Frailty

Question 1

Define ageing

Answer 1

The accumulation of cellular damage over time that leads to a generalised decline in function and increased probability of death

Question 2

How does increasing age affect an individual’s nutritional status?

Answer 2

Ageing GI system

More medical conditions (e.g. reflux, hiatus hernias) and medications (side effects of dry mouth, constipation etc which may reduce appetite)

Cognitive/mental health changes (dementia, depression, social isolation)

Question 3

Name some immune system changes that occur with increased ageing

Answer 3

• B cells reduce production of specific antibodies and produce more low-affinity antibodies
• Autoimmune antibody production increases
• T-cell numbers reduce- less reactivity to antigens and poorer immunological memory
• Chronic diseases and frailty also contribute
• Diminished or absent febrile responses
• Antibiotic choice may be more difficult (C.diff, side effects)
• Tests may be more difficult to interpret (e.g. chest x-rays and kyphosis)

Question 4

Name some nervous system changes that occur with ageing

Answer 4

• Normal minor cognitive changes (e.g new memory formation, new problem solving, mild slowing of psychomotor speed)
• Pathological changes (e.g. vascular damage) = more vulnerable brain
• Dysequilibrium (normal reduction in proprioception) = higher risk of falls
• Pain (reduction in sensitivity to noxious stimuli with normal ageing), poorly localised pain

Question 5

Name some sensory impairments that may occur in older age

Answer 5

Visual: normal visual degeneration plus eye diseases (e.g. glaucoma) more common in older people

Hearing loss: neuronal degeneration leading to bilateral sensorineural hearing impairment, plus loss of vestibular function

Neuropathy: normal reduction in proprioception with ageing plus pathological causes common in older people

Question 6

What renal system changes may occur in ageing?

Answer 6

Decreased renal reserve and concentrating ability = less ability to compensate for fluid and electrolyte imbalances.

Elderly people often have reduced fluid intake and increased fluid loss

= increased risk of dehydration and AKI

Question 7

Define frailty

Answer 7

A condition or syndrome which results from the multi system reduction in reserve capacity to the extent that a number of physiological systems are close to, or past the threshold of symptomatic clinical failure.

As a consequence the frail person is at increased risk of disability or death from minor external stresses.