Pathology of Ageing Flashcards
What are some reasons for people getting older and living longer?
Increased resources available
Better economic conditions
Improved screening programmes with earlier diagnosis and treatment
Better outcomes following major events e.g. MI, stroke
What are the consequences of people getting older?
More people survive a major event
More people have several co-morbidities
What are examples of causes of changes, not due to ageing?
Selective survival e.g. genetics, lifestyle
Cohort effects
What can changes with ageing be?
Beneficial
Neutral
Detrimental
What are the theories of ageing?
Stochastic - cumulative damage, random
Programmed - predetermined e.g. changes in gene expression
Homeostasis failure
What does the physiology of ageing affect?
Virtually every organ/system (affects organ systems differently in different people)
In ageing, what is there marked inter-individual variability in?
Development and magnitude of changes
What does inter-individuality increase with?
Age
What does degradation of the body systems mean in relation to homeostasis?
Homeostasis becomes more difficult (dyshomeostasis)
What happens to serum creatinine with ageing?
Serum creatinine clearance reduces
What happens to blood pressure with ageing?
Systolic BP tends to increase while diastolic BP tends to decrease
What is frailty?
Effectively progressive dyshomeostasis
What effect does impaired function of any body system have on homeostasis?
Makes it more difficult for the body to maintain a steady state
What is the effect of cold stress on frail people?
Frail people will be less able to vasoconstrict their arteries and therefore less able to compensate for cold stress,, and so more vulnerable to hypothermia
What is the effect of heat stress on frail people?
Less able to remove clothes as easily as people who aren’t frail, sweat less, smaller increase in CO and less blood flow redistribution so less able to compensate
What is social dyshomeostasis?
Difficulty and dyshomeostasis caused by environmental insults - not only biomedical
What are some common causes of social dyshomeostasis?
Death of a spouse
Children moved away
Son/daughter who cares for the frail person going on holiday
etc.
What is the classic presentation of hyperthyroidism vs the presentation of hyperthyroidism in a frail person?
Classic Presentation
- tremor
- anxiety
- weight loss
- diarrhoea
Person with frailty
- depression
- cognitive impairment
- muscle weakness
- atrial fibrillation
- heart failure
- angina
What has resulted in the evidence gap for older/frail people?
Many conditions are more common in older people but there are fewer trials of medication in this age group (people excluded from trial based on age) - evidence gap
What are the practical implications of people living longer?
Increasing number of older people with multiple co-existing medical conditions
Increased inter-individual variability in organ function and homeostasis reserve
Different presenting symptoms and signs
Relatively little evidence of drug efficacy and safety for patients 80+
Multiple medications carries risks of drug-drug interactions and adverse drug reactions
