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LMAP2 > Older People Health > Flashcards

Older People Health Flashcards

1
Q

Why does food intake decline with age?

A

Lower basal metabolic rate
Decreased lean body mass
Decreased sense of taste
Decreased sense of smell

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2
Q

How does malnutrition affect the UK?

A

When the diet does not contain the right amount of nutrients, undernutrition and over-nutrition

Affects around 10% of over 65s in the UK

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3
Q

What factors can put a person at risk of malnutrition?

A

Poor dentition
Swallowing difficulty
Arthritis and declining co-ordination
Deteriorating eyesight

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4
Q

What % of men and women over the age of 65 experience low mood?

A

22% of men

28% of women

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5
Q

What are the two types of cognitive decline?

A

Normal cognitive decline

Pathological cognitive decline

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6
Q

What medical conditions and medication can put you at risk of malnutrition?

A

Medical conditions: Appetite, including cancers, heart failure, chronic kidney disease and hypothyroidism

Conditions: Coeliac disease, and IBD can cause malabsorption syndrome

Medication like diuretics and antihypertensives can alter appetite

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7
Q

Which types of medications can alter appetite?

A

Diuretics and antihypertensives

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8
Q

What vitamin deficiency is associated with osteomalacia?

A

Calcium and vitamin D

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9
Q

What is associated with Vitamin B12 and folate deficiency?

A

Macrocytic anaemia

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10
Q

What are the risks of vitamin C deficiency?

A

Poor wound healing

Scurvy

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11
Q

What vitamin deficiency is associated with poor vision?

A

Vitamin A

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12
Q

Outline the clinical assessment of nutrition history taking

A 
Changes to weight and BMI
Additional symptoms of malnutrition 
Mental health 
Drug history
Past medical history
Social history
Food and fluid diary
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13
Q

What is involved in the examination during a clinical assessment of nutrition?

A

Weight, BMI, dentition

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14
Q

What investigations are performed during a clinical assessment of nutrition?

A

Malnutrition universal screening tool (MUST)

Consider blood tests

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15
Q

What is the role performed by a doctor during an MDT approach to improve malnutrition?

A

Review medication, manage conditions, co-ordinate

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16
Q

Who performs a formal nutritional assessment and implement recommendations during an MDT approach concerning malnutrition?

A

Dietician

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17
Q

What is the role of an occupational therapist in terms of managing malnutrition?

A

Assess and provide aids for shopping, cooking and feeding

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18
Q

What is the role performed by a social care professional?

A

Assess and provide increased support e.g carers, meal delivery

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19
Q

What is the title of the health professional whose formal role within the NHS is to assess, diagnose and treat dietary and nutritional problems?

A

Dietician

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20
Q

What is sarcopenia?

A

Loss of lean muscle mass

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21
Q

What is sarcopenia associated with?

A

Reduced functional ability and is a component of frailty syndrome

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22
Q

What is the main risk factor of sarcopenia?

A

Malnutrition

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23
Q

What causes obstructive sleep apnoea?

A

Results from a partial or fully blocked airway, starving the brain of oxygen and causing hypercapnia

Reinvigorates the musculature of the airway

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24
Q

What is the characteristic trait for obstructive sleep apnoea?

A

Snoring followed by a pause of breathing and a large of gasp of air

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25
Q

What is the primary complaint of OSA?

A

Excessive daytime sleepiness

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26
Q

What are the increased risks associated with OSA?

A 
Stroke
CVD
T2DM
Independent of weight and age
Severe depression
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27
Q

How is OSA diagnosed?

A

PSG- EXPENSIVE

STOP-BANG questionnaire

28
Q

What is the main cause of OSA?

A

Obesity

29
Q

Why does obesity cause OSA?

A

Excessive adipose at the base of the tongue and pharynx

30
Q

What is the gold standard treatment for OSA?

A

CPAP

31
Q

What lifestyle factors are associated with improving OSA?

A

Losing weight
Quitting smoking
Reducing alcohol consumption

32
Q

What proportion of the population is affected by insomnia?

A

10%

33
Q

What proportion of the population will report a symptom of insomnia?

A

40%

34
Q

What theory described an elevated stress response throughout the day in insomnia patients?

A

Hyperarousal theory of insomnia

35
Q

Which type of drug is not recommended for patients with insomnia?

A

Psychotropics

36
Q

Why are psychotropics not recommended for patients with insomnia?

A

The effects are short-lived and can lead to dependence

37
Q

What is the first line treatment for insomnia?

A

CBT; components include sleep hygiene, relaxation training, cognitive therapy, sleep restriction therapy (retraining people when to sleep)

38
Q

What is sleep restriction therapy?

A

Retraining people when to sleep

39
Q

What is the odds ratio of developing depression after an episode of insomnia?

A

2:1

40
Q

What criteria is used to diagnose a patient with Insomnia?

