excess mortality Flashcards
in terms of being biologists, why are we interested in excess mortality
we are interested in:
- the health of individuals
- what determines health
- what factors are modifiable
- what can we do to improve health
how does the male and female life expectancy in Scotland compare to Europe and the rest of the UK
lower than the rest of Europe
lower than England and wales
how does the male and female life expectancy in west and central Scotland compare to European cities
it is lower than other European cities
out of all the UK cities, which one has the lowest life expectancy
Glasgow
what is the second lowest UK city in terms of life expectancy and is the gap between this city and the life expectancy of Glasgow big or small
Manchester
the gap between the life expectancy of the 2 cities is quite big
is Glasgow the only area in Scotland that falls below the life expectancy average
no there are other areas but it is the lowest
what area of Scotland has the lowest life expectancy
west central Scotland
what are Glasgow’s biggest killers
CVD T2D stroke cancer obesity alcohol drugs suicide
why can we not say that the lower life expectancy in Glasgow is due to socioeconomic deprivation and poverty
because other cities have similar socioeconomic background but with higher life expectancy so there must be other influencing factors
what does the Dahlgen and Whitehead model show
the link between socioeconomic, cultural and environmental factors on health
what factors have been used to assess deprivation for research into the Glasgow effect before
- car ownership - might not show deprivation - is sometimes a choice now
- male unemployment - why only male
- % of social class IV and V and overcrowding
what are most deaths in Scottish men caused by
heart disease
lung cancer
external causes (alcohol etc)
how do we know if a factor causes a health outcome or is merely associated with it
we can do different types of experiments to infer this
what are the different possibilities of relationship between 2 variables
X can cause Y Y can cause X X and Y are associated by artefact X and Y are associated by chance X and Y can be caused by Z, a third factor called a cofounder
what is a risk factor
something that increases your likelihood of getting a disease
what are the 2 types of risk factor
modifiable and non-modifiable
give 3 examples of modifiable risk factors
smoking, physical activity, diet
give 3 examples of non modifiable risk factors
age, ethnicity, family history
what were Glasgow’s most prominent risk factors in the past
overcrowding
slums
high risk manual labour in shipyards
high unemployment when the shipyard closed
what are the most prominent risk factors in Glasgow now
smoking
obesity
sedentary lifestyle
how many hypotheses are there as to why excess mortality exists
more than 40
what is excess mortality
where the number of deaths recorded is greater than the number expected on the basis of past data
what is more controlled, field or lab research
lab
what does a research design provide
a framework for the collection and analysis of data
what are the benefits of lab research
- controlled environment
- high end equipment
what are the challenges of field research
- accessibility - lots of unforeseen logistics
- much less control of the environment
a research design reflects the aims of the research, what does this include
in terms of the activity study
- expressing causal connections between variables
- generalizing beyond participants in the investigation
- understanding health risk/outcomes/behaviour over time
what are the steps in creating the research design framework
- previous research/gap/theory
- hypothesis
- aims and objectives/research questions - clear and neither too broad or too narrow
- descriptive (what’s going on)
- explanatory (why- causation) - needs to be researchable
- research methods
- quantitative
- qualitative
what are the 2 main quantitative study criteria
reliability and validity
what is reliability
refers to the consistency of an instrument/measurement
are the result repeatable
what are the 2 main types of reliability
internal consistency
inter rata
reliability is necessary but not sufficient in determining ……..…..
