Pathophysiology of Ageing

Question 1

Why are people living longer?

Answer 1

Increase resources
Better economic conditions
improved screening programmes with earlier diagnosis and treatment
better outcomes following major events
more people surviving a major event but more co-morbidities

Question 2

Does elderly = frailty?

Answer 2

no

Question 3

how are old people different?

Answer 3

changes not due to ageing - selective survival, cohort effects
primary ageing
secondary ageing

Question 4

ageing: beneficial

Answer 4

increased experiential learning

Question 5

ageing: neutral

Answer 5

grey hair
pastime preference
these do not kill you

Question 6

ageing: detrimental

Answer 6

hypertension

decreased reaction time

Question 7

stochastic theory of ageing

Answer 7

there is random cumulative damage. For example, there is degeneration of joints over time just because of microtrauma and this gradually gets worse. Theoretically you could prevent this and stay alive.

Question 8

programmed theory of ageing

Answer 8

we are predetermined as a result of changes in gene expression during various stages. We are programmed to die it is not clear what the trigger is but by getting out of the way of using resources an evolutionary advantage is gained

Question 9

physiology of ageing: kidney

Answer 9

kidneys get worse and creatinine clearance decreases but as we are also losing muscle serum creatinine remains the same

Question 10

physiology of ageing: cardiovascular

Answer 10

Systolic BP goes up, diastolic goes up then down. Diastolic is what keeps you up right so important to consider when giving antihypertensives. i.e. lower risk of MI but increase risk of falling and breaking hip. Cardiac output decreases over time.

Question 11

physiology of ageing: respiratory

Answer 11

TLC = TLC
VC decreases
IRV decreases
RV increases
ERV decreases
FRC increases

Question 12

presentation of hyperthyroidism in the frail

Answer 12

o Depression
o Cognitive impairment
o Muscle weakness
o AF
o Angina
o Less energetic

Question 13

practical implications o learning about ageing

Answer 13

• 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
• Relatively little evidence of drug efficacy and safety for patients 80+
• Multiple medications – drug-drug interactions, adverse drug reactions