Older Persons Health Flashcards

Question

What is the gold standard treatment for OSA?

Answer 1

CPAP - continuous positive airway pressure Mask worn at night Keeps airway open - pneumatic splint keeps airway open V. effective but low compliance = behaviour changes to get them to adhere to this other treatments: - Lose weight, quit smoking, reduce alcohol - Always consider bed partner!

Answer 2

Quit smoking Lose weight Reduce alcohol intake

Answer 3

ICSD-3 (international classification of sleep disorders) diagnostic criteria: Difficulty initiating or maintaining sleep Waking up earlier than desired and resistance going to bed Difficulty sleeping without parent or caregiver Daytime difficulties because of sleep Present for 3 months = chronic 1-3months = short-term insomnia

Answer 4

Continuous elevated stress response across 24hr day - hyper arousal theory of insomnia

Answer 5

Side effects are worse than insomnia itself | Effects short lived and can lead to dependence

Answer 6

CBT - cognitive behavioural therapy: ``` other treatments: Sleep hygiene Relaxation training Paradoxical intention Sleep restriction therapy - retraining people with sleep schedule using short term sleep deprivation ```

Answer 7

New incidence / developing depression

Answer 8

Benzodiazepines = GABA receptor agonists = anxiolytic, hypnotic and sedative effects Zopiclone = 'Z' drug = removes some of the side effects of benzos Risk of dependence, tolerance, hangover side effects (unsteady gait, drowsiness, confusion), associated with road traffic accidents

Answer 9

Unsteady gait = higher fall rates in the elderly = morbidity and mortality More susceptible to cardiorespiratory depression Reduced social funcitoning die to effects on memory and gait disturbance Impaired cognitive dunction - can be wrongly diagnosed as dementia Mood disturbance = aggravation of depression, emotional blunting or anxiety

Answer 10

It can help fall to sleep - but low quality sleep - lack of deep restorative sleep Therefore, when waking in the morning - feel unrested and groggy Zopiclone also has sedative effects = daytime drowsiness

Answer 11

Less stressful evenings Less caffeine - herbal tea or hot chocolate instead of coffee Screen time Exercise during the day = help sleep better at night Reduce alcohol intake

Answer 12

Cold turkey Side effects of stopping - withdrawal symptoms 'How will I sleep?'

Answer 13

Gradually reduce zopiclone dose whilst implementing lifestyle factors Until eventually she can sleep without zopiclone

Answer 14

7 in 10 have a friend who is lonely 92% find it difficult to tell others they are lonely 1M >65 = lonely 8/10 feel judged negatively for feeling lonely 1/3 believe something is wrong with them 13% feel lonely all the time 1/4 know a parent who feels lonely

Answer 15

Social isolation = - Objective measure of the number of contacts that people have - About quantity and not quality of relationships Loneliness = - Subjective feeling about the gap between a person’s desired levels of social contact compared to their actual level of social contact - Perceived quality of the person’s relationships

Answer 16

Quality vs quantity: Possible to have a large social network and still feel lonely so measuring social isolation alone does not account for the quality of relationships or subjective experience of individuals Meaningful solutions: policy makers and researchers need to ensure that solutions are focused on creating and maintaining meaningful relationships that address both social isolation and loneliness Measurement tools: the “gold standard” measure of loneliness includes both direct (Community Life Survey single-time measure) and indirect (UCLA 3 item scale) measures

Answer 17

Social connection (social isolation and loneliness) has impacts on lifestyle. psychological and medical adherence factors Social connection can impact lifestyle factors e.g. physical activity, nutrition, sleep, smoking, risk-taking behaviours Social connection can impact psychological factors e.g. appraisal, stress, depression, resilience, meaning / purpose, hopelessness, safety Social connection can impact medical adherence and compliance e.g. taking medications, following diet plans, executing lifestyle changes These impacts on lifestyle, psychological and medical adherence factors can have an effect on biomarkers e.g. inflammation, BP, gene expression, neuroendocrine functioning, adiposity, and more These can lead to morbidities e.g. CVD, CHD, stroke, diabetes Morbidities can lead to mortality

Answer 18

Cardiovascular system Immune system Neuroendocrine system Cognition Psychological health

Answer 19

1) Stigma – they might find it difficult to admit feeling lonely and may feel that they are a burden on others. 2) Fear of admitting reliance on others and consequences of ageing 3) Fear of external action due to expressing need – e.g. having to move to a nursing or care home. 4) Previous negative experiences, which has impacted their trust and expectation of services 5) Limited awareness of relevant support services

