Pathophysiology of Ageing

Question 1

What factors are contributing to the ongoing demographic shift of ageing?

Answer 1

Age of the population rising
Fertility rates falling
Life expectancy rising

Question 2

Why are people living longer?

Answer 2

Increased resources available
Better economic conditions
Improved screening programmes with earlier diagnosis and treatment
Better outcomes following major events (cardiac, stroke, surgery)

Question 3

What are primary ageing issues?

Answer 3

Issues directly due to ageing

Question 4

What are secondary ageing issues?

Answer 4

Issues from the issues that are due to ageing

Question 5

Ageing effects

Answer 5

Beneficial = increased experiential learning
Neutral = grey hair, past time preference
Detrimental = HTN, decreased reaction time

Question 6

Theories of ageing

Answer 6

Stochastic 
- cumulative damage 
- random 
Programmed 
- predetermined programmed to die 
Homeostasis failure

Question 7

Ageing and the kidneys

Answer 7

Bloods stay the same due to muscle mass

decreased creatinine

Question 8

Ageing and the CVS

Answer 8

increased BP

decreased CO

Question 9

Ageing and the resp system

Answer 9

TLC stays the same

VC dramatically goes down

Question 10

What is frailty?

Answer 10

Progressive dyshomeostasis - A complex syndrome of increased vulnerability

Question 11

Definition of dyshomeostasis

Answer 11

An imbalance or other breakdown of a haemostatic system

Question 12

Examples of “social dyshomeostasis”

Answer 12

Not being able to socialise
Reliant on family/friends
Progressively socially isolated

Question 13

Frailty symptoms of hyperthyroidism

Answer 13

Depression 
Cognitive impairment 
Muscle weakness
AF
HF
angina

Question 14

Adverse outcomes of frailty

Answer 14

Disability 
Morbidity 
Hospitalisation 
Institutionalisation 
Death

Question 15

If there is an external stressor on someone who is managing well, what may happen?

Answer 15

May cause minor illness or injury, but will recover

Question 16

If there is an external stressor on someone who has severe frailty, what may happen?

Answer 16

Severe negative outcomes leading to dependence

Question 17

How do we assess for frailty?

Answer 17

Gait speed
Timed up and go test 
Grip strength 
Clinical frailty scale
Electronic frailty index

Question 18

What is a normal gait speed?

Answer 18

< 0.8 m/s

Question 19

What is a normal get up and go test?

Answer 19

< 12 s

Question 20

What are the 36 frailty deficits of eFI?

Answer 20

20 disease states
8 symptoms and signs 
- polypharmacy 
- dizziness
- SOB
- Falls
- sleep disturbance
- urinary incontinence
- memory and cognitive problems 
- weight loss and anorexia 
1 abnormal lab value
- anaemia and haematinic deficiency 
7 disabilities
- visual 
- hearing
- housebound
- social vulnerability 
- requirement for care
- mobility and transfer problems 
- activity limitation

Question 21

What must be done in decompensated frailty syndromes?

Answer 21

Early intervention

Question 22

What are the decompensated frailty syndromes?

Answer 22

Falls
Reduced mobility
Delirium

Question 23

What happens in the GAU?

Answer 23

Rapid functional assessment

Question 24

What is looked at in a falls assessment?

Answer 24

Falls history including previous falls 
Gait
Balance
Weakness
Mobility 
Home hazards 
Cognition review including delirium identification 
Osteoporosis risk 
Assessment for postural hypotension 
Medication review

Question 25

Falls interventions

Answer 25

Medication review
Home hazard identification
Strength and balance training

Question 26

What is used to screen for delirium?

Answer 26

4AT

Question 27

What is involved in the TIME bundle for delirium?

Answer 27

T - think exclude and treat possible triggers
I - investigate and intervene to correct underlying causes
M - management plan
E - engage and explore (capacity, next of kin etc)

Question 28

What 4 AT score is suggestive of delirium?

Answer 28

4

Question 29

GAU admission criteria

Answer 29

AGE (> 75 y/o generally)
AND admission due to frailty syndrome, typically
- falls
- confusion (particularly suspected delirium)
- rapid functional decline
- advanced frailty
- PD

Question 30

Exclusions to admission to GAU and therefore should be admitted to another speciality

Answer 30

Chest pain  
Acute breathlessness 
GI bleeding / dysphagia 
Stroke or suspected 
Fractures (other than uncomplicated pubic ramus, neck of humerus or wrist fractures or stable thoracolumbar vertebral osteoporotic collapse)