A

ICSD-3 diagnostic criteria

41
Q

What is the ISCD-3 diagnostic criteria?

A

o Difficulty initiating sleep
o Difficulty maintaining sleep
o Waking up earlier than desired
o Resistance to going to bed
o Difficulty sleeping without parents or caregiver
o Present for 3 months to be classed as chronic; 1-3 months for short-term insomnia

42
Q

How does hypnotic use affect older patients?

A
  • Reduced social functioning due to effects on memory and gait disturbance.
  • Impaired cognitive function secondary to benzodiazepines can be wrongly diagnosed as dementia.
  • Mood disturbance, i.e. this could be first presentation or aggravation of pre-existing depression, emotional blunting, in between doses increased anxiety.
43
Q

What are meaningful solutions?

A

policy makers and researchers need to ensure that solutions are focused on creating and maintaining meaningful relationships that address both social isolation and loneliness.

44
Q

What is the gold standard measurement of loneliness?

A

Direct Community life survey and indirect UCLA 3 item scale

45
Q

What are the quantitative objective measures of social connection?

A

Social isolation
Network size
social integration
Marital status

46
Q

What are the qualitative/subjective measures of social connection?

A

Loneliness
Social support
Relationship Quality
Martial quality

47
Q

What are the psychological impacts of social connection?

A 
Appraisal 
Stress
Depression 
Resilience
Meaning/purpose
Hopefulness
Safety
48
Q

What are the morbidities associated with social isolation?

A

Coronary heart disease
stroke
diabetes

49
Q

What are the wider determinants of health?

A

Diverse range of social, economic and environmental factors which impact on people’s health.

They determine the extent to which different individuals have the physical, social and personal resources to identify and achieve goals, meet their needs and deal with changes to their circumstances.

50
Q

What factors influence the wider determinants of health?

A

Local, national and international distribution of power and resources which shape the conditions of daily life

51
Q

Summarise the social prescribing pathway

A

GP to link workers to community organisation

52
Q

What is the main difference to social prescribing and self-care?

A

Self-care encompasses anything you do to support your own health and wellbeing

Whereas social prescribing involves working with a professional to develop a personalised solution to an individuals needs

53
Q

What are the essential jigsaw pieces needed for social prescribing to work?

A

A change in NHS culture, strong community links, a holistic approach to patient care, proper investment, and accurate measures of success.

54
Q

What are the benefits of physical activity to the process of ageing?

A

inflammatory effects - Reducing inflammatory visceral fat and releasing anti-inflammatory myokines during muscle contraction

Effects at a mitochondrial level - reduced free radicals and cellular damage

Weight loss

55
Q

What anti-inflammatory mediator is released from muscle contraction during physical activity?

A

Myokines

56
Q

During a sedentary, which mediator causes cell damage?

A

Increased charge the mitochondria during sedentary behaviour increases ‘electrochemical charge’ across the mitochondrial membrane. This allows leakage of free radicals into the cell causing damage in the cytoplasm and mitochondria. This damage in the cell results in inflammation, which leads to telomere shortening and over time, cell death creating yet more inflammation. This speeds up the ageing process. Using ATP during muscle contraction reduces the charge in the mitochondria and can reverse the above process, and even lengthen telomeres. Physical activity also increases the number and size of mitochondria.

57
Q

What is the effect caused by free radicals on the cell?

A

Results in telomere shortening - and cell death, potentiating inflammation

58
Q

What did Jerry Morris postulate about the effects of physical activity on chronic disease?

A

Morris was perhaps the first person to analyse data on cardiovascular disease and activity. By performing a large scale survey, he first noticed in 1949 that the sedentary drivers of London’s double-decker buses had higher rates of cardiovascular disease than the conductors who climbed the stairs. He extended the study and noticed that postmen who delivered the mail by bike or on foot had fewer heart attacks than sedentary men who served behind counters or as telephonists and clerks.

59
Q

Outline which trials have shown about diabetes and exercise improvements

A
  • Aerobic exercise reduced mortality risk for both type 1 and type 2 diabetes
  • Aerobic or resistance exercise increases insulin sensitivity
  • 5-6 months of resistance training increase insulin sensitivity beyond that is seen in standard care
60
Q

What impact does resistance training have on insulin sensitivity?

A

Increases insulin sensitivity

61
Q

What impact does exercise have on the blood vessels?

A

Vasodilation and angiogenesis - increases cardiopulmonary drive

62
Q

What impact does exercise have on mitochondrial biogenesis?

A

Cardiovascular improvements

63
Q

Which cells and cellular components are implicated in exercise?

A

Adipocyte
Myotube
Cardiomyocyte

64
Q

What are the anti-inflammatory effects of exercise on muscle?

A

Release of myokines

65
Q

Which myokines are released from muscles during exercise?

A

FSTL1, IL-6, NDNF, BDNF

LMAP2 (15 decks)

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