Lecture 11 Holistic Theme - How and Why Older People Get Sick Flashcards
How many over 85 expected by 2026?
2.4 million
Whta is frailty?
The loss of physiological reserve causing increased vulnerability to poor health outcomes.
Changes in CNS with age?
neuronal loss
cochlear degradation
lens rigidity and opacification
anterior horn and dorsal column cell loss
Changes in respiratory system with age?
reduced lung elasticity
increased chest wall rigidity
V/Q mismatch
reduced cough action
Changes in cardiovascular system with age?
reduced maximum HR
dilation of aorta
reduced elasticity of vessels and number of pacing monocytes in SAN
Changes in gastrointestinal system with age?
reduced motility
Changes in renal system with age?
loss of nephrons
reduced glomerular filtration rate and tubular function
Changes in endocrine system with age?
deterioration in pancreatic beta-cell function
What is postural hypotension?
A fall in systolic BP of =>20mmHg and/or a fall in diastolic BP of =>10mmHg from lying to standing.
What are the causes of postural hypotension?
ageing
hypovolaemia
medication like diuretics and anti-hypertensives
autonomic dysfunction
How can you manage postural hypertension?
stop medications
lifestyle factors like adequate fluid intake and standing up slowly
stockings
fludrocortisone
Describe fractured neck of femur.
Common
High mortality and can occur with minor trauma in the elderly as bone density decreases with age.
What is the presentation of a fractured neck of femur?
usually after a fall
painful
shortened and externally rotated leg
What is the investigations for fractured neck of femur?
X-Ray
sometimes CT
What is the management for fractured neck of femur?
analgesia
surgery like a hip replacement
What are the clinical consequences of CNS ageing?
delirium
hearing loss
presbyopia
cataract
muscle wasting
risk of falling increases
What are the clinical consequences of respiratory system ageing?
reduced vital capacity
increased residual volume
reduced oxygen saturation
What are the clinical consequences of cardiovascular system ageing?
reduced exercise tolerance
widened pule pressure
increased risk of postural hypertension
What are the clinical consequences of gastrointestinal system ageing?
constipation
What are the clinical consequences of renal system ageing?
impaired fluid balance
increased risk of dehydration
impaired drug excretion
What are the clinical consequences of endocrine system ageing?
increased risk of impaired glucose tolerance
What is poly pharmacy?
defined as 5 or more medications taken at a time.
research shows a strong relationship between poly pharmacy and negative clinical consequences.
What % of older adults take one or more medications that are not necessary?
50%
Why are elderly people at risk of under nutrition?
basal metabolic rate is reduced and energy requirements are reduced.
What are the reasons for under nutrition?
decreased appetite
difficulty preparing food
loss of taste
financial difficulties
poor dental health
illness
poor cognition
What are the clinical consequences of under nutrition?
impaired immunity
muscle weakness
poor wound healing
How does the clinical frailty scale describe very fit people?
people who are robust, active, energetic and motivated.
these people commonly exercise regularly and are among the fittest for their age.
How does the clinical frailty scale describe well people?
people who have no active disease symptoms but are less fit than very fit people.
exercise and are very active occasionally.
How does the clinical frailty scale describe managing well people.
people whose medical problems are well controlled but are not regularly active beyond routine walking.
How does the clinical frailty scale describe vulnerable people?
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.
How does the clinical frailty scale describe mildly frail people?
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.
How does the clinical frailty scale describe moderately frail people?
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.
How does the clinical frailty scale describe severely frail people?
completely dependent for personal care from whatever cause.
they seem stable and not at high risk of dying within 6 months.
How does the clinical frailty scale describe very severely frail people?
completely dependent, approaching end of life.
typically they could not recover from even a minor illness.
How does the clinical frailty scale describe terminally ill people?
approaching the end of life.
applies to people with a life expectancy of less than 6 months who are not otherwise evidently frail.
