Complex Systems at the Edge of Failure

Question 1

What are the characteristics of geriatric syndromes?

Answer 1

Multiple aetiological factors
Multiple interacting pathogenic pathways
Single symptom - affects higher order functions

Question 2

Name the higher order functions affected by geriatric syndromes

Answer 2

Divided attention
Highly opposable thumbs
Bipedal ambulation

Question 3

Which 2 types of factors determine the loss of higher order function?

Answer 3

Protective factors

Precipitating factors

Question 4

Name the precipitating factors that affect the loss of higher function

Answer 4

Age
Cognitive impairment
Frailty

Question 5

How is loss of higher function different in older compared to younger patients?

Answer 5

Smaller stressor required to reach threshold for symptom

Same symptom presentation

Question 6

What is geriatric syndrome due to?

Answer 6

Single precipitating factor overwhelming protective factors

Question 7

What are geriatric syndromes?

Answer 7

Decompensations of higher order functions

Question 8

Name the geriatric syndromes

Answer 8

Delirium
Functional impairment
Falls and poor mobility

Question 9

Name the 2 functional hierarchies in ageing

Answer 9

Instrumental activities of daily living

Personal activities of daily living

Question 10

What are instrumental activities of daily living?

Answer 10

Activities required for satisfying life

Question 11

What are personal activities of daily living and how does illness affect these?

Answer 11

Activities required everyday to remain healthy
In hierarchy
Illness causes deterioration of most complex activities first

Question 12

How does life space change with illness?

Answer 12

Shrinks

Question 13

Define frailty

Answer 13

State that increases risk of adverse events

Question 14

How does frailty develop?

Answer 14

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

Question 15

What is the frailty phenotype model?

Answer 15

‘What you are’
Certain visual features of frailty - sarcopenia (loss of muscle mass), decreased strength, decreased walking speed, undernutrition

Question 16

Name the 2 measures of frailty

Answer 16

Frailty phenotype model

Frailty index

Question 17

What is the frailty index?

Answer 17

‘What you have’
Broader than phenotype model - considers functional (cognition, emotion, communication) deficits
Number of deficits experienced out of total possible deficits

Question 18

What does the frailty index predict?

Answer 18

Likelihood of death within next 5 years

Question 19

What is the frailty index most useful for?

Answer 19

Epidemiological study

Question 20

What is the frailty phenotype model most useful for?

Answer 20

Clinical trials on frailty

Question 21

What is resilience?

Answer 21

Responses to stressors

Difference between basal physiological level and reserve - min. and max. physiological capacity

Question 22

What are the 2 types of system?

Answer 22

Simple - modularity - as stress applied system adapts

Complex - connectivity - as stress applied sudden transition to different state

Question 23

Which type of system is a human?

Answer 23

Complex

Question 24

Why do clinicians try to predict the critical transition in frailty?

Answer 24

Prevent loss of higher order functions - poor outcomes

Question 25

What is dynamic phenotyping?

Answer 25

Measure of resilience

Quantification of difference between basal and max. capacities

Question 26

How does an acute ailment differentially affect younger and frail elderly individuals?

Answer 26

Functional impact persists after acute ailment only in elderly - acute functional impairment

Question 27

What is the aim of testing responses of frail elderly to controlled stressors in the clinic?

Answer 27

Predict effect of natural stressors - before acute functional impairment and loss of higher functions