the characteristics of frailty in the phenotype model?
Unintentional weight loss Weakness Exhaustion Slow walking speed Low physical activity
What is the classification system of frailty in the phenotype model?
Pre-frail = have 1-2 criteria Frail = have 3+ criteria
What is the Canadian clinical frailty scale?
Measure of deficit model of frailty
70 item index of accumulated deficits
Strong correlation with need for institutional care and mortality
Spectrum: independence to complete dependence
Gold standard but more research than clinical tool
What is sarcopenia?
Loss of muscle mass and strength
When does sarcopenia happen?
Starts after 50 but more rapid after 60
What accelerates sarcopenia?
Chronic disease
What contributes to sarcopenia?
Changes in alpha motor neurons Type 2 muscle fibre loss Muscular atrophy Poor nutrition Low physical activity Decreased GH Decreased sex steroid levels
What are some potential interventions for frailty?
Exercise
Nutritional support
Pharmacology?
What are some examples of geriatric syndromes?
Falls Incontinence Delirium Pressure ulcers Functional decline
