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2021 Epi Comps > Epi of Aging > Flashcards

Epi of Aging Flashcards

1
Q

Change in shape of age pyramid due to increasing proportion of older adults in population

A

Rectangularization

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2
Q

Falling fertility rates & rising life expectancy

A

Reasons for Increased Number of Older Adults

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3
Q

Time required/expected for percentage of population aged ≥ 65 to rise from 7% to 14%; greatest in developing countries

A

Hyperaging

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4
Q

Decrease in infectious disease (communicable, maternal, perinatal, & nutrition conditions) vs. increase in non-communicable disease (chronic conditions)

A

Epidemiologic Transition

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5
Q

Physical, cognitive, & social

A

Domains of Aging

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6
Q

Numerical age since birth

A

Chronological Age

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7
Q

Rate of aging; dependent on other factors (e.g. gender, education, BMI, sleep, etc.)

A

Biological Age

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8
Q

Major contributor to lower quality of life (loss of autonomy, decreased social interaction, emotional burden); risk factor for disease; increased healthcare utilization & costs; predictor of mortality

A

Disability

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9
Q

Mobility, complex function (IADLs), basic self-care (ADLs), upper-extremity function

A

Domains of Physical Function

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10
Q

Walking 1/4-1/2 mile, climbing stairs, heavy housework

A

Mobility

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11
Q

Higher functioning tasks required for independent living; shopping, using telephone, balancing checkbook/managing money, preparing meals, housekeeping, managing/taking medications

A

Instrumental Activities of Daily Living

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12
Q

Basic self-care tasks required for independent living; bathing/showering, transferring in/out of bed/chair, dressing, toileting, eating

A

Activities of Daily Living

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13
Q

Grasping or handling, lifting, carrying objects

A

Upper-Extremity Function

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14
Q

Self-report; more common & easy to collect (gold standard); questions about ability, difficulty, & dependency

A

Subjective Assessments of Function

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15
Q

Performance-based measures; more sensitive in showing change over time; SPPB, gait speed, 400-meter walk, chair stands, muscle strength (e.g. grip strength), dexterity & fine motor skills, static balance

A

Objective Assessments of Function

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16
Q

Time to walk 4-meters at usual pace, time to complete 5 chair stands, & standing balance tests; 10-12 = high, 4-9 = intermediate, 0-3 = low; predictive of disability

A

Short Physical Performance Battery

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17
Q

Declines with age; < 1.0 m/s predictive of negative health outcomes

A

Gait Speed

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18
Q

Disability framework; pathology –> physiological impairment –> limitations in function & performance –> disability

A

Nagi Scheme

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19
Q

Disability Framework; pathology –> functional impairment –> functional limitation –> disability; risk factors for impairment & intra-/extra-individual factors for limitation

A

Verbrugge & Jette

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20
Q

Age-related state of vulnerability; progressive syndrome with clinical & sub-clinical stages; high risk for mortality, falls, disability, & hospitalization; characteristics include weakness/sarcopenia, deconditioning/fatigue, poor appetite, weight loss, balance/gait abnormalities, risk of falls, delirium, incontinence, disability, dependency

A

Frailty

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21
Q

Frailty model; weight loss, weakness, exhaustion, slowed walking speed, low activity (at least 3)

A

Fried Frailty Phenotype

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22
Q

Frailty model; global measure of fitness & frailty in older adults (many criteria)

A

Rockwood Model

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23
Q

Frailty model; score of 1-7 based on descriptions (very fit to severely frail)

A

Canadian Study of Health & Aging Clinical Frailty Score

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24
Q

Collection of mental processes controlled by brain; attention, memory, language, learning, reasoning, problem solving, decision making

A

Cognitive Functioning

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25
Q

Memory, attention, perceptual/visuospatial ability, language, executive function

A

Cognitive Domains

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26
Q

Recall words after hearing them read aloud; tests memory, language (sum of words recalled), attention (trial 1 recall), & executive function (order of recalled items, types of errors); Hopkins Verbal Learning, Auditory Verbal Learning, California Verbal Learning, Bushke Selective Reminding

A

Word-List Learning Tests

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27
Q

Trail making, digit symbol

A

Timed Tests

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28
Q

Name as many items (e.g. animals) as possible over certain time (e.g. 60 seconds)

