Case 25- calcium and old age Flashcards

Question

PTH action on bone

Answer 1

1) Directly on bone to stimulate Ca2+ resorption- increase in osteoclast number, increase in osteoclast activity 2) Directly on bone to decrease collagen synthesis by osteoblasts (i.e. decrease bone formation)

Answer 2

1) Directly to stimulate Ca2+ reabsorption in the distal tubule 2) Directly to stimulate the activity of 1alpha-hydroxylase, which catalyzes the formation of 1,25 DHCC from Vitamin D

Answer 3

1) Has no direct effect | 2) Acts indirectly by stimulating 1,25 DHCC synthesis- stimulates calcium absorption

Answer 4

The active form of vitamin D | Needs help from 1-α hydroxylase to convert vitamin D3 to 1,25 DHCC

Answer 5

Stimulates calcium absorption and increases plasma calcium concentration How it works- Greater expression of calbindin so helps to sequester larger amounts of Ca - increases capacity of epithelial cell to pull Ca out of lumen so increased concentration in epithelial cells to be actively transported into the blood

Answer 6

Stimulates calcium absorption and increases plasma calcium concentration How it works- Greater expression of calbindin so helps to sequester larger amounts of Ca - increases capacity of epithelial cell to pull Ca out of lumen so increased concentration in epithelial cells to be actively transported into the blood

Answer 7

Kidney- Increases tubular reabsorption of calcium, relatively minor effect Bone- promotes action of PTH, relatively minor. Net effect=resorption Intestine- main action is on the intestine, increases calcium reabsorption

Answer 8

Synthesised and secreted by parafollicular C cells of the thyroid Major stimulus of calcitonin secretion increases plasma calcium levels Calcitonin is a physiological antagonist to PTH with regard to calcium homeostasis

Answer 9

Bone - mainly osteoclast - inhibits osteoclast motility and cell shape - inactivates cell - major effect is a rapid decrease in calcium inhibition of bone resorption - inhibits bone removal, promotes bone formation

Answer 10

Kidney- decrease tubular reabsorption of calcium (weak effect) Intestine- no effect

Answer 11

Very minor role Chronic excess does not produce hypocalcaemia Removal of parafollicular cells does not cause hypercalcaemia May be more important in bone remodelling than in calcium homeostasis

Answer 12

• In 2015 life expectancy at 65 was +18.6 (men), +21.1 (women) – most of these years are spent with 1 or 2 diseases • By 2035 life expectancy at 65 will be higher, but with more time spent with MLTCs (2+ diseases)

Answer 13

Between 2015 and 2035 absolute numbers of people 65+ will increase by 48.6% • Numbers of people 65+ living independently will increase 61%

Answer 14

``` • Overall life expectancy increasing faster than healthy life expectancy • Increase in chronic non-communicable diseases (NCDs) • Scope for prevention eg treatment of hypertension • Social and economic benefit • Traditional care systems may not meet needs for NCDs eg dementia ```

Answer 15

1) Attitudes improving but ongoing evidence of ageism and negative stereotyping, including in healthcare 2) This is seen in Workplace discrimination, Gender-based abuse and a Lack of prioritisation in policy

Answer 16

``` • Changing “frontline” presentations (GP, A and E) • Lack of guidelines and infrastructure appropriate for multimorbidity ```

Answer 17

``` • Numbers of older people presenting to A and E are rising disproportionately to increases in the population • Older people are likely to spend longer in A and E and are more likely to be admitted ```

Answer 18

``` • NHS historically set up to deal with single system conditions (eg cardio or GI or respiratory) rather than multimorbidity • Research and guidelines based on single conditions in younger populations (OP excluded) • Lack of guidance and evidence base in relation to OP with complex pathologies • Lack of service integration ```

Answer 19

1) Kings fund (2014) | 2) NHS long term plan (2018)

Answer 20

``` King’s Fund (2014) – evidence synthesis: • Shift from high cost reactive care to preventative and supportive care • Continuity of care (eg GP) • Prevention through lifestyle change • Comprehensive Geriatric Assessment (CGA) • Successful interventions ```

Answer 21

• Moves forward from the biopsychosocial model • Person-centred • An approach to managing MLTCs • Requires the complementary skills of the MDT to make a truly holistic assessment • Different settings e.g. emergency care, community, day hospital Established evidence bases, results in a reduced- Length of stay, Costs, Admission to longterm care, Post-operative complications

Answer 22

1) New service model- community based MDT teams 2) Social prescribing 3) 'Same day' emergency care/CGA 4) Integration of health and social care 5) Prioritise prevention- smoking, alcohol, air pollution, inequalities, screening

Answer 23

1) Consent and capacity 2) End of life care and resuscitation 3) When to investigate and when to pallitate (risk/benefit balance)

Answer 24

1) Research is most often condition or systems based 2) Older people are often excluded from trials 3) Lack of evidence in relation to multi-morbidity (at any age) 4) Disproportionate concern about risk

Answer 25

``` A medical syndrome with multiple causes and contributors that is characterized by diminished strength, endurance, and reduced physiologic function that increases an individual’s vulnerability for developing increased dependency and/or death ```

Answer 26

``` A medical syndrome with multiple causes and contributors that is characterized by diminished strength, endurance, and reduced physiologic function that increases an individual’s vulnerability for developing increased dependency and/or death ```

Answer 27

Neurology- slower reaction time Cardiovascular- heart valve calcification Psychiatry- loss of neurons and brain mass

Answer 28

1) Identification of older people 'at risk; 2) Planning services, support and recources- Immediate, long term 3) Intervention to prevent morbidity/mortality- Physical activity, dietary supplementation, reduction of polypharmacy 4) Improves quality of life

Answer 29

2 main academic models: 1) Frailty phenotype (Fried)- rule based 'objective' 2) Frailty index (Rockwood)- deficit model 'subjective'

Answer 30

``` Choice depends on context (eg): • Rockwood Clinical Frailty Score (CFS) • Gait speed/TUG • Self-report eg PRISMA-7 ```

Answer 31

``` Holistic, integrated approach (person, pathology, environment) Person-centred care: • Dignity respect and compassion • Care co-ordination and transition • Personalised (not standardised by disease) • Enabling (not disabling) Multidisciplinary>CGA ```