validity
what is validity
refers to the accuracy of an instrument/measurement
the degree to which you are measuring what you claim to measure
what are the different types of validity
measurement validity
internal validity
external validity - ecological validity - can the measurement be taken then translated and generalized to a real life situation
what is internal validity
the extent to which changes in the study dependent variable can be attributed to changes in the independent variable
what kind of studies have the highest internal validity
studies with control and randomisation
what is external validity
the extent to which the results can be generalised to another setting
the higher the ………….. validity the more the generalizability and external validity are compromised
internal
what are the 2 different broad types of research design
exploratory - pilot
conclusive
what are the 2 different types of conclusive research design
causal
descriptive
what are the 2 different types of causal research
RCT
Quasi
what are the 2 different types of descriptive research
cross sectional
longitudinal
what is meant by powered and non powered in primary and secondary outcomes of causal evaluation
it is to do with the number of cases in the study
the primary outcome needs to have enough cases to be able to draw a conclusion but can’t have too many as that would be unethical and time wasting
the secondary outcome does not need to be powered
what is quasi-experimental design
impact of an intervention without random assignment
what is the one group before and after design
measure outcome in exposed group before intervention apply intervention measure outcome again estimate the effect of the intervention can we immediately conclude - NO
what is secular change
saw effect due to something other than the intervention
what is the two group before and after design
2 groups - one exposed to the intervention and one not
measure baseline outcome in both groups
expose one group to intervention
measure outcome of both groups again
estimate effect of intervention by comparing groups
can we conclude immediately - NO
how can we solve participant and researcher bias
blinding system - researchers and participants don’t know the assignment of the groups
describe the Lanarkshire milk experiment
teachers put children into milk and non-milk groups but they generally put smaller less nourished children into the milk category which created a bias
study found that milk group were smaller and lighter but in reality the 2 groups were just not the same at baseline
what is a randomised control trial
randomisation is used to allocate people to the groups
measure at baseline
intervention is applied to the intervention group
measure the outcome
estimate the effect
why do we randomise
to eliminate bias and ensure there are no systematic differences between groups
what are limitations of randomised control trials
- can be large and expensive
- participants need to be willing
- ethics often questioned
- cannot always randomise individuals e.g. primary school children but can randomise groups e.g. 2 primary schools
- those randomised to control may not maintain their commitment - major threat to differential drop out
- external validity lowered due to highly controlled manner of RCTs
what is a cross-sectional study
snap shot study
each participant assessed at one point in time
allows researchers to look at many things at once
designed to determine what is happening now
cannot assume causation, only association
what are the 3 different types of sampling
random
stratified
convenience
what is random sampling
every member of the population has an equal chance of being picked
which type of sampling is the most representative
random
what is stratified sampling
separate groups e.g. ethnic minority vs. majority then sample systematically to ensure you have adequate samples in each group
what is convenience sampling
take those people who are available e.g. door knocking
which type of sampling is least representative
convenience - representability is questioned
what is a longitudinal design
involves measuring participants at more than one point in time
observing change in these participants gives a better basis for causal inferences than a cross sectional design
what are the challenges of analysing field data
data often messy - needs extensive cleaning
data missing - needs imputation
what are the different types of statistical testing
standard descriptive stats e.g. mean and stdv
comparison of means using t test
more complex tests (modelling) can also be carried out to look at associations
the more risk factors you have the greater/smaller your chance of getting a disease
greater
what is another name for a non-modifiable risk factor
biological risk factor
can the effect of non modifiable risk factors be reduced through changing modifiable risk factors
yes
modifiable risk factors could have an additive adverse effect on our health, what does this mean
combined risk factors increase you chance of getting a disease compared to risk factors on their own
what are disease genes and give 2 examples
genes that determine that you are going to get a disease
e.g. BRCA and CFTR
what are susceptibility genes
genes that increase the risk of getting a disease
what is genomics
looking at the while genome and its interactions
what is precision medicine
individual response to certain treatment
what is ageing
change in physiological function/cellular metabolism over time
what is senescence
the decline of fitness components of an individual with increasing age, owing to internal deterioration
what is gerontology
the scientific study of the biological, psychological and sociological phenomena associated with old age and ageing
what is geriatrics
the branch of medicine that deals with the diagnosis and treatment of diseases and problems specific to the aged
what is biogerontology
the study of the biology of ageing and longevity
what are the changes seen in the trajectories
the population demographic is changing
people are living longer
by 2050 over 15% of the worlds population will be over 65
in about 5 years the number of people over 65 will outnumber children under the age of 5 - this is driven by falling fertility rates and remarkable increases in life expectancy
what is a non-communicable disease
non-infectious - strongly linked to ageing
what is the leading non-communicable disease
CVD
what is the biggest risk factor for dementia
age
five examples of age related diseases
arthritis cancer alzhiemers diabetes heart disease depression
give examples of age related conditions
loss of hearing, vision etc
loss of coordination
increased proportion of fat to muscle
