Geriatric medicine

Question 1

What are the biological theories of ageing?

Answer 1

Programmed:
programmed longevity
Neuroendocrine theory 
Immunology theory
Error:
Wear and tear
Rate of living 
Cross linking 
Free radicals 
Somatic DNA damage

Question 2

What are the social theories of ageing?

Answer 2

Disengagement theory
Activity theory
Continuity theory
Life course theory

Question 3

What are the psychological theories of ageing?

Answer 3

Maslow
Jung
Erikson
Selective- optimisation and compensation theory

Question 4

Physiology of ageing- immune system?

Answer 4

Immunosenescence
B-cell numbers are preserved, decreased specific antibody and increased autoantibody
T-cell numbers are decreased, reduced activation
Decrease in seroconversion and seroprotection rates following vaccination
20-30% diminished febrile response to infection

Question 5

Physiology of ageing- renal?

Answer 5

Loss of renal mass after 40- occurs mostly in the cortex with loss of nephrons
Basement membrane thickening
Increased renal artery resistance: with reduced blood flow to kidneys
Decreased glomerular filtration rate pf around 10% every 10 years from age 40

Question 6

Physiology of ageing- eyes?

Answer 6

Presbyopia loss of accommodation
Changes in the lens nucleus and decreased ciliary muscle contractility
Lens becomes transparent

Question 7

Physiology of ageing- endocrine?

Answer 7

Decreased testosterone production
Decrease in oestrogen levels post-menopause
Nocturnal ADH secretion is lost, changes in RAAS leads to nocturia
Increased in insulin resistance due to increase in adipose tissue

Question 8

What is frailty?

Answer 8

Medical syndrome with multiple causes and contributors that is characterised by diminished strength and endurance and reduced physiological function that increases an individual’s vulnerability for developing increased dependency and/or death

Question 9

What is the frailty phenotype?

Answer 9

3 or more of the following characteristics?
Unintentional weight loss
Weakness evidenced by poor grip strength
Self-reported exhaustion
Slow walking speed
Low level of physical activity
2 or more pre-frail

Question 10

What is the frailty index?

Answer 10

The number of deficits an individual has / the total number of deficits considered
<0.09 (robust), 0.27 (mildly frail), 0.42 (severely frail)

Question 11

What are the physiological markers of frailty?

Answer 11

Increased inflammation (CRP, IL6, VIII, fibrinogen )
Elevated insulin and glucose levels in fasting state
Low albumin
Raised D-dimer and a1-antitrypsin
Low vitamin D levels

Question 12

What are interventions for frailty?

Answer 12

Physical activity
Protein-calorie supplementation
Vitamin D (associated with muscle weakness and sarcopenia)
Polypharmacy (associated with an increased progression)

Question 13

What are the elements to assess in the comprehensive geriatric assessment (CGA)?

Answer 13

Physical health- optimising co-mobidities, new diagnoses, medication review, nutritional status, frailty status, advanced directives
Mental health- cognition, capacity, mood/anxiety, fears
Functional ability- mobility, balance, ADL, participation restriction
Social circumstances- formal or informal carers, community team involovement, legal matters (POA)
Environment- housing/place of residence, safety features, equipment, transport facilities

Question 14

What is immobility associated with?

Answer 14

Thromboembolic disease 
Chest infection 
Constipation 
Pressure ulceration 
Risk factor for delerium

Question 15

What should be assessed before walking with a patient?

Answer 15

Joint range of movement and strength
Sitting balance and standing balance
Ability to transfer their position from lying to sitting, sitting to standing and round a chair

Question 16

What is the Berg balance test?

Answer 16

Standardized scale used to determine the ability or failure of an individual to balance while performing a task
Scale is comprised of 14 everyday tasks

Question 17

What is the timed up-and-go test?

Answer 17

Person is asked to get up from a standard chair, walk to a point 3m away and return to their chair whilst being timed

Question 18

What are the principles underlying the mental capacity act?

Answer 18

Assume capacity unless proven otherwise
Take all practicable steps to help a person in decision-making
A person is allowed to make unwise decisions
Always act or take decisions for people without capacity, in their best interests
Consider whether the outcome could be achieved in a less restrictive way

Question 19

Which items are assessed in the comprehensive geriatric assessment?

Answer 19

Medical: co-morbidities, medication, nutrition
Mental health: cognition, mood, fears
Functional capacity: activities of daily living, gait and balance, activity/exercise
Social circumstances: support, social network
Environment: home comfort, transport, access to local resources

Question 20

What are the benefits of CGA?

Answer 20

Live longer
Live independently for longer
Reduces morbidity
Reduces readmissions 
Reduces care home admissions 
May reduce admissions to hospital