A

Count Tests

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29
Q

Most common measure of global mental status; orientation, registration, attention, calculation, recall (memory), language; valid as screening test for all-cause dementia in clinical but not community samples; poor measure of longitudinal change

A

Mini-Mental State Exam

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30
Q

Planning, problem solving, strategizing (candle problem, semantic fluency); shifting (trail making, Wisconsin card sort); inhibiting (Stroop, Wisconsin card sort); goal-directed behavior (tests that simulate real-world experience)

A

Executive Function Tests

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31
Q

Brief test of attention, digit span

A

Attention Tests

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32
Q

Boston naming test, phonemic fluency

A

Language Tests

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33
Q

Visual search, pattern comparison

A

Visuospatial Tests

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34
Q

Pre-clinical –> mild cognitive impairment –> dementia; distinct trajectory from normal cognitive decline

A

Continuum of Alzheimer’s Disease

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35
Q

Increase in Alzheimer’s biomarkers during pre-clinical & MCI stages before clinical disease; beta-amyloid –> tau –> brain structure –> memory –> clinical function

A

Jack’s Dynamic Biomarkers Hypothesis

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36
Q

Intermediate state between normal & impaired cognition; problems/complaints about memory or other domain but everyday functioning not yet impaired

A

Mild Cognitive Impairment

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37
Q

Progressively debilitating, chronic disorder characterized by loss of independent functioning; pathology understood but not etiology; poor episodic memory but procedural memory relatively well-preserved

A

Alzheimer’s Disease

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38
Q

Acute change in cognitive function (particularly attention & memory); marker of absence of cognitive reserve; most common among patients with AD or in ICU; associated with significant decline in cognitive function

A

Delirium

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39
Q

Selection bias (recruitment, attention, survival), measurement error/instrument reliability, unequal interval scaling properties (floor/ceiling effects), time scale, high-dimensional exposure data, practice effects

A

Methodological Challenges of Studying Cognitive Aging

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40
Q

Participants improve with repeat testing due to familiarity, procedural memory, or episodic memory; difficult to know true pace of cognitive decline without adjusting; different ways to model based on varying assumptions

A

Practice Effects

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41
Q

Change which characterizes populations born at particular point in time; independent of aging process (e.g. Flynn Effect)

A

Cohort Effect

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42
Q

On average everyone in successive generations tends to perform better on tests than their parents’ generation

A

Flynn Effect

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43
Q

Change which occurs at particular time & affects all age groups/cohorts uniformly

A

Period Effect

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44
Q

Measure of global mental status; orientation to time/place, registration, mental speed/flexibility, memory

A

Montreal Cognitive Assessment

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45
Q

Gender with significantly higher incidence of hip fracture; gender with significantly higher 1-year mortality after hip fracture

A

Women vs. Men

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46
Q

Bone turnover, bone mass, bone quality, risk of fall, force of impact

A

Methods to Assess Risk of Hip Fracture

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47
Q

18-33% die within 1-year; average 3-8 days in hospital, 15-25% institutionalized for at least 1-year; 25-75% do not regain function; loss of bone & muscle mass; increase in functional limitations & disability; inflammatory response; increase body fat

A

Consequences of Hip Fracture

48
Q

Osteoporosis, sarcopenia, chronic conditions, etc.

A

Pathology Leading to Hip Fracture

49
Q

Medical conditions existing simultaneously, either independently or with related medical condition; conditions can exacerbate each other & confound effects; associated with current & future risk of disability & mortality

A

Comorbidity

50
Q

Diabetes & heart disease

A

Lower Extremity Limitations

51
Q

Diabetes & osteoarthritis

A

Mobility Limitations

52
Q

Prevent disease onset

A

Primary Prevention

53
Q

Identify disease in sub-clinical phase (e.g. screening) & prevent progression

A

Secondary Prevention

54
Q

Minimize symptoms of disease & maximize quality of life

A

Tertiary Prevention

55
Q

Vascular conditions, hearing impairment, diabetes, & arthritis

A

Most Common Chronic Conditions

56
Q

Recruitment & retention (burden), loss to follow-up, missing data, competing risks, reverse causation, heterogeneity

A

Challenges of Studies of Older Adults

57
Q

Risk factor influencing health vs. health influencing risk factor

A

Reverse Causation

58
Q

Predicts 10-year mortality for patient with range of chronic conditions; weighted score summed to predict mortality

A

Charlson Index

59
Q

Complex treating concurrent diseases (interactions, contraindications, prioritizing treatment, polypharmacy, continuum of care)

