Complex Systems at the Edge of Failure Flashcards
What are the characteristics of geriatric syndromes?
Multiple aetiological factors
Multiple interacting pathogenic pathways
Single symptom - affects higher order functions
Name the higher order functions affected by geriatric syndromes
Divided attention
Highly opposable thumbs
Bipedal ambulation
Which 2 types of factors determine the loss of higher order function?
Protective factors
Precipitating factors
Name the precipitating factors that affect the loss of higher function
Age
Cognitive impairment
Frailty
How is loss of higher function different in older compared to younger patients?
Smaller stressor required to reach threshold for symptom
Same symptom presentation
What is geriatric syndrome due to?
Single precipitating factor overwhelming protective factors
What are geriatric syndromes?
Decompensations of higher order functions
Name the geriatric syndromes
Delirium
Functional impairment
Falls and poor mobility
Name the 2 functional hierarchies in ageing
Instrumental activities of daily living
Personal activities of daily living
What are instrumental activities of daily living?
Activities required for satisfying life
What are personal activities of daily living and how does illness affect these?
Activities required everyday to remain healthy
In hierarchy
Illness causes deterioration of most complex activities first
How does life space change with illness?
Shrinks
Define frailty
State that increases risk of adverse events
How does frailty develop?
Genetic and environmental factors cause cumulative molecular and cellular damage
Decreases physiological reserve with age
Causes decreased physical activity and poor nutrition
Causes frailty
Enables stressors to cause falls and delirium
Feedback to further decrease physiological reserve
What is the frailty phenotype model?
‘What you are’
Certain visual features of frailty - sarcopenia (loss of muscle mass), decreased strength, decreased walking speed, undernutrition
Name the 2 measures of frailty
Frailty phenotype model
Frailty index
What is the frailty index?
‘What you have’
Broader than phenotype model - considers functional (cognition, emotion, communication) deficits
Number of deficits experienced out of total possible deficits
What does the frailty index predict?
Likelihood of death within next 5 years
What is the frailty index most useful for?
Epidemiological study
What is the frailty phenotype model most useful for?
Clinical trials on frailty
What is resilience?
Responses to stressors
Difference between basal physiological level and reserve - min. and max. physiological capacity
What are the 2 types of system?
Simple - modularity - as stress applied system adapts
Complex - connectivity - as stress applied sudden transition to different state
Which type of system is a human?
Complex
Why do clinicians try to predict the critical transition in frailty?
Prevent loss of higher order functions - poor outcomes
What is dynamic phenotyping?
Measure of resilience
Quantification of difference between basal and max. capacities
How does an acute ailment differentially affect younger and frail elderly individuals?
Functional impact persists after acute ailment only in elderly - acute functional impairment
What is the aim of testing responses of frail elderly to controlled stressors in the clinic?
Predict effect of natural stressors - before acute functional impairment and loss of higher functions