loss of bone density
worldwide women live an average of …… years longer than men
4
list some sex differences in diseases
men more likely to commit suicide
women more susceptible to depression and anxiety
most common cancer in women - breast
most common cancer in men - prostate
prostate cancer is a bigger killer than breast cancer
what is the effect of men and women having different fat and muscle distribution
can affect metabolic risk factors, cholesterol etc
different ethnicities have higher rates of poor health give some examples
some ethnic groups are more susceptible to T2D
some ethnic groups are more susceptible to CVD - indian Asian > European > african carribean - CVD risk also increase in those with diabetes
do reliability and validity apply to qualitative data
no
what is the point of qualitative data
usually for understanding how things work or to get an in depth understanding or a phenomenon
what are the 2 types of probability sampling for quantitative data
random
stratified
why don’t we use probability sampling for qualitative data
social factors are not predictable like objects
randomized events are irrelevant to social life
probability sampling is expensive and inefficient
what type of sampling do we use for qualitative studies
non-probability sampling - purposive sampling
what is purposive sampling
used to get an in depth understanding of a phenomenon
- where you understand the population that you are interested in and you sample across that population to get a broad range of views
- need to understand what the different types of experience may be then sample people accordingly
qualitative researchers seek saturation, what does this mean
when you stop getting new information
number aren’t an issue its more about if you have learned enough
do qualitative studies need to be powered
no
you just need to have sufficient cases in the study to be able to detect a significant difference in the outcome
qualitative researchers seek saturation, what do quantitative researchers look for
statistical validity
what is meant by qualitative data being analysed thematically
to answer the research question but also to reveal any unanticipated themes
is qualitative research deductive or inductive
generally inductive
what is meant by deductive
hypothesis and study designed to address it - hypothesis found to be correct or incorrect
what is meant by inductive
looking at interview transcripts and detecting theme within them - anything related to the research question and anything unrelated also
what are the steps in inductive analysis from initial observation to forming a theory
observation
pattern
tentative hypothesis
theory
how can we integrate quantitative and qualitative studies
we can use a quantitative study to test the theory or hypothesis created from a qualitative study
what is meant by qualitative analysis being highly subjective
how it is interpreted often depends on ones knowledge and background
we need teamwork to ensure analysis is robust (double coding and discussion)
give an overview of the lecturer’s football trial
use the loyalty men have to their football team to encourage them to attend a weight loss programme
aim - to see if the programme was effective in helping men lose weight 12 months after being in the 12 week programme
what were the main reasons to do the football trial
male obesity increasing rapidly in Scotland
almost 4/5 of middle aged men in Scotland are overweight or obese
what are barriers to weight loss for men
slimming and dieting to them are female activities
they are happy with their size
they control their weight through exercise
avoid NHS/commercial weight loss programmes
in the football trial why were the control group offered an opportunity to take part in the programme after the trial
because they were pretty certain it was going to be effective
how did the football trial have between group contamination and how was it minimised
men in the intervention group were friends of men in the control group
groups were measured at different times at 12 weeks
why could a cluster randomised control trial not be carried out in the football trial
because that would involve randomising football clubs but they all needed to be treated equally
what is mean by blinding in research
research don’t know the grouping and neither do the participants
why is blinding important
it prevents bias as researchers and participants could influence results
what is meant by maximising retention
making sure that as many people as possible that started the trial finish the trial
why is maximising retention important
without is you may no longer have the power for statistical significance
it affects the validity of the results - we could get differential dropout
what is differential dropout
more people dropping out of one group than another
what was the fit for life study
adapted football trial for delivery to prisoners and assess the feasibility of collecting data from high security establishments
what are the challenges of collecting data in a high security establishment
fieldworker safety
equipment clearance
prohibited equipment
participant generally have low literacy and attention spans and there are ethical considerations
what was the euro fit trial
to determine whether the eurofit programme could help men aged 30-65 with a BMI > 27 increase physical activity and decrease sedentary time over 12 months
they also monitored many secondary outcomes e.g. blood biomarkers, food intake etc
what are the main risk factors for CVD and indicate which are modifiable and non-modifiable
smoking - modifiable sedentary lifestyle - modifiable age - non modifiable sex - can be both ethnicity - non modifiable hypertension - modifiable family history - non modifiable
what are the biomarkers of CVD
hypertension dyslipidaemia T2D insulin resistance/metabolic syndrome endothelial dysfunction oxidative stress inflammation
how does smoking affect mortality risk
someone who smokes has a 57% higher risk of mortality
what % of people smoke globally
26%
how much does mortality risk increase by in physically inactive people
28%
what % of people globally are inactive
35%
what do we need to calculate population attributable risk
prevalence and hazard ratio
smoking is attributable to what % of all death
8.7%
physical inactivity is attributable to what % of all death
9%
what is epidemiology
the study of the distribution and determinants of health related states or events in specified populations and the application of this study to control health problems
most physical activity epidemiology is ……………. and shows associations between exposures and disease. experimental data is needed to establish ……………….
