Ageing + Caring

Question 1

What is the average life expectancy in the UK? (M/F)
What % UK population is over 65
What % inpatients are over 65
What % of over 65s are in care home

Answer 1

M: 80; F: 83

18% UK pop >65
65% inpatients (2/3rd) >65
5% of over 65s in care home

Question 2

What chronic conditions can be helped/prevented by physical activity (7)

Answer 2

HTN
Dyslipidaemia
DM
Obesity

Osteoporosis
Osteoarthritis
Sarcopenia

Question 3

What is the global prevalence of physical inactivity in adults?
How does this compare to the prevalences of smoking/HTN

Answer 3

17%

UK prevalence of physical inactivity (higher)
= Twice as much as prevalence of HTN/Smoking

Question 4

List some benefits of physical activity in elderly people (8)

Answer 4

Reduce mortality of all CV/DM causes
Slowed cognitive decline
Social opportunities
Delay need for nursing home

Improve strength/balance/coordination:
Reduce falls
Reduce immobility complications
Maintain ADL independance

Question 5

What % >75s do recommended physical activity levels
What % >80s are sedentary
What % >65s cannot walk independently / manage stairs
What % >65s have insuff quads to stand from chair

Answer 5

9% men + 4% women >75 do recomm. physical activity
40% men + 65% women >80 are sedentary

12% >65s cannot walk independently
9% can’t manage stairs

30% men + 50% women >65 insuff quads

Question 6

What aspects of functional capacity change/worsen with age (8)

Answer 6

Muscle strength (1-3% loss/yr)
Muscle power (3-4% loss/yr)
Proprioception
Kinesthetic awareness
Thermoregulation
Aerobic capacity (10% loss/10yrs)
Loss of flexibility (+ balance)
Loss of bone density (1%/yr men + 2-3%/yr women)

Question 7

What are the 3 Categories of people in the Heidlberg WHO Framework (of physical function)

Answer 7

Physically unfit-unhealthy dependant:
Could enhance QoL/restore indépendance w. physical

Physically unfit-unhealthy dependant:
Still living indep but doesn’t do adequate physical

Physically fit-healthy
Adequate physical + ADL independent

Question 8

Describe the Hierachy of Physical Function groups (5)

Answer 8

Elite
Fit
Independent
Frail
Dependant

Question 9

What types of activity can be recommended for the elderly? (5)

Answer 9

Strength + Balance exercises (e.g. aqua aerobic, tai-chi)
Muscle power + strength exercises
Flexibility exercises
Cardio
Bone exercises (anti-gravity, in fracture sites)

Question 10

What % adults are unpaid carers? (+ M/F)

What is the peak age of being a carer?

Answer 10

12.5% (1/8) adults unpaid carers - 58% women/42% men

Peak age - 50-59

Question 11

What are the adverse health impacts of being a carer? + give some stats behind this

Answer 11

85% -ve physical effects (e.g. man handling injuries)
and -ve mental effects (stress/depression)

40% put off own GP/Tx

Question 12

What are the adverse social impacts of being a carer?

What % care ± family / ± social services?

Answer 12

Social isolation
40% no day off in 18m/ holiday in 5yrs

37% no fam + no social services
29% fam but no social services

Question 13

What is the average life expectancy in a nursing home VS in a residential home

Answer 13

Nursing home = 1yr

Residential = 2yrs

Question 14

What % residents in care homes...:
Cognitive impairment
Urinary incontinence
Bed bound
Behavioural Sx
Risk of malnutrition
Malnourished

Answer 14

50-75% cog impaired
50-75% incontinent

25-50% bedbound
66% (2/3) behavioural Sx

56% malnutrition risk
30% malnourished

Question 15

List the domains of a CGA (6)

Answer 15

Medical (co-morbs/ meds/ nutrition/ problem list)
Psychological (cognition / mood / fears)
Functional (core funcs e.g. balance, ADLs, pts life roles)
Social (networks / statutory care)
Environmental (home/ transport facilities/ technology)

Question 16

When is a CGA used? (IIII)

Answer 16

Instability (falls)
Immobility
Incontinence
Intellectual impairment (delirium/dementia)

Question 17

What is defined as ‘approached end of life’?

Answer 17

= likely to die within 12m (inc. where death imminent)
And those with:
- Advanced/progressive/incurable conditions
- General frailty w. co-existing conditions
- Existing conditions w. risk of sudden acute crisis
- Life threatening acute condition (from catastrophic event)

Question 18

List some indicators of decline (regarding terminal care) (10)

Answer 18

Co-morbidities**
Physical decline
Advanced disease
Reduced activity
Reduced Tx response

Sentinel event e.g. fall, bereavement
Repeated admissions (unplanned)
Choice of no further Tx
Wt loss >10% in 6m
Serum albumin <25

Question 19

List the domains of the ICF (International Classification of Functioning + Health Framework) (5)
List the advantages over previously used classifications of Disability

Answer 19

Health Condition:
Body Functions+Structures / Activity / Participation
Contextual Factors:
Environmental factors / Personal factors

ICF recognises disability as a universal experience, not just based on medical but taking account of social/environment aspects of disability

Question 20

What are the indicators of severe frailty (7)

Answer 20

Deteriorating functional score (Barthel's)
Combo of ≥3: 
Depression
Weakness
Slow walking
Signif wt loss
Exhaustion
Low physical activity

Question 21

List some drugs used for Sx control in palliative care (5)

Answer 21

Morphine (pain + breathlessness)
Midazolam (agitation + breathlessness)
Levopromazine (agitation + N+V)
Hyoscine/Butylbromide (resp tract secretions)

Question 22

What is the prevalence of elder abuse in the community + residential care

Which groups of people is the abuse from

Answer 22

4% prevalence
(5% verbal; 2% physical; 2% financial)

US study suggests 5-10% in residential care

Partners (35%) / Family (35%) / Neighbours etc (35%)
+ more

Question 23

Who should be contacted if suspect Elder Abuse

Answer 23

Safeguarding! Police!

Medic/ nurse/ social worker / psychiatrist