Chronic Disease - Old Age

Question 1

what is the definition of epidemiology

Answer 1

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

Question 2

why will the world population continue to grow fast?

Answer 2

highly predictable fill up of adults - increased life expectancy

Question 3

what factors affect health trajectories as we age?

Answer 3

genes
nutrition
lifestyle
environment
SES
attitude
mental health

Question 4

what bodily functions are altered as we age

Answer 4

cellular senescence
loss of proteostasis
stem cell exhaustion
poor muscle quality
brain health
arterial stiffness
disability

Question 5

outline the newcastle 85+ study

Answer 5

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

Question 5

how was data gathered in the newcastle 85+ study

Answer 5

multidimensional health assessment by a trained research nurse in subjects home and review of GP medical records

Question 6

what did the Newcastle 85+ study find on disease

Answer 6

78% rated their health compared with others of the same age as ‘good’ , very good or excellent

Question 7

what did the newcastle 85+ study conclude about comorbidities

Answer 7

1/4 men and 1/6 women had no important functional limitation at age 85

Question 8

is health expectancy more important than life expectancy

Answer 8

yes now that we have chronic diseases, people may live longer but quantity of remaining life is not sufficient

Question 9

how is health expectancy calculated

Answer 9

standard life table and prevalence of ill-health from survey (age and sex specific prevalence)

Question 10

what is health expectancy used to monitor

Answer 10

population health over time
compare countries
compare regions within countries
compare different social groups within a population

Question 11

how much health is lost at 65% through life

Answer 11

50%

Question 12

when does observable functional decline happen

Answer 12

when all resilience mechanisms of biology and phenotype are exhausted

Question 13

outline the hierarchy of disability

Answer 13

difficulties of daily life unfold in an order
from shopping to walking, housework, cooking, dressing, bed transfer and feeding

Question 14

what is the MRC CFAS

Answer 14

cognitive function and ageing study
sampled cambridge, newcastle and nottingham
CFAS I = screen, then assessment
CFAS II = one interview

Question 15

outline the relationship of dementia with age

Answer 15

prevalence increases in older ages for men and women

Question 16

what did CFASA find about cognitive impairment free LE

Answer 16

from 1991 to 2011 CIFLE increased by 4 years in women
and so life expectancy increased by 3.6 years

Question 17

what did the CFAS find about disability free life expectancy

Answer 17

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

Question 18

what does the ONS show about the north and south of england

Answer 18

inequalities in DFLE exceed those in LE
LE inequalities have reduced over last 5 years but DFLE have continued to increase

Question 19

what is PACSim

Answer 19

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

Question 20

how does PACSim work

Answer 20

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

Question 21

what does PACSim predict the prevalence of disease will be in 2041

Answer 21

arthiritis, hypertension and obesity
prevalence of all other conditions apart from overweight and depressed is expected to increase

Question 22

outline age specific prevalence of diabates in 2041 as indicated by PACSim

Answer 22

overall increase in prevalence is being driven by people in older age groups
and clear gender difference emerging - more men

Question 23

what is meant by dependancy - Interval of Need - Isaacs and Neville 1975

Answer 23

high - requires 24h care , bed bound, MMSE<10
medium - need help preparing meal or dressing
low - help less than daily, light housework/bathing
independent

Question 24

outline dependency for men

Answer 24

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

Question 25

outline dependency in women

Answer 25

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