Chronic Disease - Old Age Flashcards
what is the definition of epidemiology
study of the distribution and determinants of mortality and morbidity in populations and application of that knowledge to the planning and evaluation of preventative and therapeutic services
why will the world population continue to grow fast?
highly predictable fill up of adults - increased life expectancy
what factors affect health trajectories as we age?
genes
nutrition
lifestyle
environment
SES
attitude
mental health
what bodily functions are altered as we age
cellular senescence
loss of proteostasis
stem cell exhaustion
poor muscle quality
brain health
arterial stiffness
disability
outline the newcastle 85+ study
population-based longitudinal study of those aged 85 in newcastle
aim to understand the factors associated with health maintenance
subjects followed up at 18,36,60 and 120 months
how was data gathered in the newcastle 85+ study
multidimensional health assessment by a trained research nurse in subjects home and review of GP medical records
what did the Newcastle 85+ study find on disease
78% rated their health compared with others of the same age as ‘good’ , very good or excellent
what did the newcastle 85+ study conclude about comorbidities
1/4 men and 1/6 women had no important functional limitation at age 85
is health expectancy more important than life expectancy
yes now that we have chronic diseases, people may live longer but quantity of remaining life is not sufficient
how is health expectancy calculated
standard life table and prevalence of ill-health from survey (age and sex specific prevalence)
what is health expectancy used to monitor
population health over time
compare countries
compare regions within countries
compare different social groups within a population
how much health is lost at 65% through life
50%
when does observable functional decline happen
when all resilience mechanisms of biology and phenotype are exhausted
outline the hierarchy of disability
difficulties of daily life unfold in an order
from shopping to walking, housework, cooking, dressing, bed transfer and feeding
what is the MRC CFAS
cognitive function and ageing study
sampled cambridge, newcastle and nottingham
CFAS I = screen, then assessment
CFAS II = one interview
outline the relationship of dementia with age
prevalence increases in older ages for men and women
what did CFASA find about cognitive impairment free LE
from 1991 to 2011 CIFLE increased by 4 years in women
and so life expectancy increased by 3.6 years
what did the CFAS find about disability free life expectancy
from 1991 to 2011
increase in DFLE was smaller than the increase in LE and significant increase in DLE (years with disability) in women aged 65
but most increase is years with mild disability - dynamic equillibrium
what does the ONS show about the north and south of england
inequalities in DFLE exceed those in LE
LE inequalities have reduced over last 5 years but DFLE have continued to increase
what is PACSim
population ageing and care simulation
- made to plan services ahead of time based on estimates of ill-health and those who may require long term care and HLE
estimates for range of diseases and multimorbidities
how does PACSim work
takes longitudinal data from 3 studies in england
simulation which ages people on a monthly basis - from the data obtained
allows analysis of disease trends, multimorbidity, dependancy and HLE
what does PACSim predict the prevalence of disease will be in 2041
arthiritis, hypertension and obesity
prevalence of all other conditions apart from overweight and depressed is expected to increase
outline age specific prevalence of diabates in 2041 as indicated by PACSim
overall increase in prevalence is being driven by people in older age groups
and clear gender difference emerging - more men
what is meant by dependancy - Interval of Need - Isaacs and Neville 1975
high - requires 24h care , bed bound, MMSE<10
medium - need help preparing meal or dressing
low - help less than daily, light housework/bathing
independent
outline dependency for men
estimates show total life expectany will increase between 2015 and 2035 by 3.5yrs and this gain is largely independent
so men are predicted to experience a compression of dependancy - good news
outline dependency in women
also estimates of an increase in LE of 3 yrs but there is an expansion of time they spend in high and low dependency - bad
2015-2035
