Pathophysiology of Ageing

Question 1

Why are people getting older?

Answer 1

• More resources
• Better economic conditions
• Improved screening and diagnosis, and treatment
• Better outcomes from major events
  
  • Stroke, Cardiac, Surgery
    
    • However, some may be left with morbidities.

Question 2

How are old people different?

Answer 2

Selective survival - particularly true of less men in the WW2 generation.

Cohort effect

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Question 3

What is the correlation between diagnosis of conditions and age?

Answer 3

With increased age, there is an increased likelihood of being diagnosed with diseases.

Particularly, MI, HT, DM, Stroke, Dementia, MSK diseases etc.

Question 4

What are the beneficial, neutral and detrimental effects of ageing?

Answer 4

Beneficial

• Increased experiential learning

Neutral

• Grey hair
• Pastime preference

Detrimental

• Hypertension, increased reaction time

Remember that its not all bad.

???

Question 5

What are the theories of ageing?

Answer 5

Various theories.

Stochastic

• Cumulative damage - such as the impact on joints, hair follicles, etc.
• Random - can effect anywhere.

Programmed

• Predetermined
• Changes in gene expression during various stages.
• In terms of evolution, “free up space” for future generations.

Likely that ageing is a cumulation of both of these factors.

Homeostasis failure results from this. - As organ systems get worse.

• Affecting virtually every organ/system.

SLIDE 16

Question 6

How does kidney function change through ageing?

Answer 6

Creatinine levels in blood stay same due to loss of muscle mass. >>>> see slide 18 for figures

Question 7

How is the CVS affected through age?

Answer 7

• Systolic goes up
• Diastolic goes up and then decreases with elderly age
• Diastolic keeps ya upright

Question 8

How does ageing impact the respiratory system?

Answer 8

• Lung volumes change
  
  • TLC stays the same
  • But VC goes down (useful bit)

Question 9

What is dyshomeostasis?

Answer 9

Impaired function of an organ system, whereby physiologically homeostasis cannot be maintained.

(results in frailty - effectively progressive dyshomeostasis)

Question 10

What is social dyshomeostasis?

Answer 10

Difficulty caused by environmental insults not only bio-medical

• Rely on people more
• World get’s smaller
• More and more socially isolated
• May need to care for yourself
• Different ability to compensate
• Slipping slowly towards the gentle embrace of death

Question 11

What is the evidence gap?

Answer 11

• Many conditions more common in older people
• Few trials of medications in older people

Question 12

What are the practical implications of frailty?

Answer 12

• Increasing number of older people with multiple co-existing medical conditions
• Increased inter-individual variability in organ function and homeostatic reserve
• Different presenting symptoms and signs
  
  • Presentation of different “illnesses” can be v similar

Question 13

What is the drug efficacy for patients 80+?

Answer 13

• Relatively little evidence of drug efficacy and safety for patients 80+
  
  • Pre-marketing development still largely involving young and middle age pts with fewer co-morbidities