A

Healthcare Implications of Comorbidity

60
Q

Need for rehabilitation/community services to decrease risk of social isolation, dependency, & mortality

A

Healthcare Implications of Disability

61
Q

Vulnerability to stressors; treat underlying conditions & prevent adverse events

A

Healthcare Implications of Frailty

62
Q

Extrinsic factors play negative role vs. neutral or positive role in aging

A

Usual vs. Successful Aging (Rowe & Kahn)

63
Q

Slower rate of metabolism associated with greater longevity; resting metabolic rate decreases with age but may be truncated by comorbidities (diseases require extra energy to maintain body function)

A

Rate of Living Theory

64
Q

Mood disorder; symptoms include sadness, irritability, overreacting, change in appetite, listlessness, restlessness, sleep changes, forgetfulness, brain fog, feeling worthless, feeling guilty, thoughts of death or suicide

A

Depression

65
Q

Depressed mood or loss of interest/pleasure for more than 2 weeks + impaired function + 5 symptoms

A

Major Depressive Disorder

66
Q

Depressed mood or loss of interest/pleasure for over 2 weeks + 2-4 symptoms; not linked to substance abuse or grief

A

Minor Depression

67
Q

Depressed mood for over 2 years + 2-5 symptoms; not linked to chronic condition

A

Dysthimia

68
Q

Triggers include social isolation, life losses, physical illness, & medications; signs include physical complaints, mood changes that don’t let up, problems concentrating, apathy, deficits in executive function & processing speed; vascular risk factors

A

Depression in Older Adults

69
Q

Proportion of true positives correctly identified by test; A/(A+C)

A

Sensitivity

70
Q

Proportion of true negatives correctly identified by test; D/(B+D)

A

Specificity

71
Q

Proportion of those with disease among those that test positive; A/(A+B); depends on disease prevalence

A

Positive Predictive Value

72
Q

Proportion of those without disease among those that test negative; D/(C+D); depends on disease prevalence

A

Negative Predictive Value

73
Q

PHQ-9 (cut-off 10), CES-D (cutoff 21), GDS (cutoff 10)

A

Questionnaires for Depression

74
Q

2 leading cause of disability-adjusted life years, cause of 2/3 suicides, risk factor for mortality, risk factor for MCI & dementia

A

Consequences of Depression

75
Q

CVD depression (unknown directionality); cardinal features include vascular disease/risk factors, secondary features include cognitive impairment, guilt, poor insight, & disability, cardiovascular risk factors

A

Vascular Depression

76
Q

Percent of cases in population that would be avoided if exposure eliminated; depends on prevalence of exposure in population

A

Population Attributable Fraction

77
Q

Under-recognition, lack of trained staff members, stigma, overlap with symptoms of physical illness/medications

A

Barriers & Diagnostic Challenges for Depression

78
Q

Rapid development in early life –> short maintenance period –> gradual decline in function

A

Trajectory of Aging

79
Q

Changes in body composition, energy imbalance production/utilization, homeostatic dysregulation, & neurodegeneration

A

Aging Phenotypes & Geriatric Syndromes

80
Q

Reduced lean body mass, increased fat mass, reduced bone density, reduced muscle mass/quality

A

Body Composition Changes

81
Q

Loss of muscle mass late in life; associated with decreased mobility, function, & energy regulation

A

Sarcopenia

82
Q

High basal metabolic rate & lower fitness (VO2 max)

A

Energy Imbalance

83
Q

Energy use at rest

A

Basal Metabolic Rate

84
Q

Energy use at maximum capacity

A

VO2 Peak

85
Q

Insulin resistance, low testosterone, anemia, low-grade chronic inflammation, immunosenescence

A

Homeostatic Dysregulation

86
Q

Brain atrophy, decreased cognitive function, amyloid plaques, impaired balance

A

Neurodegeneration

87
Q

Traditional method of measurement; surveys to assess frequency, intensity, & duration of activity & function; subject to error, failure to capture variability of activity, difficult to discern benefits of lifestyle activities, burden, difficult interpretation of responses

A

Self-Reported Physical Activity

88
Q

Oxygen consumption of 70 kg, 40-year-old at rest; higher values associated with more vigorous activities; may not translate to older adults

A

Metabolic Equivalents (METs)

