Older Age - Ageing, Dementia, Falls & Frailty

Question 1

What is the difference between chronological age and biological age?

Answer 1

Chronological - actual age

Biological - health of body

Question 2

What are the main respiratory effects of ageing?

Answer 2

• decreased elasticity and compliance
• total lung capacity, FVC, FEV1 and vital capacity are reduced
• increased risk of post-operative complications e.g. PE, pneumonia, atelectasis (lung collapse)

Question 3

Why do you need to be cautious when giving opiates to elderly?

Answer 3

Opiates suppress CNS function which can lead to airway obstruction (elderly already at risk of airway obstruction due to reduced elasticity around oropharynx).

Question 4

Why is it significant that elderly have reduced hepatic and renal function?

Answer 4

Slower metabolism and elimination of drug - can lead to toxicity.

Question 5

Why does atrial fibrillation have a risk of collapse?

Answer 5

• atrial contraction contributes to 1/3 of normal ventricular filling
• patient with AF has reduced CO
• can lead to collapse due to low BP

Question 6

What is ‘arm-brain’ time? How does it differ in elderly?

Answer 6

• time it takes for drugs to become effective

- increased in elderly due to decreased CO

Question 7

How can decreased plasma proteins in the elderly result in toxicity/needs reduced dosage?

Answer 7

Results in decreased protein binding and therefore increased free drug availability.

Question 8

Name 2 drug classes that are nephrotoxic.

Answer 8

ACEi

NSAIDs

Question 9

How does hypertension cause HF?

Answer 9

Increased LV strain
LV hypertrophy
Heart failure

Question 10

What is the average number of medications in the elderly population?

Answer 10

4

Question 11

How is a diagnosis of dementia made?

Answer 11

• thorough Hx, Ex, cognitive assessment and MSE (mental state examination)
• blood tests (to exclude other underlying causes)
• imaging

Question 12

What is the National Dementia Strategy?

Answer 12

National response to try to deal with increasing demands of dementia - includes medical schools having more teaching based around dementia.

Question 13

What is malnutrition?

Answer 13

In-balance between what an individual eats and what they require to maintain health - includes over-eating and under-eating. Also includes incorrect balance of nutrients.

Question 14

What are the effects of malnourishment in the elderly in hospital?

Answer 14

• increased risk of pressure sores
• more likely to have longer hospital admissions
• respond less well to treatment
• 3 times more likely to develop complications after surgery
• higher mortality rate

Question 15

What is the most important thing to ascertain when someone has fallen.

Answer 15

Whether there was any loss of consciousness leading to the fall.

Question 16

What is the difference between a syncopal and non-syncopal fall?

Answer 16

Syncopal - loss of consciousness caused the fall
Non-syncopal - syncope did not cause the fall, even if someone has loss of consciousness due to head injury following fall, this is still non-syncopal.

Question 17

State some risk factors for falls.

Answer 17

• trip hazards
• septic/infection
• UTI
• MI

Question 18

What are pre-syncopal symptoms?

Answer 18

Symptoms that precede a syncope e.g. Dizziness, chest pain, sweating, pallor, blurred vision.

Question 19

Name the 3 main types of syncope.

Answer 19

1) Reflex syncope
2) Postural/orthostatic hypotension
3) Cardiac syncope

Question 20

What is a reflex syncope?

Answer 20

Dysfunction of the autonomic NS which regulates blood pressure and heart rate, BP is not controlled e.g. Vasovagal, situational syncope (after coughing, urinating or weights), carotid sinus massage.

Question 21

What is postural/orthostatic hypotension and how does it lead to syncope?

Answer 21

Pre-syncopal symptoms when standing from a sitting or lying position that progress to syncope. Standing causes blood to pool in legs, decreasing EDV, SV and CO. Baroreceptor reflex fails to maintain BP.

Question 22

Which cranial nerves are the afferent and efferent branches of the baroreceptor reflex?

Answer 22

Afferent - glossopharyngeal

Efferent - vagus

Question 23

What is cardiac syncope?

Answer 23

Syncope caused by cardiac disease or abnormality, can be:

• electrical - bradycardia or tachycardia
• structural - aortic stenosis
• coronary - MI/IHD

Question 24

What main investigations should you do when someone presents at A+E after a fall?

Answer 24

• LSBP (lying standing BP)
• ECG
• FBC
• urea and electrolytes
• creatine kinase

Question 25

Why should you measure creatine kinase in someone that has fallen?

Answer 25

This is the most reliable test to check for rhabdomyolysis, which is a common complication of falls with a ‘long-lie’.

Question 26

What is rhabdomyolysis?

Answer 26

Release of intracellular ions, myoglobin, creatine and kinase and urates due to skeletal muscle damage caused by a crush injury or prolonged immobilisation e.g. A fall.

Question 27

What is the frailty index score?

Answer 27

Frailty index score = number of deficits of an individual/total number of deficits measured.
E.g. In a dataset with 50 health deficits, if a person had 10 of these problems, they have a score of 0.2

Question 28

How does a frail person react to the same insult as a fit person e.g. For flu?

Answer 28

A frail person is likely to have a much more profound deterioration and a longer recovery, they may also not completely recover to baseline.

Question 29

Name some consequences of frailty.

Answer 29

• increased risk of falls, immobility, collapse or confusion
• cognitive impairment
• osteoarthritis
• depression
• deafness/blindness