Aging and healthcare of the elderly

Question 1

Definition of Aging

Answer 1

Progressive, generalised impairment of function resulting in the loss of adaptive response to stress and growing risk of disease

Question 2

Definition of Senescence

Answer 2

Process of deterioration in structure and function leading to reduced viability and increased vulnerability to external and internal threats ending in death

Question 3

Strehlers criteria for normal aging

Answer 3

Must be universal, progressive, intrinsic and deleterious

Question 4

Cardiac changes with aging

Answer 4

More fat less blood, decreased CO, large vessel compliance and homeostatic mechanisms,
decreased cardiac B receptor sensitivity

Question 5

Respiratory changes with aging

Answer 5

reduced elasticity, lower volumes due to kyphosis, decreased respiratory muscle strength

Question 6

Renal changes with aging

Answer 6

Loss of glomeruli leading to decreased GFR meaning slower drug clearance
Post menopausal atrophy of the vagina and urethra increases the risk of UTIs

Question 7

GI changes with aging

Answer 7

Prolonged transit time and decreased H+ production

No evidence for malabsorption

Question 8

Immune changes with aging

Answer 8

Reduced helper and suppressor T cells causes T cell CM immunity to drop – increased risk of autoimmunity and malignancy. Little evidence of changes in humoral immunity

Question 9

Sensory changes with aging

Answer 9

Eyes - Presbyopia, cataracts, senile macular degeneration
Ears - High tone deafness due to hair cell death
Brain - loss of neurones, astrocytes & sensory horn cells but no loss of learning ability but some reduction in cognitive speed

Question 10

Muscle changes with aging

Answer 10

50% loss of bulk by 80yrs – predominantly type II fibres lost – loss of physiological reserve

Question 11

Presentations of disease in older people

Answer 11

Present later often with atypical picture (afebrile, silent MIs, etc) – multiple diseases simultaneously
Illnesses cascade into more serious illnesses and interact with normal aging process

Question 12

Social context of diseases in the elderly

Answer 12

poverty is more common in the elderly – more likely to be living without support – patients and society are ageist and this impacts how they present and are treated

Question 13

Ageing Population

Answer 13

The proportion, rather than the number is increasing – this is a developing country problem – the population is already aged in developed countries

Question 14

Causes of ageing populations

Answer 14

Fertility – The most important general factor behind population structure
Mortality – Declining in older people, particularly the oldest old
Migration – historically weak but becoming more important

Question 15

LIfe expectancy in UK

Answer 15

Increasing, particularly for the old – but the healthy and disability free life expectancy is lower which places a major burden on healthcare provision

Question 16

Ethnicity and ageing

Answer 16

White british and white irish are the ‘oldest’ groups while black and mixed groups are the ‘youngest’ – but these groups are also about to undergo rapid ageing of their populations

Question 17

Living arrangement of older people

Answer 17

Above 75yrs 30% of men and 60% of women are living alone with the rest mostly in married couples (men die earlier leaving more widows)

Question 18

Social role of the elderly

Answer 18

A massive amount of informal care and volunteering is done by people over 65yrs

Question 19

By 2035

Answer 19

3.5million over 85yrs (in 2010 1.4million)

110,000 centenarians (in 2010 13,000)

Question 20

Elderly health burden

Answer 20

up to 98% of older adults have some co-morbidities

820,000 people in UK with dementia

Question 21

Cost of health and social care of the elderly (2010)

Answer 21

£23bn - £9bn social care but £12bn unpaid care

Question 22

The Geriatric giants (five ‘I’s)

Answer 22

Immobility, Instability, Incontinence, Impairment (mental), Infection

Question 23

Atypical Geriatric presentations - Cardiac

Answer 23

MI – SOB, palpitations, stroke
Arrhythmia – LOC, LVF, angina
Aortic Stenosis – angina, syncope, exhaustion, hypertensive ECG

Question 24

Atypical Geriatric presentations - Respiratory

Answer 24

PE – wheeze, new AF, unilateral pulmonary oedema

COPD – chronic asthma, orthopnoea,

Question 25

Atypical Geriatric presentations - GI

Answer 25

acute abdomen – delirium, pyrexia, gut ischemia, AAA
Ulcer – anaemia, anorexia, dysphagia
Intestinal Obstruction – may be pseudo-obstruction

Question 26

Atypical Geriatric presentations - Neurological

Answer 26

Stroke – acute confusion, falls, fits, impaired speech,
Tumour – stroke, confusion, incontinence or depression
Parkinson’s – slowing, problems swallowing, falls or tremors
Cord compression – problems walking, incontinence, falls, sensory loss

Question 27

Atypical Geriatric presentations - Metabolic

Answer 27

Hypothyroidism - depression or memory loss

Hypoglycaemia - confusion, fits, LOC

Question 28

Atypical Geriatric presentations - Infection

Answer 28

Site unclear (urinary, endocarditis, chest) and non-specific presentation (confusion, anorexia, falls, collapse)