causality
the higher/lower the calorie intake the lower the risk of CVD
higher calorie intake = lower risk
men/women have higher CVD risk compared to men/women
men have higher risk
the CVD and calorie association is strange what can we take from this
just because there is an association it doesn’t mean that one is causing the other
there are confounding variables - those who eat more may be more physically active and that’s why mortality is decreased as an example
what are the criteria for causality with epidemiological evidence
- appropriately sequenced - does the measure physical activity precede onset of disease
- plausibility - is the association consistent with other knowledge
- consistency - are findings consistent in different populations
- strength - what is the strength of the association
- dose response - are increased levels of physical activity associated with a greater effect
- reversibility - is a reduction in PA associated with an increase in risk
- strong study design - i.e. randomised control trial
what was jerry morris’ study of PA and CVD
looked at bus, postmen and civil servants
rates of CVD were compared in occupations with higher vs. lower levels of PA
bus conductors found to have lower incidence than drivers
study of postmen and call centre workers showed similar results
what were the problems with Jerry Morris’ study
self selection - someone less healthy may choose a less active job - less healthy at baseline
bus drivers had larger trouser sizes, higher blood pressure and cholesterol and smoked more than conductors but these factors were already present before employment
what was the Ralf paffenbarger study
there was a very strong union for dock workers and they assigned your job - removal of selection bias
paffenbarger measured PA in different jobs and followed people for 22 years and measured CVD incidence
found same results as morris
what is meta analysis
take results form lots of studies and pull them all together to find the true results
what is cardio respiratory fitness
the ability of your body to use oxygen to do work
what % if fitness is heritable
50%
are fitness and PA the same thing
no but a large proportion of fitness is changeable by PA
what was found in the longitudinal study of men in Copenhagen looking at fitness and cumulative incidence of all cause mortality
- over time more less fit people died than more fit people
we can predict life expectancy after adjustment for various ………….. ……………
confounding factors
is being fat worse for men or women and why
worse for men because they store fat higher up in the body whereas women store it lower which is less dangerous
smoking reduces ………….. ……….. and increases …………… this is why we need to take out smokers when looking at ……….. and ……………
body weight
mortality
BMI and mortality
what is lean mass and how is it calculated
lean mass is protective fat free mass calculated by subtracting body fat weight from total body weight
what other measurement can we take in conjunction with BMI and why doe we do this
waist circumference
because BMI cant differentiate between muscle and fat
what is the main factor that increases risk of T2D
obesity
which ethnicities have higher risk of diabetes than whites
south African
Chinese
black
what is the fat that you can pinch called
subcutaneous fat
what is the fat on the inside of our body/ectopic fat called
visceral fat
which type of fat is more dangerous
visceral
how can people have low BMI and not be skinny
because they have less lean mass
in the diabetes prevention programme which intervention was most effective out of placebo, metamorphin (increases insulin sensitivity) and lifestyle (increases PA)
lifestyle
what were the results form the Da Quing 30 year study follow up
lower risk of CVD and diabetes with lifestyle intervention
intervention also associated with increased life expectancy
what is the problem with longitudinal studies
take a long time to get data - need to wait for people to die
what is the WHO definition of health
a complete physical, mental and social well-being and not merely the absence of disease or infirmity
what are the problems with the definition of health
- it was formed in 1948 when acute diseases presented the main burden of illness and disease patterns have since changed
- the definition declares those with chronic diseases and disability as definitively ill
- it minimises the role of the human capacity to cope with life’s ever changing physical, emotional and social challenges
- the term complete is neither operational or measurable
what have some of the proposed changes to the health definition been
- emphasis on social and personal resources as well as physical capacity
- that an increase in copying capacity may be more relevant and realistic than complete recovery
- remove the word complete
what is the preferred view on health
the ability to adapt and self manage
the movement of the static formulation towards a more dynamic one based on resilience or coping capacity is needed
in the physical domain, a healthy organism is capable of ………..