Answer 20

Nutrition Social networks Physical activity Financial well-being

Answer 21

20% - e.g. education, work, housing, finance

Answer 22

Way of enabling frontline healthcare professionals to refer people to a range of local, non-clinical services (e.g. community gardening to housing charities) Way of addressing patient's needs in a holistic manner - often at a lower cost than prescribing medications

Answer 23

GP / frontline worker assesses needs to patient Refers patient to link worker - a person with a background in health and social care who has received special training in social prescribing Link worker signposts appropriate support and activities to patients Patient has multiple meetings with link worker over subsequent months follow up patients

Answer 24

Self care = broad term encompassing anything done to support own health and well being e.g. painkillers, mindfullness app Social prescribing = personalised plan to help needs

Answer 25

- Increased quality of life and mental health | - Reduction in use of NHS services

Answer 26

How well patients are signposted to the right interventions to help their needs Compliance How well the interventions work

Answer 27

Due to heterogenous (mixing together unlikely substances - like oil and water) nature of the programmes, service users, and their outcomes - Without strong evidence to support, hard to commission social prescribing programmes - Risk of seeming like you are trivialising the patient’s issues

Answer 28

Decreased risk of pre-term birth and small size gestational age Decreased risk of T2DM Decreased risk of cardiovascular mortality and all cause mortality Reduced incidence of stroke, hypertension, dyslipidaemia, asthma, and coronary heart disease.

Answer 29

Reduced salivary cortisol Reduced diastolic BP Reduced HR Changes in HRV (heart rate variability)

Answer 30

Reduced feelings of stress Reduced anxiety and depression Improved attention and memory Improved childhood development

Answer 31

Improved social cohesion and interaction Reduced crime Improved work productivity Increased job opportunities

Answer 32

Less suffering from cardiovascular, musculoskeletal, mental health, respiratory, neurological, and digestive diseases Diabetics show better blood sugar ocntrol Associated with better cognitive development in children Decrease in BP / hypertension Outdoor activity improves physical and mental well being more than indoor activities Decrease in anxiety, negative thinking and lowers levels of depression and stress

Answer 33

- hay fever

Answer 34

1. Anti-inflammatory effects = delivers the greatest health benefit in two main ways - by reducing inflammatory visceral fat and releasing anti-inflammatory myokines during muscle contraction 2. Effects at the mitochondrial level = increased charge in the mitochondria during sedentary behaviour increases 'electrochemical charge' across the mitochondrial membrane. 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 3. Weight loss = however, remember the benefits of being active and overweight outweigh the benefits of weight loss while being inactive 4. CVD Coronary artery disease - plaque regression Reduces blood pressure Can prevent re-hospitalisation after an MI 5. Diabetes Aerobic/resistance exercise reduces mortality and increases insulin sensitivity Better HbA1c/blood lipids/waist circumference/BMI

Answer 35

Hypertension | Diabetes

Answer 36

Hypertension Hypercholesterolaemia Diabetes All to help prevent deterioration

Answer 37

30 mins of daily exercise target can be met within a commute 2 days of strength exercises/ week can be met by carrying bags of shopping home

Answer 38

Exercise = significant reduction in systolic and diastolic BP regardless of weight Even after cardiac event, or with established cardiac disease, exercise can help prevent subsequent hospitalisations Aerobic / resistance exercise helps reduce mortality for T1DM and T2DM as it increases insulin sensitivity

Answer 39

It induces adaptations in multiple cells and tissues - changes can be seen in the mitochondria, cardiomyoctes and skeletal muscle myocytes Effect on endothelia to allow for vasodilation Effect on anti-oxidant systems and anti-inflammatory effects systemically

Answer 40

Diet - home deliveries from the supermarket for meals, corner shop for snacks and convo with shopkeeper Batch cooking

Answer 41

She actively engages with NHS (attends annual appointments) Cares about her health - took the initiative to make the appointment Refer to dietician Last cup of tea before 4pm - switch out tea for hot choc Sleep - fix sleep schedule esp diverging due to social isolation Join group activities - helps social isolation and if its cooking/exercise, also helps that Drinking - lower ability to clear, so maybe lessen drinking habits or if she enjoys it, go to the pub and socialise Take up a healthy hobby Go outside in the garden or park

Answer 42

Poor dentition Difficulty swallowing Declining coordination + eyesight Arthritis Low mood Cognitive decline Cancer, heart failure, CKD, hypothyroidism Coeliac disease + IBD can cause malabsorption Medications (diuretics, antihypertensives) Reduced physical activity Dependent on staff if in care homes etc.

