Ageing and Healthcare

Question 1

Describe the molecular theory of ageing.

Answer 1

• Age-related ‘programmed’ regulation of gene expression at different stages in life.
• Epigenetic modifications e.g. DNA methylation.
  
  • Addition of methyl group to cytosine - has the effect of making the gene less active.
  • Global reduction in methylation, focal increase near tumour suppressor genes.
• Histone modification.
  
  • Histones package and order DNA
  • Activity and function can be modified by acetylation and methylation.
  • Changes can affect gene regulation and DNA repair.

Question 2

Describe the cellular theory of ageing.

Answer 2

• Telomere shortening - progressive loss of chromosome ‘caps’.
• Free radical damage in oxidative metabolism.
• Apoptosis - programmed cell death of terminally differentiated cells or with excessive DNA damage.

Question 3

Describe the environmental and evolutionary theory of ageing.

Answer 3

• ‘Wear and tear’ (ie inability to regenerate damaged tissue).
• Cumulative DNA damage including by UV and ionising radiation.
• ‘Whole body metabolism and energy expenditure theory’.
• ‘Disposable soma’ ie no evolutionary advantage in survival beyond reproduction and rearing children.

Question 4

Describe the organ function decline associated with age.

Answer 4

• Age-related decline in every organ / system.
• Not life-threatening but declining reserves.
• Organ function decline - renal and cardiac:
  
  • Decline in things like kidney function is actually natural age-related physiological change (decline) rather than disease.

Question 5

What is the correlation between disease incidence and age?

Answer 5

• With the exceptions of accident / suicide, most health issues are more common with increasing age.
• As a result, health and social care costs rise with increasing age.
• Burden of disease links to deprivation index:
  
  • Smoking
  • Alcohol
  • Diet and obesity
  • Housing

Question 6

What muse be considered in a comprehensive geriatric assessment?

Answer 6

• Medical and medication reviews.
• Environmental hazards.
• Functional capacity.
• Psychological assessment.
• Balance - assessment of falls risk.
  
  • Sarcopaenia?
  • Postural HTN?

Question 7

What is frailty?

Answer 7

A clinically recognisable state of increased vulnerability resulting from ageing-associated decline in reserve and function across multiple physiological systems such that the ability to cope with everyday or acute stressors is compromised.