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FOPC > Ageing Well or Not So Well > Flashcards

Ageing Well or Not So Well Flashcards

1
Q

What is demographics?

A

Study of populations based on factors such as race, age and gender

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2
Q

What is demographic data?

A

socio-economic info expressed statistically.

Income, education, marital status, employment status etc

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3
Q

Are population demographics static?

A

No

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4
Q

Why are population demographics not static?

A

birth
death
migration
= these are all measurable, balance of factors

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5
Q

What factors influence population growth?

A
  • cost of education
  • female labour market participation
  • economic growth
  • stability of society
  • availability of contraception
  • social norms
  • government policy
  • healthcare standards
  • net migration
  • cultural attitudes to family size
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6
Q

What are the 5 stages of demographic transition?

A

Stage 1 – pre-industrial; birth and death rates high – population size fairly constant – wars and pandemics etc can have a big impact.
Stage 2 – modern medicine – lower death rates esp. among children. Birth rates remain high – rapid population growth.
Stage 3 – birth rates gradually decrease, improved economic conditions and contraception. Population growth continues but at a lower rate.
Stage 4 – population stabilises as birth rates and death rates low. Stronger economies, better education, better healthcare, more women in work.
Stage 5 – in the future fertility rates fall and elderly population > younger.

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7
Q

What can affect life expectancy?

A

deprivation
ie lower life expectancy in least deprived areas eg 10yrs in least deprived areas in Scotland for females and 13.3 years for males.

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8
Q

What can be used to measure deprivation?

A

Scottish index of multiple deprivation (SIMD)

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9
Q

What 7 factors does the SIMD include?

A
  • income
  • employment
  • education
  • health
  • access to services
  • crime
  • housing

(deciles each containing 10% of population and quintiles each containing 20% of the population)

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10
Q

What were the leading causes of death in Scotland?

A
  1. ischaemic HD
  2. dementia and alzheimer’s
  3. lung cancer
  4. cerebrovascualr disease (inlc stroke)
  5. chronic lower resp diseases (eg bronchitis and emphysema)
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11
Q

What does the risk of preventable death increase with?

A

deprivation

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12
Q

What is healthy life expectancy linked to?

A

life expectancy and deprivation (where someone lives has a profound impact on morbidity and mortality)

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13
Q

What is the impact of an ageing population?

A
  • need for health and social care
  • increased spending on pensioners
  • increase in dependency ratio
  • housing needs
  • workforce shortages
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14
Q

What do populations change due to?

A

changes in birth rates, death rates, immigration and emigration

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15
Q

What do populations curves in different countries and in different regions of the same country reflect?

A

local socio-economic differences

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16
Q

Are life expectancy and health life expectancy linked?

A

yes

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17
Q

what does deprivation have a significant impact on?

A

both life expectancy and healthy life expectancy

18
Q

What is the physiology of ageing?

A
  • decline
  • loss of cells
  • loss of function
  • across body systems
  • less ability to respond to metabolic stress
  • less reserve capacity
  • less ability to recover

Cardiovascular system – hypertension, arteriosclerosis, reduced ejection fraction.
Respiratory system – reduced lung volumes, alveolar enlargement, reduced respiratory muscle strength.
Musculoskeletal system – osteopenia, sarcopenia, degeneration of articular cartilage.
Ocular system – dry eyes, presbyopia, cataracts, macular degeneration.
Vestibulocochlear system – hearing loss, loss of balance.
Urinary and renal systems – reduction in GFR, reduction in bladder capacity, reduction in urinary flow rate

19
Q

how can long term conditions affect people?

A

by age 65 - 2/3 of people have long term conditions
60% of all death and 80% of of GP consultations due to long term conditions
Cancer, asthma, diabetes, COPD, depression, anxiety, alcohol and substance abuse, heart disease, chronic pain, multiple sclerosis, rheumatoid arthritis, inflammatory bowel disease, psoriasis, sight loss, hearing loss, learning disability.

20
Q

what is multimorbidity?

A

presence of 2 or more long term conditions

1/4 of people aged 75-84 have 2 or more long term conditions

Linked with reduced quality of life, higher mortality, higher use of health services and polypharmacy.