allostasis
what is allostasis
the maintenance of physiological homeostasis through changing circumstances
the healthy organism is able to mount a protective response to reduce potential for harm and restore equilibrium
id the physiological coping strategy is not successful ……..…. …………. remains which may finally result in illness
allosteric load
in the mental health domain ……….. ………. ………… is a factor that contributes to a successful capacity to cope, recover form strong psychological stress and prevent ptsd
sense of coherence - enhancing the comprehensibility, manageability and meaningfulness of a difficult situation
how can sense of coherence and other mental health factors influence physical health
it improves subjective well being and may have a positive impact between mind and body
what is social health
people’s capacity to fulfil their potential and obligations - their ability to manage their life with some degree of independence despite a medical condition
give 2 examples of what social health can be affected by
social and environmental challenges
how do we measure health
measurement instruments should relate to health as the ability to adapt and self manage
good tools include existing methods for measuring functional status and measuring quality of life and well being
a new formulation of health could help us measure is more successfully
what are 5 physical aspects of CVD
- stroke
- congenital heart disease
- angina
- heart attack
- coronary heart disease
what is atherosclerosis
the build up of plaque in the blood vessels which constricts blood flow and can underlie CVDs
what is the first stage of atherosclerosis
the build up of a fatty streak this is due to macrophages engulfing lipids - but at this point you can still be perfectly healthy
what happens after the build up of a fatty streak during atherosclerosis development
the next stage is the atheroma stage where there is a fatty core in the middle with plaque growing around it keeping it all localised in one place
what is the next step in atherosclerosis development after atheroma formation
this structure becomes more permanent and becomes a fibrous plaque with the tissue growing around it
when an atheroma gets really large what can it cause
angina - reduced blood flow to the heart muscles
what happens if the plaque ruptures in atherosclerosis
parts break off and get into the blood and into smaller vessels supplying the heart and brain which can lead to heart attack or ischaemic stroke
what is the main cause of death in people with T2D
CVD
what are the 4 basic steps in development of a cancer cell from a normal cell
normal –> hyperplasia –> dysplasia –> cancer
what happens to cells in hyperplasia
there is an increase in the number of cells in an organ or a tissue that still appear normal under a microscope
what happens to cells in dysplasia
the cells look abnormal under a microscope but are not cancer
do hyperplasia and dysplasia always become cancer
no
what is metastasis
when cancer cells break away from the main tumour (primary cancer) and travel through the blood or lymph system and form metastatic tumours in other parts of the body
what is asthma
airway inflammation that causes wheezing and shortness of breath
what is COPD
a branch of respiratory diseases including bronchitis and emphysema
what is bronchitis
where the airways are inflamed and narrowed
what is emphysema
where the alveoli lose structure and trap air
what is cystic fibrosis
mutation in both copies of the gene for CFTR leads to a thick sticky mucous which leads to chromic infections and reduced lung function
what is unusual about the genetic basis of cystic fibrosis
it is caused by a polymorphism in a single gene
what is depression
a low mood which lasts for a long time and affects your everyday life
what is the risk of more chronic depression
suicide
what is dementia
the brad term used to describe a range of progressive neurological disorders - some people may present with a combination of dementia diseases
what is the most common type of dementia in the UK
Alzheimer’s
what is the second most common type of dementia to be diagnosed
vascular dementia
what 2 characteristics does frontotemporal dementia generally affect
behaviour and personality
what are lewy bodies and what is the effect of dementia sufferers having them
lewy bodies - abnormal deposits of alpha synuclein protein in the brain
cognitive impairment can fluctuate and movements are particularly affected with poor motor control
which type of dementia can be particularly problematic
young onset 1
what is alzhiemer’s disease
it is characterised by memory loss, language deterioration, impaired mental manipulation if visuals, poor judgement, confusion, restlessness and mood swings
what are plaques
