Older adults - clinical aspects Flashcards
In the 19th century, what was the retirement age?
70 years (then 65 years)
What are the exogenous causes of ageing?
- sunlight
- ionizing radiation
- cigarette smoke
- alcohol
- drugs oxidation
- iron overload
- air pollution (O3, NOx)
- xenobiotica (mycotoxins, paraquat)
What are the endogenous causes of ageing?
- electron transport chain (mitochondria)
- enzymatic reactions (xanthine oxidase, NADPH oxidase, cytochrome c P450, d-amino acid oxidase)
- metal catalyst redox reactions (Haber weiss cycle, fenton reaction)
What is health?
a state of complex physical, mental and social well being and not merely the absense of disease
What is healthy ageing?
the process of developing and maintaining the functional ability that enables wellbeing in older age
What is successful ageing as defined by Rowe and Kahn?
- avoiding disease
- engagement in life
- maintaining high cognitive physical functioning
Name the neurological aspects of ageing:
- cortical problems
- reset pathways
- dyspraxia/motor planning
Name the muscle/supporting structure situations in ageing:
- reduced tongue strength
- teeth
- muscle strength/sarcopenia
What are some devices to aid the outcomes of ageing?
- dentures (teeth)
- nasogastric tubes
Name all the possible outcomes of ageing:
- reduced physical activity/metabolic rate
- reduced LBM, bone mass, body water
- increased body fat/redistribution
- reduced hunger, energy efficiency
- increased satiation and food specific satiety
- less efficient taste memory, decline in sensory effectiveness (visual, taste, smell)
- reduced proprioception tongue and lips
What is frailty as described by Li, 2012?
- multisystem dysregulation
- decreased physiological reserve
- heightened inflammatory state
- immune dysregulation
- loss of complexity in resting dynamics and maladaptive response to stressors
- raised IL-6
What is frailty as described by Fried, 2003?
- weight loss
- exhaustion
- low energy expenditure
- reduced muscle strength
- slow walking (TUG)
What is sarcopenia?
- loss of muscle mass and quality with age
- contractility decrease more than mass
- change in muscle balance, catabolism > anabolism
What is the % reduction of contractility as age reduces?
33%
What is the % of sarcopenia in those above 80years?
50%
In sarcopenia state, what increases protein synthesis?
amino acid gradient
What is immune modulation?
- impaired glucocorticoid/catecholamine feedback
- inhibition of macrophage cytokine release
- reduced effectiveness of iNKT
What is dysphagia?
transferring food to stomach
List out some primary medical factors causing ageing:
- stroke
- brain injury
- degenerative neurological (motor neuron disease, parkinson’s disease, multiple sclerosis, dementia)
- scleroderma
List out some secondary medical factors causing ageing:
- cardiorespiratory disease
- rheumatoid
- OA/ankylosing spondylosis
- infection
- GORD
What is the meaning of edentulous?
lack of teeth
What are some GI changes in ageing?
- reflux and dysphagia
- oesophagus affected
- decrease in myenteric neurons
- decrease in resting UOS pressures
- pharyngeal dysphagia
What are the specific changes in the oesophagus in ageing?
- decrease in in LOS relaxation
- upward displacement of LOS into thorax
- delayed emptying of oesophagus
- increase in non-peristaltic contractions
From studying 90 elderly patients, what was the % of those with oral tissue disease?
60%
From studying 90 elderly patients, what was the % of those with dentures?
81%
Why is there consequences of nosocomial infections in the elderly?
- long stay ward (malnourished)
- BMI below <20, increased risk of infection, mortality and dependency
- eventually organ failure