Multiple symptoms, multiple medications, burden of disease and treatment. Complex.

21
Q

does deprivation affect multimorbidity?

A

yes - most deprived experience multimorbidity 10-15yrs earlier than most deprived

22
Q

what is the commonest multimorbidity in deprivation?

A

mental health

23
Q

what is polypharmacy?

A

definitions vary = 4-9 or >10

  • multiple meds introduced for each condition
  • appropriate vs inappropriate
  • increased treatment burden
  • increased likelihood of interactions
  • “law of diminishing returns”
  • reduced ability of patients to adhere to treatment
24
Q

what is the complexity involved in polypharmacy?

A

Guideline based treatments focus on single diseases.
Medications are tested in isolation.
Drugs often interact with one another.
Drugs that help one system hinder another.
Multimorbidity – frailty – less reserve – higher likelihood of harm.

25
Q

what does ageing increase likelihood of?

A

long term conditions and multi-morbidity

26
Q

what is multi-morbidity assc with?

A

reduced QoL, increased mortality and increased use of health services

27
Q

what are the different care services?

A

Care services.

  • At home cared for by family/friends – carers.
  • Formal care - Visits once/multiple times a day to assist with tasks including washing, dressing, meals and medications.

Sheltered housing.
-Warden available during the day.

Very sheltered housing.
-Warden available during the day and the evening, often have their own carers.

Care home.
-24 hour care in supported environment.

Nursing home.
As above + nursing staff.

28
Q

who are carers?

A

17% of the Scottish adult population are carers (759,000 people).
4% of children under 16 are carers (29,000 young people).
59% of carers are female.
3 in 5 of us will be carers at some point in our lives.
Late 50’s to early 60’s – 1/3 women and 1/5 men are carers.
Carers save the Scottish economy 10.3 million (the cost of providing NHS services in Scotland).

29
Q

what constitutes care?

A

Many carers don’t identify as carers.
40% care for parents/parents in law. 26% care for spouse.
8% of carers look after disabled children and 5% look after adult children.
Often starts with “invisible tasks” – emotional support.
Women are more likely than men to see caring as part of their role, and not additional.
Many people work (including looking after children) and have other roles whilst they are caring.
Shopping, help with managing day to day activities and finances, assistance with washing, dressing and meal preparation, day trips.

30
Q

What is the impact of caring on carers?

A

physical health, mental health, social and financial impact (may be in debt, have to cut back on essentials, may not be able to afford bills without struggling financially etc)

31
Q

what does the need for care increase with?

A

ageing population

32
Q

who can all range of care options available have an impact on?

A

those providing the care

33
Q

what is anticipatory care planning?

A

advance and anticipatory care planning promotes discussion in which individuals, their care providers and often those close to them, make decisions with respect to their future health or personal and practical aspects of care

34
Q

when should anticipatory care planning be done?

A

at any time in life that seems appropriate and continuously

35
Q

who should do anticipatory care planning?

A

anyone with an appropriate relationship

36
Q

how should anticipatory care planning be done?

A

thinking ahead and making plans

do carefully, write it down

37
Q

how can ACP be shared?

A

KIS (key information summary) and other communication

38
Q

what is the legal aspect of ACP?

A

welfare power of attorney
financial power of attorney
guardianship

39
Q

what is the medical aspect of ACP?

A 
Potential problems​
Home care package​
Wishes re DNA CPR​
Scottish Palliative Care Guidelines​
Communication which has occurred withother professionals​
Details of “just-in-case” medicines​
Electronic care summary​
Assessment of capacity/competence​
Current aids and appliances (helps assesscurrent functional level)
40
Q

what is the personal aspect of ACP?

A

Statement of wishes regarding treatment/advancedirective​
Next of kin​
Consent to pass on information to relevant others​
Preferences and priorities regarding treatment​
Who else to consult/inform​
Preferred place of death​
Religious and cultural beliefs re death​
Current level of support e.g. family/carers

41
Q

when is seeking patients views on care and discussing ACP appropriate?

A

anytime

FOPC (4 decks)

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