Older Adult Health

Question 1

list nutritional challenges that come with age

Answer 1

decreased food intake

decreased basal metabolic rate, lean body mass, sense of taste/smell

Question 2

causes of malnutrition in the elderly

Answer 2

poor dentition
difficulty swallowing
declining coordination + eyesight
arthritis
low mood
cognitive decline
cancer, HF, CKD, hypothyroidism
coeliac disease + IBD
medications (diuretics, antihypertensives)
reduced physical activity
dependent on staff if in care homes

Question 3

effects of malnutrition in the elderly

Answer 3

impaired immune function
poor wound healing
osteoporosis
cognitive impairment
mood disturbance
joint + muscle pain
Ca2+, vit D/C/B12, folate deficiencies > osteomalacia, anaemia, sarcopenia

Question 4

how to assess nutrition in the elderly

Answer 4

changed weight/BMI?
mental health
social/drug/past medical history
food and fluid diary
MUST (malnutrition universal screening tool)

Question 5

which healthcare staff are involved in the support of the elderly in terms of nutrition?

Answer 5

doctors
dieticians
occupational therapists
social care
speech and language therapists
dentists

Question 6

list examples of common sleep disorders

Answer 6

obstructive sleep apnoea

insomnia

Question 7

OSA results from?

Answer 7

partial/fully blocked airway

Question 8

partial/fully blocked airway in OSA is predisposed by?

Answer 8

tonsils too large
jaw set too far back
excess weight

Question 9

outline what occurs in OSA when sleeping

Answer 9

airway blocked > brain hypoxia > mini arousal > sharp intake of breath

Question 10

OSA increases risk of?

Answer 10

CVD
stroke
T2DM
severe depression
severe COVID-19

Question 11

presentation of OSA

Answer 11

loud snoring > pause in breathing > large gasp of air

excessive daytime sleepiness

Question 12

diagnosis of OSA

Answer 12

ideally with PSD - expensive + resource intensive

STOP-bang questionnaire

Question 13

STOP-bang questionnaire

Answer 13

snoring 
tiredness
observed
pressure (blood)
BMI
age
neck
gender

Question 14

risk factors for OSA

Answer 14

sleeping on back

anything that impacts REM sleep (alcohol, some antidepressants)

Question 15

treatment of OSA

Answer 15

CPAP gold standard but low compliance
lifestyle: weight loss, quit smoking, reduce alcohol
always consider bed partner

Question 16

insomnia is a predictor of?

Answer 16

depression

Question 17

cause of insomnia?

Answer 17

continuously heightened stress

Question 18

diagnosis of insomnia

Answer 18

difficulty initiating/maintaining sleep, waking up earlier + resistance going to sleep, difficulty sleeping w/o parent, daytime difficulties

Question 19

time course of short term insomnia

Answer 19

1-3 months

Question 20

time course of chronic insomnia

Answer 20

3 months

Question 21

first line treatment for insomnia

Answer 21

CBT (sleep hygiene, relaxation training, paradoxical intention, sleep restriction therapy)

Question 22

what is NOT recommended in the treatment of insomnia?

Answer 22

psychotropic medications

side effects can be worse

Question 23

what is social isolation?

Answer 23

objective measure of the measure of the number of contacts someone has (QUANTITY)

Question 24

what is loneliness?

Answer 24

subjective feeling about the gap between a person’s desired levels of social contact compared to the actual level (PERCEIVED QUALITY)

Question 25

measurement of loneliness

Answer 25

community life survey

UCLA 3

Question 26

role of social prescribing

Answer 26

enables primary care professionals to refer people to local, non clinical service

Question 27

professionals involved in social prescribing

Answer 27

GP > link worker > community organisation > follow up

Question 28

successes of social prescribing

Answer 28

improves QoL
improved mental health
reduction in use of NHS services

Question 29

challenges of social prescribing

Answer 29

hard to measure outcomes due to the heterogenous nature of the programmes/service users/outcomes
w/o strong evidence hard to commission programmes
risk of seeming to trivialise the patient’s issues

Question 30

outline the health benefits of green space

Answer 30

improved social cohesion
reduced stress
improved attention + memory
reduced diastolic BP/salivary cortisol/HR
reduced risk of preterm birth/small size gestational age/all cause mortality/T2DM
reduced incidence of stroke/hypertension/dyslipidemia/asthma/CHD
reduced crime
increased job opportunities/work productivity

Question 31

outline the anti-inflammatory effects of physical activity

Answer 31

reduced inflammatory visceral fat

anti-inflammatory myokines during muscle contraction

Question 32

outline the effects at a mitochondrial level of physical activity

Answer 32

ATP use in muscle contraction reduces charge in mitochondria > reverses inflammation + telomere shortening
^ number and size of mitochondria

Question 33

outline health benefits of physical activity - CVD

Answer 33

weight loss

CVD: CAD plaque regression, reduces BP, prevents rehospitalisation after an MI

Question 34

outline health benefits of physical activity - diabetes

Answer 34

diabetes: reduces mortality, ^ insulin sensitivity, better HbA1c, lipids, waist circumference, BMI