Pathophysiology of Ageing Flashcards
What factors are contributing to the ongoing demographic shift of ageing?
Age of the population rising
Fertility rates falling
Life expectancy rising
Why are people living longer?
Increased resources available
Better economic conditions
Improved screening programmes with earlier diagnosis and treatment
Better outcomes following major events (cardiac, stroke, surgery)
What are primary ageing issues?
Issues directly due to ageing
What are secondary ageing issues?
Issues from the issues that are due to ageing
Ageing effects
Beneficial = increased experiential learning Neutral = grey hair, past time preference Detrimental = HTN, decreased reaction time
Theories of ageing
Stochastic - cumulative damage - random Programmed - predetermined programmed to die Homeostasis failure
Ageing and the kidneys
Bloods stay the same due to muscle mass
decreased creatinine
Ageing and the CVS
increased BP
decreased CO
Ageing and the resp system
TLC stays the same
VC dramatically goes down
What is frailty?
Progressive dyshomeostasis - A complex syndrome of increased vulnerability
Definition of dyshomeostasis
An imbalance or other breakdown of a haemostatic system
Examples of “social dyshomeostasis”
Not being able to socialise
Reliant on family/friends
Progressively socially isolated
Frailty symptoms of hyperthyroidism
Depression Cognitive impairment Muscle weakness AF HF angina
Adverse outcomes of frailty
Disability Morbidity Hospitalisation Institutionalisation Death
If there is an external stressor on someone who is managing well, what may happen?
May cause minor illness or injury, but will recover
If there is an external stressor on someone who has severe frailty, what may happen?
Severe negative outcomes leading to dependence
How do we assess for frailty?
Gait speed Timed up and go test Grip strength Clinical frailty scale Electronic frailty index
What is a normal gait speed?
< 0.8 m/s
What is a normal get up and go test?
< 12 s
What are the 36 frailty deficits of eFI?
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
What must be done in decompensated frailty syndromes?
Early intervention
What are the decompensated frailty syndromes?
Falls
Reduced mobility
Delirium
What happens in the GAU?
Rapid functional assessment
What is looked at in a falls assessment?
Falls history including previous falls Gait Balance Weakness Mobility Home hazards Cognition review including delirium identification Osteoporosis risk Assessment for postural hypotension Medication review
Falls interventions
Medication review
Home hazard identification
Strength and balance training
What is used to screen for delirium?
4AT
What is involved in the TIME bundle for delirium?
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)
What 4 AT score is suggestive of delirium?
4
GAU admission criteria
AGE (> 75 y/o generally)
AND admission due to frailty syndrome, typically
- falls
- confusion (particularly suspected delirium)
- rapid functional decline
- advanced frailty
- PD
Exclusions to admission to GAU and therefore should be admitted to another speciality
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)
