Geriatrics: frailty

Question 1

Why are people getting older?

Answer 1

Increased resources available
Better economic conditions
Improved screening programs
Early diagnosis and treatment
Better outcomes following major events
More people survive major events

Question 2

What is primary ageing?

Answer 2

Inevitable e.g. osteoarthritis

Question 3

What is secondary ageing?

Answer 3

Being less mobile because of primary ageing e.g. osteoarthritis

Question 4

What are benefits, neutral and detrimental affects of ageing?

Answer 4

Benefit - increased experiential learning
Neutral - grey hair, pastime preference
Detrimental - HT, decreased reaction time

Question 5

What are the 3 man theories of ageing?

Answer 5

Stochastic
Programmed
Homeostatic failure

Question 6

What happens to the kidneys during ageing?

Answer 6

Creatinine clearance goes down
Kidney function reduces
eGFR includes age in order to compensate for this

Question 7

What happens to the CVS during ageing?

Answer 7

Systolic tends to increase
Diastolic peaks at 60, then tends to drop
More SE from anti-hypertensive therapy 60+
CO gets worse over time

Question 8

What happens to the respiratory system during ageing?

Answer 8

Total lung capacity = same

Vital capacity reduces over time

Question 9

What is dyshomeostasis?

Answer 9

An imbalance or other breakdown of a homeostasis system

Question 10

What is frailty in connective with dyshomeostasis?

Answer 10

Frailty effetely progressive dyshomeostasis

Question 11

What is frailty?

Answer 11

A susceptibility state that leads to a person being more likely to lose function in the face of a given environmental challenge

Question 12

What are the ‘Frailty Syndromes’?

Answer 12

Falls
Delirium
Immobility
Incontinence

Question 13

What might not work in people with frailty and what are the consequences?

Answer 13

Carotid sensor sensitivity + sympathetic nervous system

= heart less able to pick up HR + unable to compensate for low BP

Question 14

What are frail people more prone to?

Answer 14

Hypothermia and heat stroke

Question 15

Why are older people more prone to hypothermia?

Answer 15

Reduced peripheral vasoconstriction

Question 16

Why are older people more prone to heat stroke?

Answer 16

Reduced sweat gland output
Reduced skin blood flow
Smaller increase in CO
Less redistribution of blood from renal and splanchnic circulations

Question 17

What is social dyshomeostatsis?

Answer 17

Difficulty caused by environmental insults, not just biomechnical
Different ability to compensate for change e.g. death spouse/family on holiday

Question 18

An example when medical conditions might have different presenting signs and symptoms in people with frailty?

Answer 18

Hyperthyroidism:
Normal: tremor, anxiety, weight loss, diarrhoea
Frailty: depression, cognitive impairment, muscle weakness, AF, HF, angina

Question 19

What is the problem with medicines and frailty?

Answer 19

Few trial medications in older people

Question 20

What are the practical implications of frailty?

Answer 20

Increasing no older people with multiple co-existing medical conditions
Increased inter-individual variability in organ function and homeostatic reserve
Different presenting symptoms + signs
Little evidence of drug efficacy and safety for patients 80+
Multiple medications: DDI and ADR

Question 21

What is the stochastic ageing theory?

Answer 21

Random

Cumulative damage

Question 22

What is happening to total fertility rate as time goes on?

Answer 22

Reducing

Question 23

What is happening to the number of people over 60 in world as time goes on?

Answer 23

Increasing