clumps of beta amyloid protein can damage and destroy brain cells in several ways including
- interfering with cell-cell communication
the collection of plaques in brain cells is thought to be one of the causes of cell death
what are tangles
in alzhiemer’s threads of tau proteins twist into abnormal tangles inside brain cells leading to failure of the transport system which is strongly implicated to the death of brain cells
what is the transport system of brain cells
they depend on an internal support and transport system to carry nutrients and other materials throughout their long extensions
this requires the normal structure and functioning of tau proteins
what is vascular dementia caused by
small strokes
areas of the brain stop getting oxygen and die
do the strokes that cause vascular dementia generally have other symptoms other than memory loss
generally there are no other symptoms
what was the leading cause of death in males in 2015
heart disease
what was the leading cause of death in females in 2015
dementia and alzhiemer’s
in 2015 what did 4 out of 10 of all of the leading causes of death have in common
they were all cancers
what is obesity typically measured by
BMI
what do we need to calculate BMI
BMI = weight/height squared
what has happened to the average BMI in the last few years
it has increased - people are on average more overweight
in 2010 what % of the UK were overweight or obese and what had this increased to by 2015
50% –> 65%
how are BMI and mortality associated
increased BMI results in increased mortality rate
how are obesity and CVD mortality related
being underweight or overweight increases your risk o developing CVD and dying form them
name the obesity gene that has been found
FTO
how does having the obesity risk FTO gene affect people
they have higher circulating levels of the hunger hormone grehlin in their blood meaning that the start to fell hunger again soon after eating
people eat more and prefer higher calorie foods compared to chose with the low risk version of the gene
what are the 3 scenarios for the FTO gene
1 - no copy of the risk variant
2- 1 copy of the risk variant - weigh 1.7 kg more
3 - 2 copies of the risk variant - weigh 3.5kg more
how many regions of the genome have been found to be associated with increased BMI so far
97
is everyone who has the obesity risk genes obese
no - environmental factors have a very large impact
how many genes do we have
24 000
why did scientists think we should have lots of genes
because we are complex
outline the food for me study
looked at risk based on different food categories using participants from across 12 countries
looked at the risk of BMI > 25 depending on how much of each food category was consumed
how does consuming veg affect excess mortality
consumption decreases excess mortality and progressively more effective with increased number of portions
intake of what 2 substances partly explain the Glasgow effect
alcohol and drugs
is alcohol related death greater in men or women
men
what are the national physical activity recommendations
moderate activity - 30 mins - 5 days - 150 mins
vigorous activity - 25mins -3 days - 75 mins
build strength 2 days per week
improve balance 2 days per week
what % of the population is physically inactive and what % don’t meet guidelines
31%
39%
if 2 people have the same genetic risk score and one person is inactive and the other is active what is the difference in their BMI - what type of test is this
this is an interaction test
the people who are active have a lower BMI
how many calories does 150 mins of moderate exercise burn
800-1200 calories
what kind of relationship is the link between exercise and all cause mortality
does response relationship
what is the effect of increasing walking pace on mortality risk
it decreases mortality risk
what is hand grip strength a good measurement for
overall muscle mass
what is the effect on mortality of decreased grip strength
mortality risk increases
what are the main barriers to physical activity
lack of time - high commuting time - could actively commute
lack of interest
lack of accessibility
list some diseases related to outdoor air pollution
ischaemic heart disease cerebrovascular disease lower respiratory infections COPD trachea bronchus and lung cancers
what is the relationship seen between age and sedentary time
as you get older, sedentary time increases
what conditions do we have increased risk for with increased sedentary time
all cause mortality CVD diabetes colorectal cancer endometrial cancer lung cancer
what are the 4 things we should all try and do to keep healthy
sleep well
sit less
be active
eat healthy
what are the 2 major demographic changes
population ageing
population migration
births outnumber ……….