Answer 43

- Decreased food intake - Decreased basal metabolic rate, lean body mass, sense of taste/smell - Malnutrition is not a normal part of ageing

Answer 44

- Impaired immune function - Poor wound healing - Osteoporosis - Cognitive impairment - Mood disturbance - Joint + muscle pain - Calcium, vitamin D/C/B12, folate deficiencies - -->Osteomalacia, anaemia, sarcopenia

Answer 45

``` Changed weight/BMI Mental health Social/drug/past medical history Food and fluid diary MUST = malnutrition universal screening tool ```

Answer 46

Doctors, dieticians, occupational therapists, social care, speech and language therapist, dentists

Answer 47

Key points a. Malnutrition is when a diet does not contain the right amount of nutrients, which may be in the form of under-nutrition or over-nutrition. This can result in various health problems which can be mitigated with a multi-disciplinary approach to improve nutrition. b. Sleep plays an important role in disease prevention and health promotion. Long term use of hypnotics can have various negative health effects especially among the elderly population. c. Social prescribing is a personalised solution for an individual’s need, provided with the support of healthcare professionals.

Answer 48

Sarcopenia is loss of lean muscle mass. This is associated with falls, reduced functional ability and is a component of frailty syndrome. Malnutrition is a risk factor for sarcopenia.

Answer 49

Dietitians are employed by the NHS to assess, diagnose and treat dietary and nutritional problem. They work both in the community and in hospitals. ‘Dietitian’ is a legally protected title and all dietitians must be registered with the Health & Care Professions Council.

Answer 50

Around 10% of over 65s in the UK are malnourished, equivalent to over one million people.

Answer 51

* Stress: finances around retirement, support required to or from other family/friends, bereavement, social isolation, loneliness, illness of friends or family, difficulties with activities of daily living, fear of falling. * Mental health problems: Depression and anxiety are common in the elderly population which can result in poor sleep. * Physical Inactivity: Physical activity typically declines with age. Less physical activity with age is associated with poor sleep * Diet: Caffeine use and timing of meals disrupting sleep * Chronic conditions disrupting sleep eg osteoarthritis causing pain * Less of purpose/ structure to the day so naps during the day * Sedative substances such as medication or alcohol to assist with falling asleep but affect quality of the sleep * Physiological changes in sleep as people age: melatonin production decreases, sleep is more fragment, fall asleep and waking from sleep happens earlier in the day . * Reduced exposure to sunlight in house bound and in those with cataracts, limited social activities or in nursing home, disrupting the bodies biological clock.

Answer 52

Impact on daily functioning attributed to sleep loss

Answer 53

Insomnia is diagnosed when difficulty initiating and/or maintaining sleep is present 3 or more nights a week and results in difficulties in the patients waking life. This can manifest across various domains: difficulty concentrating; impacting relationships or mood instability for example. In middle aged adults sleep onset of greater than 30 minutes, or being awake for greater than 30 minutes in total during the desired sleep period is considered clinically significant.

Answer 54

Obstructive Sleep Apnoea (OSA) is a disorder of the upper airway. Essentially the airway becomes obstructed during sleep. This leads to oxygen desaturation, which causes a micro-arousal from sleep. This reinvigorates the nerves and opens the airway. Often you will hear loud snoring, a pause in breathing and then a large gasp of air. This is the airway closing, causing snoring. The airway closes so breathing stops. The airway opens and there is a gasp for air. Firt Line treatment is continuous positive airway pressure (CPAP). The creates a pneumatic splint in the airway to keep it open. It is very effective, however it is difficult to support patients in using it.

Answer 55

Benzodiazepines are GABA receptor agonists and have anxiolytic, hypnotic and sedative effects. - Zopiclone is an example of ‘Z-drug,’ a non- benzodiazepine hypnotic which was developed to overcome some of the adverse side effects of benzodiazepines. - short term management of insomnia under certain circumstances, following lifestyle interventions such as addressing sleep hygiene. - every effort must be made to avoid dependence, keeping to a minimum dose for the shortest possible time due to the risk of dependence. - Tolerance can develop rapidly, resulting in higher doses required to achieve the desired effects. - can have serious ‘hangover’ effects, including drowsiness, unsteady gait, slurred speech, and confusion. Hypnotic use has been associated with accidents such as road traffic accidents too.

Answer 56

- 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, ie. this could be first presentation or aggravation of pre-existing depression, emotional blunting, in between doses increased anxiety.

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Older Persons Health Flashcards

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