AID Flashcards
What are the demographic trends in the first 30 years of the NHS?
infant mortality/1000 live births
Girls: (1948) 39, (1996) 7
Boys: (1948) 30, (1996) 5
With the introduction of the NHS, there have been lots of factors contributing to increasing old age. There is therefore less infant mortality and the dramatic initial change was due to the introduction of the NHS, but it is still decreasing.
proportion of deaths below 65 in England and Wales
(1948) 40%
(1996) 7%
Are the increasing numbers of people reaching old age worrying figures?
- By 2007 there were more people over 65 than under 18
- The over 85s are the fastest growing segment of the population and are set to double by 2020
- The potential problems with this are that they are the people taking pensions and needing health care, and these things are paid for and supplied by the younger working people, which there may not be enough of, and this can have a huge impact
What shape of population pyramid have we reached now?
This is how we have now reached. A barrel shape with a bulge in the middle – this is the ‘baby boomers’, those born in 40s/50s after WWII, they are now in their 60s-70s and are the ones who could cause potential problems in the future
What are survival curves?
graphical representation of population survival with age
What are logarithmic scales?
haracteristic of populations that do not age or live under such severe conditions that none survive to old age.
This gives some more information about % population at birth and how they decline with time
What does it mean to ‘square the rectangle’ of a logarithmic scale?
With further improvements in living conditions death is compacted to old age, squaring the rectangle of survival.
This is the ideal situation – we want to ‘square off’ the rectangle
What needs to be done to square the rectangle of survival in the UK?
- Decreased infant mortality
- Increased standard of living
- Improvements in public health
- Improvements in sanitation
- Improved diet – 1842 abolition of corn laws allowed importation of cheap American Food.
These are what have caused the changes in life expectancy/population
What is the future of old age?
- meagre increments?
- unenjoyed?
What are meagre increments?
- Expected length of retirement increased 4-8 fold since 1870
- Nearly all of this due to increased life expectancy rather than early retirement
- Average length of retirement increased by 5 years between 1981 and 2001
What is theoretical gloom?
- Exponential relationship between age and prevalence of disability
- Exponential relationship between age and chronic disabling diseases
- The older you are, the more likely you are to be disabled
What are some chronically disabling diseases that have a steep relationship to age?
- stroke
- alzheimers
- parkinsons
- osteoarthritis
What are dependency profiles of elderly people by age?
Height of column represents the number of people dependent on someone else for that activity
What are the 4 scenarios of the future of old age?
1 - 1 year of additional woe for every year of life gained
2 - less than 1 year of additional woe for one year of life gained
3 - no additional woe for each year of life gained
4 - less woe despite life gained: Fries’ ‘compression of morbidity’
What are the GHS trends from 1980-2001?
- no overall change in proportion of elderly people reporting their health as good (37%) fairly good (38%) and not good (25%)
- proportion of people reporting long-standing illness has not changed significantly
The height is the cumulative number of days spent in hospital until you die. This shows that its always the last three years that you spend most time in hospital regardless of what age you die at.
What are the days spend in hospital in 3 years prior to death?
- median 23 days
- did not rise with age above 45
About the predicted numbers of people over 65 in the UK unable to perform activities of daily living…
- predictions of people over 65 that are dependent on people for activities
- predictions made at different times
- when re-estimated using best actual data at the time, the more up to date statistical information we had, the lower and lower the estimate was getting
- the figures didn’t project – something is changing!
About ‘squaring the circle’…
‘ageing to the rescue!’
- progressive generalised impairment of function
- resulting in the loss of adaptive response to stress
- and a growing risk of age related disease
ageing starts at 14 – the eyes being the firs thing to be affected, needing more light to see things.
What is frailty?
a physiological syndrome characterised by decreased reserve and diminished resistance to stressors, resulting from cumulative decline across multiple physiological systems and causing vulnerability to adverse outcomes.
What is physical frailty?
the combination of weight loss, fatigue, impaired grip strength, diminished physical activity of a slow gait
Ageing vs disease
- disease need to be identified as it may respond to treatment or be preventable
- ageing is not reversible but may be compensatable
- all changes should not be put down to age
we cant just assume that something is down to ageing when there might be something more serious going on underneath
What are Strehler’s concepts for a true ageing process?
- universal
- intrinsic
- progressive
- deleterious
to be a true ageing process all 4 must be fulfilled
What is the universal aspect of Strehler’s concepts?
- identifiable in all members of a species
- may effect individuals to a different extent
- eg collagen cross links, loss of calcium from bones
What is the intrinsic aspect of Strehler’s concepts?
- restricted to changes of endogenous origin
- e.g. skin in axilla, hair loss
What is the progressive aspect of Strehler’s concepts?
- all changes continue progressively with time
- eg greying of hair, loss of muscle power
What is the deleterious aspect of Strehler’s concepts?
- should be eventually harmful to the organism
- eg reduced visual acuity, loss of hearing
What are the differences between ageing and disease?
AGEING
- universal
- intrinsic
- progressive
- deleterious
DISEASE
- individual
- intrinsic or extrinsic
- progressive but may be halted or reversed
- deleterious but may be arrested or cured
What is the geriatrician’s profession de foi?
Squaring the circle
By delaying the onset of disabling diseases to alter ages when intrinsic ageing has raised frailty by reducing adaptability, the average duration of disability before death will be shortened. In brief, we will spend a longer time living and a shorter time dying
About dependent life before death…
The older the age one attains without becoming disabled the shorter the period of dependency to be expected before death. The suggests that for disability in later life, postponement of age onset would result in preventing suffering
What is the untapped potential for postponing disability in old age?
- health promotion
- illness prevention
- appropriate use of existing technologies
- technologies around the corner
What is the rule of halves?
- of the population qualifying for lipid lowering treatment
- approximately, half are treated with lipid lowering therapy
- less than half achieve treatment goals
This data precedes the introduction of rosuvastatin and helps explain the need for rosuvastatin. Some of this lack of ideal management may be attributable to the efficacy of drugs and some may be due to compliance issues. However patients who get to their LDL goal at the first dose they use may well be more likely to comply to treatment.
Despite the universally accepted evidence that confirms the benefit of lipid lowering therapy, large observational studies such as EUROASPIRE II have shown that many patients in need of lipid lowering therapy remain untreated. The EUROASPIRE II study was a large survey of lifestyle, risk factor management and drug therapy undertaken in clinical practice and involving over 8000 CHD patients in 15 countries across Europe. The results provide valuable insight into what is actually happening in practice and highlight that many patients - two in every five - in need of lipid lowering therapy remain untreated
What is the drug treatment of older people?
- 10% on contraindicated drugs
- 6% acute admissions due to inappropriate prescriptions
What is the effect of older people on finances?
- We cant afford to make or keep old people healthy
- We cant afford healthy old people
We cant afford to make or keep old people healthy
- Prevention is cheaper than cure
- Postponement and compression of morbidity is cheaper than community or institutional care for people with chronic disability
Increases in healthcare expenses in old age
- Availability of new treatments
- Appropriate expectation that older people would benefit from them
- Age specific need for health care is falling
- Expenditure on health care always maximal in the last year, irrespective of age of death
Health expenditure UK
- Smaller increase in per capita costs for older rages compared with younger age groups
- Combined NHS and hospital and community services for 85+ has decreased in real per capita costs between 1985-87 and 1996-99
Affording to keep healthy old people
- Old age is a social construct as well as a biological phenomenon
- Older people can be producers as well as consumers
- Peg median age of compulsory retirement to median age of death