Pathology of Ageing

Question 1

What are some reasons for people getting older and living longer?

Answer 1

Increased resources available
Better economic conditions
Improved screening programmes with earlier diagnosis and treatment
Better outcomes following major events e.g. MI, stroke

Question 2

What are the consequences of people getting older?

Answer 2

More people survive a major event

More people have several co-morbidities

Question 3

What are examples of causes of changes, not due to ageing?

Answer 3

Selective survival e.g. genetics, lifestyle

Cohort effects

Question 4

What can changes with ageing be?

Answer 4

Beneficial
Neutral
Detrimental

Question 5

What are the theories of ageing?

Answer 5

Stochastic - cumulative damage, random
Programmed - predetermined e.g. changes in gene expression
Homeostasis failure

Question 6

What does the physiology of ageing affect?

Answer 6

Virtually every organ/system (affects organ systems differently in different people)

Question 7

In ageing, what is there marked inter-individual variability in?

Answer 7

Development and magnitude of changes

Question 8

What does inter-individuality increase with?

Answer 8

Age

Question 9

What does degradation of the body systems mean in relation to homeostasis?

Answer 9

Homeostasis becomes more difficult (dyshomeostasis)

Question 10

What happens to serum creatinine with ageing?

Answer 10

Serum creatinine clearance reduces

Question 11

What happens to blood pressure with ageing?

Answer 11

Systolic BP tends to increase while diastolic BP tends to decrease

Question 12

What is frailty?

Answer 12

Effectively progressive dyshomeostasis

Question 13

What effect does impaired function of any body system have on homeostasis?

Answer 13

Makes it more difficult for the body to maintain a steady state

Question 14

What is the effect of cold stress on frail people?

Answer 14

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

Question 15

What is the effect of heat stress on frail people?

Answer 15

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

Question 16

What is social dyshomeostasis?

Answer 16

Difficulty and dyshomeostasis caused by environmental insults - not only biomedical

Question 17

What are some common causes of social dyshomeostasis?

Answer 17

Death of a spouse
Children moved away
Son/daughter who cares for the frail person going on holiday
etc.

Question 18

What is the classic presentation of hyperthyroidism vs the presentation of hyperthyroidism in a frail person?

Answer 18

Classic Presentation

• tremor
• anxiety
• weight loss
• diarrhoea

Person with frailty

• depression
• cognitive impairment
• muscle weakness
• atrial fibrillation
• heart failure
• angina

Question 19

What has resulted in the evidence gap for older/frail people?

Answer 19

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

Question 20

What are the practical implications of people living longer?

Answer 20

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