Preventative Approaches to Ageing I Flashcards
What are the effects of more older people on health and social care?
Increased prevalence of age-related conditions
Increased demand for health and social care - increased cost
What is healthy ageing?
Maintaining functional ability for wellbeing in old age
What is functional ability?
Having capabilities that enable people to be and do what they have reason to value
Capabilities vary between individuals and cultures
What do functional abilities typically include?
Meeting basic needs Learning and making decisions Mobility Relationships Contributing to society
What are the stages of the life-course approach taken to decrease frailty and dementia risk?
Whole life - address inequalities
Mid-late life - prevent disease, early identification
Late/very late life - maintain health and function
How can inequality be addressed?
Population-level interventions - across lifespan - e.g. opportunities, education, accessible healthcare
Which inequalities are specific to later life?
Ageism
Fewer psychological therapy referrals for depression
Name 6 key risk factors in mid-life
Physical activity Diet Weight Smoking Alcohol Leisure, cognitive, social activities
How does mid-late life physical activity affect late-life health?
Decreases mortality, dementia, disability, CVD, T2D
How does mid-late life diet affect late-life health?
Decreases CVD
How does mid-late life weight affect late-life health?
Obesity linked to CVD, T2D, arthritis, depression
How does mid-late life smoking affect late-life health?
Decreases motility
Increases dementia, mortality, CVD, T2D, some cancers
How do mid-late life leisure, cognitive, social activities affect late-life health?
May reduce cognitive decline
Name 5 key interventions in mid-late life
Mental health support groups Tobacco and alcohol taxation Screening Exercise groups Social prescribing
Why is a person-centred approach to ageing needed?
Ageing is diverse experience
Variation in abilities and experiences of old people
What is Fried’s measure of frailty?
Physiological measure - does not consider mental health and support mechanisms
Frail if >=3 traits
Can frailty be reversible?
Yes
What are the frailty trait’s in Fried’s measure?
Slow gait
Weakness
Weight loss
Low activity levels
What is the main method to prevent frailty progression in older people?
Exercise
What is the effect of exercise on physical abilities in prefrail individuals?
Improves balance, muscle strength
No effect on self-reported functioning, gait speed
What is the best form of exercise to decrease falling risk in older people?
Strength and balance exercises
Are group or individual exercise sessions most effective for older people?
Combined - group and individual
Which form of exercise is best for the very frail and why?
Individually-tailored approach
To decrease falling risk during exercise
Name 2 interventions that decrease falling risk in older people
Tai chi
Home safety assessment and modification
What are the reasons that malnutrition is common in the elderly?
Lifelong eating habits/views
Physical frailty and lack of time - unable to cook
Lack of motivation/confidence - could be due to bereavement
Which dietary interventions are useful in older people?
Dietary education - change behaviours
Multi-nutrient supplements - increase handgrip strength, decrease chair rise time
Mediterranean diet - decreases frailty risk
Which mental health conditions are common amongst the elderly?
Anxiety
Depression
What is the link between frailty and depression?
Frail more likely to be depressed
Depression increases frailty risk
How do medical professional responses to depression and anxiety differ in older patients?
Fewer psychological service referrals
Increased antidepressant and sleeping tablet prescriptions
Why do medical professional responses to depression and anxiety differ in older patients?
Older people and medical professionals prioritise physical over mental health
Older people prefer self-management - do not recognise mental illness or seek help
Stereotyping of older people - assuming they do not want mental health support
What is the most effective therapy for depression in frail older people?
Problem-solving therapy
How does loneliness effect health outcomes in older people?
Increases risk of mortality, depression, CVD
What is an intervention for loneliness in older patients?
Shared interest groups
Marketing important - many do not like idea of groups for ‘lonely old people’
Which intervention reduced cognitive decline in older people and what is a limitation of this?
Intensive long-term diet, exercise, vascular risk monitoring, cognitive training programme
Intensive interventions hard to maintain - not practical for widespread use
How does smoking in old age affect frailty risk and how can this be altered?
Increases frailty risk - mainly via COPD
Stopping smoking in old age can decrease frailty risk
How is alcohol consumption in old age linked to frailty risk and what is a possible limitation of this?
Increases frailty risk
No evidence that decreasing alcohol decreases frailty risk
Probably reverse causality - reducing alcohol as become unwell
What are the challenges in later life health promotion?
Health promotion in late life and prefrailty recent idea - lack of policy and evidence
Different goals - different old people already have different long-term conditions
Engaging elderly in health promotion
Addressing multiple interacting risk factors - most services targeted to single conditions
Why is it difficult to engage the elderly in health promotion and how could these issues be overcome?
Not motivated by increasing lifespan as feel not possible - phrase interventions as improving independence and wellbeing
Unaware of benefits of making changes
Difficult to reach - could access via GP
What did a quantitative study of health promotion for prefrail older people find their goals and motivating factors are?
Maintenance more important than change
Fear of dependency, memory problems, care homes
‘Teachable moments’ - triggers for change - e.g. health scare
What did a quantitative study of health promotion for prefrail older people suggest would be a good approach?
Multidomain interventions - e.g. HomeHealth
Sessions with social worker - address mood, socialising, mobility, nutrition
What are the aims of long-term condition management?
Secondary prevention - e.g. falls, stroke
Rehabilitation
Self-management
Avoid polypharmacy - linked to increased frailty risk
Which mid-late life risk factors are key modifiable factors to reduce the risk of late-life negative outcomes?
Physical activity
Smoking
