frailty Flashcards
why do we have an increasing ageing population
fertility rates falling worldwide regardless of ‘developed’ status
increasing life expectancy
why are people getting older
increased resources available
better economic conditions
improved screening programmes w/ earlier diagnosis and treatment
better outcomes following major events - stroke, cardiac, surgery
consequences - more people survive a major event, more people have several co-morbid conditions
what effect does ageing have
beneficial: increased experimental learning
neutral: e.g. grey hair, past time preference
detrimental: HT, decreased reaction time
theories of ageing
stochastic - cumulative damage from micro trauma and free radicals, random
programmed - predetermined, changes in gene expression during various stages of life
result is homeostatic failure - less reserve to cope with any given environmental challenge, less able to maintain homeostasis
physiology of ageing
affects virtually every organ/system
marked inter-individual variability in both development and magnitude of changes
inter-indvidual variability increases w/ age
evidence for interventions and investigations very limited for >80y/o
ageing and the kidney
poorer clearance of creatinine but also reduction in muscle mulk
ageing and the CVS
systolic BP increases
beyond 6th decade diastolic BP starts to drop
reduced CO
ageing and the respiratory system
total lung capacity stays the same
vital capacity goes down
dyshomeostasis = FRAILTY
the point of physiology is to maintain a steady state
impaired function of any organ system makes this more difficult
frailty is effectively progressive dyshomeostasis
what is frailty
a susceptibility state that leads to a person being more likely to lose function in the face of a given environmental challenge
results in frailty syndromes
what are frailty syndromes
falls
delirium
immobility
incontinence
why are older people less able to maintain their blood pressure
decreased CO - less able to increase this when BP is low
baroreceptor reflex becomes less effective over time - less good at sensing a reduction in BP
result: more likely to have blackouts and falls
why are frail people more likely to suffer from hypothermia and heat stroke
less likely to be able to vasoconstrict
less likely to increase heat production metabolically
similarly: less likely to be able to react to heat stress by sweating and increasing skin blood flow; increasing CO and redistributing blood flow therefore more likely to present w/ heat stroke
what is social dyshomeostasis
difficulty caused by environmental insults is not only biomedical
ageing often associated with whole system dyshomeostasis - different ability to compensate for e.g. death of spouse or daughter going on holiday
accounts for why frail people tend to present w/ dysfunctional decline rather than classic presenting symptoms of the illness
hyperthyroidism - classic presentation vs frailty presentation
classic: tremor, anxiety, weight loss, diarrhoea
person w/ frailty: depression, cognitive impairment, muscle weakness, AF, heart failure, angina - these things lead to falls, delirium, incontinence etc
