Health and disease

Question 1

What does biological age mean and how is it different from chonological age? How can me measure biological age?

Answer 1

Kronologisk ålder - tid från födsel

Biologisk ålder - beror av genetik, hälsa, rutiner och vanor, livsstil, sjukdomar etc.

Measure markers: The degree of frailty, based on the participants’ self-reports of various symptoms, is one; another is the epigenetic clock (DNA methylation age estimator), which is linked to how different genes are expressed. Other markers studied include telomere length, blood biomarkers and cognitive and physical abilities. These markers were also associated with an increased risk of early death.

Question 2

What is frailty? How can we assess it in research? What is the added value of measuring frailty together with multimorbidity when assessing older adult’s health?

Answer 2

Frailty is a medical condition of reduced function and health in older individuals.

Getting older doesn’t necessarily mean someone is frail, but it does increase the odds of developing multiple medical conditions and frailty. Things like inactivity, poor nutrition, and social isolation or loneliness, and multiple medications contribute to frailty. When you are frail, your body does not have the ability to cope with minor illnesses that would normally have minimal impact if you were healthy. With frailty, these minor stressors may trigger rapid and dramatic deterioration.

Question 3

Discuss the different ways of measuring the burden of chonic disease (i.e multimorbidity) in older adults and the pros and cons linked to each approach.

Answer 3

Ordinal: Just count the number of chronic diseases present in the individual Pros: simplest way to measue. Give you an exaxt number
Cons: Neglects the non-linear burden of multimorbidity. 1+1 does not not always equal 2. Every new disease adds exponentially to the burden. This is in fact one of the biggest reasons that multimorbidity is important to consider.

Weighted: This method gives different weight to different diseases. Pros: Some diseases have a larger impact on a person’s life and well-being. This fact is taken into account when using this method. It might therefore give a more valid measure of the individuals burden. Cons: It can be tricky to know how to weigh different diseases. For some previous very active persons a disease that affects mobility might be extra affected. This makes it hard to create standards for the weighting criteria.

Categorical: Assign different number of diseases to different categories. Maybe one category is 2 diseases, another 3-4, and 5+. Pros: This takes the non-linear burden of multimorbidity into account. Maybe carriers of 5 or more diseases are affected in a special way that carriers of 3-4 is not. Cons: by using this methos, informatin is lost when lowering the resolution of the measure.

Question 4

In relation to polypharmacy in old age: Define the concept, prevalence and how it is related to multimorbidity

Answer 4

Polypharmacy: Current use of 5 or more medications. Around 40% of older people.

Med åldern försämras hälsan (70% over 70 suffers from multimorbidity) which means having more than two diseases at the same time. Will need medication for all diseases, often in varying combinations with different side effects.

Att komma ihåg de många medicinerna kan vara svårt för äldre p.g.a. demens

för att få full poäng saknas det en beskrivning av att patologin avser patologiska förändringar i hjärnan.

Question 5

Pathology-cognitive map

Pathology cognition gap

Answer 5

Finns ofta en diskrepans (skillnad) i kognitiv förmåga + den kognitiva förmåga som förväntas baserat på den uppmätta hjärnhälsan

Ex.
Reserver: Person med mindre åldersrelaterad patologi från början kommer upprätthålla funktionen längre

Den skillnad som finns i faktiskt kognitiv förmåga, och den förväntade funktionen utifrån uppmätt hjärnhälsa.

• *Möjliga förklaringar kan här vara:**
• Brain reserve. Att en person med mer hjärnvolym inte kommer påverkas lika mycket av patologi som en person med mindre volym.
• Cognitive reserve. Att en person som kan anpassa sitt sätt att processera och problemslösa kan upprättahålla funktion längre genom att “förbigå” patologin.
• Brain maintanence. Personer som har mindre åldersrelaterad patologi kommer att upprätthålla funktion längre, då de helt enkelt har mer “hälsosam” vävnad att ta ifrån.

Question 6

Förklara skillnaden mellan komorbiditet och multimorbiditet. Beskriv hur multimorbiditet kan påverka behandlingen av äldre personer.

Answer 6

Komorbiditet = Sjukdomar som uppstår inom en individ i anslutning till en indexdiagnos. 
Multimorbiditet = Närvaron av två eller fler kroniska sjukdomar hos en individ, oberoende av varandra,