Ageing and Frailty

Question 1

Why are more people living to later life?

Answer 1

Mostly because of social engineering
Medicine helped in
- Childbirth
- Perinatal health
- Immunisations

Question 2

For how long do people tend to have severe disability and high utilisation of services?

Answer 2

2-3 yrs before death, no matter what age you die at

Question 3

What is compression of morbidity?

Answer 3

Decreasing disability before death

Question 4

Define ageing

Answer 4

Total of all changes an organism undergoes from conception to death

Question 5

What is cellular senescence?

Answer 5

Cells lose ability to divide

Question 6

What do cells do in response to DNA damage, including shortened telomeres?

Answer 6

Senesce

Apoptose

Question 7

What is organismal senescence?

Answer 7

Ageing of whole organism

Question 8

What is the physiology of ageing?

Answer 8

Decline due to normal ageing
Exaggerated/accelerated by disease and deconditioning
Decreased reserve to respond to challenges

Question 9

Do all body parts age at the same rate?

Answer 9

No

Question 10

What is deconditioning?

Answer 10

Decreased physical activity

Question 11

What is successful ageing?

Answer 11

Changes due solely to ageing process, unaffected by disease, environmental, or lifestyle factors

Question 12

What is usual ageing?

Answer 12

Changes associated with combined effects of ageing process, disease, and adverse environment and lifestyle factors

Question 13

What is frailty?

Answer 13

Multi-system dysregulations > loss of dynamic homeostasis, decreased physiological reserve, and increased vulnerability for subsequent morbidity and mortality

Question 14

What is frailty associated with?

Answer 14

Low-grade, chronic activation of immune system with abnormalities of endocrine and coagulation systems

Question 15

What is the phenotype model of frailty?

Answer 15

Group of patient characteristics which if present can predict poorer outcomes

Question 16

What is the deficit model of frailty?

Answer 16

Accumulation of deficits that can occur with ageing > combine to increase frailty index > increases risk of adverse outcome

Question 17

What are the characteristics of frailty in the phenotype model?

Answer 17

Unintentional weight loss
Weakness
Exhaustion
Slow walking speed
Low physical activity

Question 18

What is the classification system of frailty in the phenotype model?

Answer 18

Pre-frail = have 1-2 criteria
Frail = have 3+ criteria

Question 19

What is the Canadian clinical frailty scale?

Answer 19

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

Question 20

What is sarcopenia?

Answer 20

Loss of muscle mass and strength

Question 21

When does sarcopenia happen?

Answer 21

Starts after 50 but more rapid after 60

Question 22

What accelerates sarcopenia?

Answer 22

Chronic disease

Question 23

What contributes to sarcopenia?

Answer 23

Changes in alpha motor neurons
Type 2 muscle fibre loss
Muscular atrophy
Poor nutrition
Low physical activity
Decreased GH
Decreased sex steroid levels

Question 24

What are some potential interventions for frailty?

Answer 24

Exercise
Nutritional support
Pharmacology?

Question 25

What are some examples of geriatric syndromes?

Answer 25

Falls
Incontinence
Delirium
Pressure ulcers
Functional decline