deaths
immigration outnumbers ………..
emigration
by how much does the population of the UK grow by each year
200,000
life expectancy is inc/dec
increasing
what are some of the issues with increased longevity
proportion of those of a working age is shrinking
proportion of those of a pensionable age is growing
pressure and questions the sustainability to provide social services such as education, healthcare and housing
increase in pressure for elderly and social care services
list some age related conditions
dementia frailty sarcopenia depression chronic conditions (heart, musculoskeletal, circulatory) social isolation
can dementia be cured
no bur research is working in developing drugs, vaccines and other treatments
why is the prevalence of dementia increasing
because the population is getting older - there are more people alive in the age category where dementia is most prevalent
what is frailty
a state of increased vulnerability due to poor resolution of homeostasis after a stressor event and this increases the risk of adverse outcomes including falls, delirium and disability
people can become lonely and isolated, struggling to care for themselves with decreased quality of life
does everyone become frail
no but it increases in prevalence with age
what are some of the outcomes that frailty can lead to
increased risk of falls poorer mobility inability to perform activities of daily living disability incident hospitalisation death
what is sarcopenia
the reduction in mass and function of muscle
we get more fat within the muscle which can lead to metabolic abnormalities and increased diabetes risk
what factors is the rate of muscle loss form sarcopenia dependent on
exercise level
co-morbidities
nutrition and other factors
what is the muscle loss in sarcopenia caused by
changes in muscle synthesis signalling pathways
which sex does sarcopenia affect most
women
what happens to the subcutaneous fat layer with increasing age
it gets thinner
what is the biggest risk factor for many chronic conditions
age
what is polypharmacy
difficulty of prescribing so many drugs to people with multiple difficulties as many things cannot be taken together because they interact
between 1981 and 2001 what happened to the % of excess mortality and CVD explained by socioeconomic deprivation
it decreased
what were the 4 indicators for the carstairs index
male unemployment
lack of car ownership
overcrowding in households
low occupational social class
what were the pros of the indicators for the carstairs index
simple
doesn’t include health measures
what are the cons of the indicators for the carstairs index
only male unemployment considered
lack of car
neither a very fair reflection
what factor hit Glasgow much harder than other cities
deindustrialisation period - one of the reasons for EM to this day
has smoking in Scottish adults increased or decreased since 2003
decreased
explain lung cancer and mortality in each sex
mortality is increasing in females
mortality is currently higher in males
mortality is decreasing in males
what factor makes you more likely to die from CVD
smoking
what diseases have been established as causative from smoking
oral cancer lung cancer oesophageal cancer liver cancer stroke diabetes pancreatic cancer atherosclerosis ischaemic heart disease laryngeal cancer etc etc
which diseases have been established to have an association with smoking
infections breast cancer ischaemic intestine disorders prostate cancer hypertension rare cancers liver cirrhosis etc etc
how are stopping smoking and coronary heart disease related
when you stop smoking your relative risk of coronary heart disease decreases and the longer you have been quit for the lower the risk becomes
what are the steps in liver cirrhosis
healthy liver
fatty liver - deposits of fat lead to liver enlargement
liver fibrosis - scar tissue forms
liver cirrhosis - growth of connective tissue destroys liver cells
what is the most vulnerable group to alcohol abuse
working class men living in deprived areas
what combined effects on alcohol affordability and consumption for particular socioeconomic groups explains the greater rise and fall in alcohol related mortality in Scotland compared to the rest of the UK
- income falls
- higher proportion of scots in deprived areas
- higher proportion of alcohol related deaths in Scotland
