Geriatrics - ageing + frailty Flashcards
- Understand aspects of demography and recent and future trends.
- Discuss aspects of the ageing process at cellular, organ and individual levels.
- Contrast physiological decline in reserve with the impact of disease processes in different body systems.
- Define frailty in the context of ageing and consider its impact on the delivery of individualised healthcare.
- Defining an older person – qualitative or quantitative?
- Population change with compression of morbidity/mortality
- The ageing process
- Outline of stochastic versus developmental/genetic theories
- Examples of the ageing at cellular, tissue, organ and body composition with ageing process changes contrasted with examples of diseases affecting organ systems
- Age related dyshomeostasis (i.e. frailty) and the practical implications of this
- Treatment burden and the evidence gap in older people
Why is the population ageing/growing
Although fertility rates are falling, life expectancy at birth is increasing and the elderly are also living longer
Why are people living longer (4)
Increased resources
Better economic conditions
Improved disease screening programs
Better post-treatment outcomes, e.g. for stroke
Difference between primary and secondary ageing
Primary ageing is the gradual, inevitable deterioration of the body whereas secondary ageing is the consequences of disease and environment, e.g. decreased mobility from OA
Effects of ageing at -cellular -organ -individual level
Cellular - grey hair
Organ - hypertension
Individual - enriched experiences, hobbies
Describe the 2 different theories of ageing
Stochastic - random cumulative damage, e.g. microtrauma
Programmed/developmental - predetermined changes (e.g. groups of cells are programmed to die off at a point in time), changes in gene expression
How does ageing affect the
- kidney
- heart
- lungs
Kidney - creatinine clearance falls (EGFR falls)
Heart - systolic BP increases, diastolic BP drops, CO falls, baroreceptor sensitivity falls
Lungs - VC falls
Frailty is due to … …
Progressive/age related dyshomeostasis
Frailty is defined as
A susceptibility state that leads to a person being more likely to lose function in the face of a given environmental challenge
What are the 4 frailty syndromes
- Delirium/Intellectual impairment
- Immobility
- Instability (falls)
- Incontinence
What response is produced when low BP is detected by the carotid bodies
Carotid bodies detects low BP by a low PO2 so then sends a signal via the glossopharyngeal nerve to the medulla of the brainstem, which then stimulates sympathetic nervous system to increase CO
Physiological changes in the frail
- more prone to hypothermia due to
- more prone to heat stroke due to
Increased heat loss (cold stress) due to
-reduced peripheral vasoconstriction
-reduced metabolic heat production
(so more prone to hypothermia)
Heat stress due to -reduced sweat output -reduced skin blood flow -lower CO -less blood flow redistribution (so more prone to heat stroke)
What is social dyshomeostasis
Difficulty caused by environmental problems, frailty isn’t just biomedical dyshomeostasis
Frail people will often not present in the classic way that others would but will present similar to others who are frail
Presentation of normal vs frail person with hyperthyroidism
Normal - tremor, weight loss, diarrhoea, increased sweating, increased HR
Frail - depression, cognitive impairment, falls, incontinence, AF, heart failure etc (essentially co-morbidities)
Practical implications of the the frail population
Lots of inter-individual (between-individual) variability in function
Presentation of different illnesses often very similar because it’s mixed in with all the frailty syndromes
Little evidence of drug efficacy and safety for 80+
Polypharmacy giving rise to drug-drug interactions and adverse drug reactions