89
Q

Use of technologies to detect accelerations in 1-3 orthagonal planes; shows diurnal daily pattern of activity; limited ability to assess non-impact activities, provides little information on activity type/purpose/context, cannot assess relative intensity without calibration, can be difficult to interpret

A

Objectively Reported Physical Activity

90
Q

Average number of years individual of given age is expected to live if current mortality rates continue to apply

A

Life Expectancy

91
Q

Longest documented survival of member of species; 122 years for humans

A

Life Span

92
Q

Summarizing technique used to describe pattern of mortality & survival in populations

A

Life Table

93
Q

Average number of years of remaining life which is disability free for individual of given age

A

Active Life Expectancy

94
Q

Average number of years of remaining life with disability for individual of given age; total life expectancy - active life expectancy

A

Disabled Life Expectancy

95
Q

When maximum life expectancy reached, postponement of onset of disease & disability over time; when maximum life expectancy not reached, this, dynamic equilibrium, or expansion of morbidity may occur

A

Compression of Morbidity

96
Q

Prevalent rate model (exit = death only), double-decrement model (exit for death or disability, but recovery from disability possible), or multistate/increment-decrement model (multiple exits & re-entries)

A

Life-Table Models to Account for Active Life Expectancy

97
Q

Higher education, lower prevalence of chronic conditions, improvements in nutrition & public hygiene, better health promotion/medical therapy

A

Factors Influencing Decline in Disability Rates

98
Q

Coronary heart disease & cancer

A

Chronic Conditions Causing Death without Disability

99
Q

Arthritis

A

Chronic Condition Causing Most Disability

100
Q

Information processing speed & motor skills

A

Link Between Cognition & Mobility

101
Q

Learned movement that is smooth & efficient due to neural mapping; activate neurons to activate muscles to make smooth, coordinated movements; irregular velocity, stiff movement, & unpredictable sub-movements during learning

A

Motor Skill

102
Q

Generalized slowing (motor & psychomotor functions), inefficiency (increased energetic cost & variability), reduced reserve, & reduced plasticity

A

Signs of Loss of Motor Skill

103
Q

Secondary prevention; presumptive identification of unrecognized disease or defect by application of tests; not intended to be diagnostic but to detect & treat sub-clinical disease

A

Screening

104
Q

Independent panel of non-federal experts in prevention & evidence-based medicine composed of primary care providers; conducts scientific evidence reviews of clinical preventive health care services & develops recommendations

A

United States Preventive Services Task Force (USPSTF)

105
Q

Adapting USPSTF to Older Adults

A

Consider heterogeneity in life expectancy, health status, & goals

106
Q

Act of providing unpaid assistance & support to family members/acquaintances who have physical, psychological, or developmental needs

A

Caregiving

107
Q

Family member, friend, or neighbor of person with disability who provides regular, ongoing assistance to person because of disability; unpaid caregiving; can be primary vs. secondary, spouse vs. non-spouse, living vs. not living with recipient

A

Informal Caregiver

108
Q

Difficult to construct comparable samples & convenience samples biased from population-based findings

A

Methodological Challenges of Studying Caregiver Health

109
Q

Caregiving often chronic stressor (primary stressor –> care provision vs. secondary stressor –> life changes); stress depends on how challenge is perceived, external resources, & cultural expectations

A

Stress Process Model

110
Q

20% informal caregivers report high strain –> greater risk for depression & worse physical health

A

Effects of Caregiving

111
Q

Caregivers experience longevity benefit as compared to non-caregivers; healthier individuals may be more likely to take on caregiving roles

A

Healthy Caregiver Hypothesis

112
Q

Decreasing birth rates, decreasing marriage rates, projected increase in proportion of older adults, middle-aged population projected to remain constant

A

Factors Contributing to Caregiver Shortage

113
Q

Puts individuals & populations in context; tasks & challenges vary depending on transition point & within relevant social fields/contexts; tasks & challenges determined by normative age-graded influences (ontogenic), normative history-graded influences (cohort effects), & non-normative life events

A

Life Course Approach

114
Q

Accelerometers for physical activity, biomarkers for AD progression, big data, data sharing panels, etc.

A

Examples of Objective Measurement

115
Q

Meyer –> observe patients; psychoanalytic –> interact with patients; empirical –> identify patients, count them, & sensitivity/specificity

A

Psychiatric Epidemiology Epochs

2021 Epi Comps (5 decks)

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