Intro to Ageing Flashcards
What are survival curves and what does the UK one look like?
Survival curves are a graphical representation of population survival rates with age
RED = We start off with 100% of the population, but as time progresses survival rates decrease until eventually nobody survives (they’re all too old)
YELLOW = ageing population w premature deaths, hay a different shape of curve. There are still causes of premature death, but some survive into old age
GREEN = developed societies=decreased infant mortality rate and a lower mortality rate throughout the years, before mortality rates increase again. This shape= ‘squaring of the rectangle’ and is what we have seen in the UK
Why was there squaring of the rectangle in the UK?
Decreased infant mortality
Increased living standards
Improvements in public health
Improved sanitation
Improved diet (largely promoted by the abolition of corn laws in 1842, which allowed importation of cheap American foods)
As we age, were more likley to get chronically disabling diseases. What are these?
Some chronically disabling diseases have a very steep relationship to age, inc:
Strokes, Alzheimer’s, PD, Osteoarthritis
Incidence of epilepsy is shifting into old age too; we’re usually taught that the peak age of onset is in early 20s
Cause in elderly is usually secondary to strokes or neurodegen disease
4 factors contribute to the association between increased disability and an ageing population?
There is physiological ageing that brings the clinical threshold for disability closer
Acute illness has a much bigger impact when people are older
There is relative isolation and poverty in the elderly population
Increased prevalence of chronic illness within the elderly
What is the future of old age? - 4 scenarios
This is a bit bleak tho- current evidence seems to suggest that ppl are living longer and better
What is the global health survey and what trends did it show?
The GHS is a comprehensive survey on the health of a proportion of the population
Between 1980 and 2001, it found no overall change in the proportion of elderly people reporting their health as good (37%), fairly good (38%) and not good (25%)
This is not necessarily what we’d expect. As more people get older, we’d expect the number saying that their health is not good to increase, however this was not the case – the proportion did not change
What is the definition of ageing?
Ageing is the ? of function, resulting in the loss of an ?, and a ?
Diff organs begin ? at diff time rates
Ageing is ?
Ageing is the progressive generalised impairment of function, resulting in the loss of an adaptive response to stress, and a growing risk of age-related disease
Diff organs begin ageing at diff time rates
Ageing is non-focal and asymptomatic – there is no pain, dyspnoea etc associated with the process
What is frailty?
Frailty is a ? characterised by ? and ?
It is due to ? across ? It causes ?
Only around ? of over 65s suffer from frailty at any one time
? tends to affect the elderly the most. It is the combo of ?
Frailty is a physiological syndrome characterised by decreased reserve and low resistance to stressors
It is due to cumulative decline across multiple physiological systems. It causes vulnerability to adverse outcomes
Only around 10% of over 65s suffer from frailty at any one time
Physical frailty tends to affect the elderly the most. It is the combo of weight loss, impaired grip strength, diminished physical activity and/or a slow gait
What is a way to identify a true ageing process?
Strehler suggested that, to be a true ageing process, all 4 of the criteria must be fulfilled - the process must be
Universal - seen in all individuals of the species
Intrinsic – restricted to changes of endogenous origin. It does not need external drivers (e.g. hair loss)
Progressive – all changes continue progressively with time (e.g. greying of hair, loss of muscle power)
Deleterious – should eventually be harmful to the organism (e.g. reduced visual acuity, loss of hearing).
These factors differ from disease characteristics:
Affects an single individual
Can be due to intrinsic or extrinsic drivers
Is progressive but can be halted
Is deleterious but may be arrested or cured
Why must we delay the onset of disabling diseases/ what is compression of morbidity?
By delaying the onset of disabling diseases to later ages when intrinsic ageing has raised fatality, the average duration of disability before death will be shortened
Basically we will spend a longer time living and a shorter time disabled/ dying
Eg a stroke at 45= unlikely to kill, but will leave you disabled for ages. If we prevent the stroke til 80, it’s more likely to kill you outright/soon after, meaning there is a much shorter period of disability, preventing longer term suffering
4 ways to further postpone disability in old age?
Health promotion
Illness prevention
Appropriate use of existing technologies
Developing new technologies
What are issues with postponing disability in old age?
Secondary prevention in the UK has historically not been very good- see rule of halves:
We are only aware of about half the people who suffer from a condition
Of that half, only half are treated appropriately
Of those, less than half achieve their treatment goals
Another issue=comorbidities + polypharmacy in elderly
10% of older people are actually on contraindicated drugs
ALSO: Healthcare + pensions costs money, elderly are usually economically dependent
Can we afford to keep all elderly alive and healthy?
From time to time, as a country we do worry than we can’t afford to keep all the elderly alive and healthy, when in reality:
Prevention of disease is cheaper than cures and treatment for acute events
Postponement and compression of morbidity is cheaper than community or institutional care for people with chronic disability
What are ways to be able to afford to keep older ppl healthy?
- Old age=social construct and biological phenomenon. Olders can be producers as well as consumers
- Pegging median age of compulsory retirement to median age of death so that elderly don’t become an economic burden
- We need to postpone disease onset, which will slow progression and reduce the severity, costing us less. NOT about postponing death
