Lecture 11 Holistic Theme - How and Why Older People Get Sick

Question 1

How many over 85 expected by 2026?

Answer 1

2.4 million

Question 2

Whta is frailty?

Answer 2

The loss of physiological reserve causing increased vulnerability to poor health outcomes.

Question 3

Changes in CNS with age?

Answer 3

neuronal loss
cochlear degradation
lens rigidity and opacification
anterior horn and dorsal column cell loss

Question 4

Changes in respiratory system with age?

Answer 4

reduced lung elasticity
increased chest wall rigidity
V/Q mismatch
reduced cough action

Question 5

Changes in cardiovascular system with age?

Answer 5

reduced maximum HR
dilation of aorta
reduced elasticity of vessels and number of pacing monocytes in SAN

Question 6

Changes in gastrointestinal system with age?

Answer 6

reduced motility

Question 7

Changes in renal system with age?

Answer 7

loss of nephrons
reduced glomerular filtration rate and tubular function

Question 8

Changes in endocrine system with age?

Answer 8

deterioration in pancreatic beta-cell function

Question 9

What is postural hypotension?

Answer 9

A fall in systolic BP of =>20mmHg and/or a fall in diastolic BP of =>10mmHg from lying to standing.

Question 10

What are the causes of postural hypotension?

Answer 10

ageing
hypovolaemia
medication like diuretics and anti-hypertensives
autonomic dysfunction

Question 11

How can you manage postural hypertension?

Answer 11

stop medications
lifestyle factors like adequate fluid intake and standing up slowly
stockings
fludrocortisone

Question 12

Describe fractured neck of femur.

Answer 12

Common
High mortality and can occur with minor trauma in the elderly as bone density decreases with age.

Question 13

What is the presentation of a fractured neck of femur?

Answer 13

usually after a fall
painful
shortened and externally rotated leg

Question 14

What is the investigations for fractured neck of femur?

Answer 14

X-Ray
sometimes CT

Question 15

What is the management for fractured neck of femur?

Answer 15

analgesia
surgery like a hip replacement

Question 16

What are the clinical consequences of CNS ageing?

Answer 16

delirium
hearing loss
presbyopia
cataract
muscle wasting
risk of falling increases

Question 17

What are the clinical consequences of respiratory system ageing?

Answer 17

reduced vital capacity
increased residual volume
reduced oxygen saturation

Question 18

What are the clinical consequences of cardiovascular system ageing?

Answer 18

reduced exercise tolerance
widened pule pressure
increased risk of postural hypertension

Question 19

What are the clinical consequences of gastrointestinal system ageing?

Answer 19

constipation

Question 20

What are the clinical consequences of renal system ageing?

Answer 20

impaired fluid balance
increased risk of dehydration
impaired drug excretion

Question 21

What are the clinical consequences of endocrine system ageing?

Answer 21

increased risk of impaired glucose tolerance

Question 22

What is poly pharmacy?

Answer 22

defined as 5 or more medications taken at a time.
research shows a strong relationship between poly pharmacy and negative clinical consequences.

Question 23

What % of older adults take one or more medications that are not necessary?

Answer 23

50%

Question 24

Why are elderly people at risk of under nutrition?

Answer 24

basal metabolic rate is reduced and energy requirements are reduced.

Question 25

What are the reasons for under nutrition?

Answer 25

decreased appetite
difficulty preparing food
loss of taste
financial difficulties
poor dental health
illness
poor cognition

Question 26

What are the clinical consequences of under nutrition?

Answer 26

impaired immunity
muscle weakness
poor wound healing

Question 27

How does the clinical frailty scale describe very fit people?

Answer 27

people who are robust, active, energetic and motivated.
these people commonly exercise regularly and are among the fittest for their age.

Question 28

How does the clinical frailty scale describe well people?

Answer 28

people who have no active disease symptoms but are less fit than very fit people.
exercise and are very active occasionally.

Question 29

How does the clinical frailty scale describe managing well people.

Answer 29

people whose medical problems are well controlled but are not regularly active beyond routine walking.

Question 30

How does the clinical frailty scale describe vulnerable people?

Answer 30

while not dependent on others for daily help, often symptoms limit activities.
a common complaint is being ‘slowed up’ and/or being tired during the day.

Question 31

How does the clinical frailty scale describe mildly frail people?

Answer 31

often have more evident slowing and need help in high orders IADLS.
typically mild frailty progressively impairs shopping and walking outside alone, meal preparation and housework.

Question 32

How does the clinical frailty scale describe moderately frail people?

Answer 32

people who need help with all outside activities and with keep house.
often have problem with stairs and need help bathing and might need minimal assistance with dressing.

Question 33

How does the clinical frailty scale describe severely frail people?

Answer 33

completely dependent for personal care from whatever cause.
they seem stable and not at high risk of dying within 6 months.

Question 34

How does the clinical frailty scale describe very severely frail people?

Answer 34

completely dependent, approaching end of life.
typically they could not recover from even a minor illness.

Question 35

How does the clinical frailty scale describe terminally ill people?

Answer 35

approaching the end of life.
applies to people with a life expectancy of less than 6 months who are not otherwise evidently frail.