Ageing: Pre-Placement

Question 1

Name 5 clinical findings that are not necessarily pathological in old age

Answer 1

1. Neck stiffness
2. Positive urine dipstick in women
3. Mild crackles at lung bases
4. Slightly reduced PaO2
5. Reduced skin turgor

Question 2

Name the 4 most common presentations of different illnesses in the elderly (‘geriatric giants’)

Answer 2

1. Immobility
2. Instability (falls + syncope)
3. Incontinence
4. Intellectual impairment (delirium + dementia)

Question 3

What are the 7 aspects assessed in a comprehensive geriatric assessment?

Answer 3

1. Medical diagnoses
2. Review of medication
3. Social circumstances
4. Assessment of cognition and mood
5. Functional ability
6. Environmental assessment
7. Economic circumstances

Question 4

What is frailty?

Answer 4

Progressive physiological decline in multiple organ systems marked by:

1. Loss of function
2. Loss of physiological reserve
3. Increased vulnerability to disease/death

Question 5

What 5 measures are used in Freid’s phenotype of frailty?

Answer 5

1. Grip strength
2. Walking speed
3. Fatigue
4. Activity levels
5. Weight loss

Question 6

Name 4 outcomes that have been associated with frailty

Answer 6

1. Death
2. Institutionalism
3. Adverse outcomes
4. Falls

Question 7

The production of which 3 circulating hormones decreases with age?

Answer 7

1. Growth hormone -> decreased IGF-1 production from liver
2. Estradiol + testosterone -> increased LH + FSH
3. Adrenocortical cell activity decreases -> increased cortisol

Question 8

What are the 2 frailty models used?

Answer 8

1. The Phenotype Model

2. Cumulative Deficit Model (aka. Frailty Index)

Question 9

Describe the phenotype model of frailty

Answer 9

• Frailty phenotype assigned based on 5 variables: weight loss, fatigue, low activity levels, slow gait, weak grip strength
• 3+ factors = frail
• 1-2 factors = pre-frail

Question 10

Describe the cumulative deficit model of frailty

Answer 10

• 30-92 baseline variables of symptoms/signs/lab results/disease states are used to define frailty
• Frailty being defined as the cumulative effect of individual deficits
• Frailty index is a simple calculation of the presence of each variable as a proportion of the whole (i.e. 20/92 = 0.22)
• This score is then translated into a 9-point scale (1 = fit; 9 = terminally ill)

Question 11

Of the 2 frailty models that exist, which is better?

Answer 11

Cumulative Deficit Model (aka. Frailty Index)

• It is a continuous rather than a categorical model providing more discriminatory capacity compared to the Phenotype Model.