Ageing & Frailty Flashcards
What is frailty?
FRAILTY = SUSCEPTIBLE STATE leads to a person being MORE LIKELY to LOSE FUNCTION in the face of an ENVIRONMENTAL CHALLENGE e.g. being able to walk w/o falling down, delirium w/ infections etc.
○ RESULTS in FRAILTY SYNDROME: FALLS, DELIRIUM, IMMOBILITY, INCONTINENCE ○ Environmental challenges can include biomedical changes e.g. environmental temp. changes & also social changes e.g. child on holiday, spouse passed away
Theories of Ageing
STOCHASTIC:
• CUMULATIVE DAMAGE = oxidative stress, wear & tear
• IRREPARABLE DAMAGE resulting in SYSTEM BREAKDOWN
RANDOM
PROGRAMMED:
• PREDETERMINED - at a certain age, things start breaking down e.g. telomeres
• CHANGES in GENE EXPRESSION DURING VARIOUS STAGES
Homeostatic Failure + Connection to Frailty
- DYSHOMEOSTASIS = INABILITY to MAINTAIN STEADY STATE
- IMPAIRED FUNCTION of ANY ORGAN SYSTEM MAKES HOMEOSTASIS MORE DIFFICULT
- FRAILTY = PROGRESSIVE DYSHOMEOSTASIS
Physiology of Ageing
- AFFECTS almost EVERY ORGAN/SYSTEM
- MARKED INTER-INDIVIDUAL VARIABILITY in both DEVELOPMENT & MAGNITUDE of CHANGES (not a lot of difference bwtn 20 year olds, lots of different changes bwtn old people)
- INTER-INDIVIDUAL VARIABLITY INCREASES w/ AGE
Practical Implications of Ageing
- INCREASING NUMBER of OLDER PEOPLE w/ MULTIPLE CO-EXISTING MEDICAL CONDITIONS
- INCREASED INTER-INDIVIDUAL VARIABILITY in ORGAN FUNCTION + HOMEOSTATIC RESERVE
- DIFFERENT PRESENTATIONS + DIFFERENT ILLNESSES can PRESENT SIMILARLY
- LITTLE EVIDENCE of DRUG EFFICACY + SAFETY for PATIENTS 80+
- POLYPHARMACY = drug-drug interactions + ADR
Why are more people ageing?
• INCREASED RESOURCES AVAILABILITY
* BETTER ECONOMIC CONDITIONS * IMPROVED SCREENING PROGRAMS w/ EARLIER DIAGNOSIS + TREATMENT * BETTER OUTCOMES FOLLOWING MAJOR EVENTS: cardiac, stroke, surgery
• CONSEQUENCES: more people survive major event - but may have severe disability, more people have several co-morbid conditions
