RDA Ageing

Question 1

6. What are the main causes and theories of ageing

Answer 1

1. Programmed ageing
   a. Genetically programmed ageing
   b. Hayflick limit - count how many times to divide and then stop
   c. Telomerase accounts for the limit
   d. Limit allows maturity of cells and prevent cancer
   e. Endocrine - insulin and IGF can keep track of time too
   
   2. Damage or error theories
      a. Free radicals made in body by mitochondria
      b. Damage mitochondria and mitochondrial DNA which doesn’t have very good repair systems
      c. Chronic inflammatory conditions -> age faster
      d. Smoking -> inc free radicals -> age faster
   3. People age at diff rates (chronological vs biological)
   4. Lots of theories, probably a combination

Question 2

7. What are the challenges of ageing affecting society

Answer 2

1. Working life/retirement balance
   
   2. Caring for older people
   3. Extending health old age not just life expectancy
   4. Inadequate or absent services
   5. Outdated and ageist beliefs
   6. Medical system designed for single acute diseases
   7. Limited accessibility for those with disabilities

Question 3

3. What are the implications for health care services

Answer 3

1. Cuts to NHS and social care
   
   2. Dementia tax - if you have assets more than 23,000 pounds you have to pay for your care
   3. Unsustainable system
   4. More people falling through the gaps due to social care reduction
   5. Delayed transfer of care from hospitals

Question 4

what is frailty

Answer 4

a. Loss of biological reserve across multiple organ systems leading to vulnerability to physiological decompensation and functional decline after a stressor event

Question 5

2. What is the difficulty in managing disease in older people

Answer 5

1. Multimorbitidy
   a. Worse qol, depression
   b. Burden of treatment
   c. Inc functional impairment
   
   2. Polypharmacy
      a. More drugs now bc guidelines
      b. Undetected non-adherence
   3. Iatrogenic harm
      a. Adverse reactions to medications
      b. Nosocomial conditions
      c. Falls
      d. Psychological/cognitive damage
   4. Comprehensive geriatric assessment
   5. Rehabilitation

Question 6

1. What are the physical changes of the ageing brain

Answer 6

1. Sulci are much more prominent
   
   2. Ventricles more prominent
   3. Lose grey and white matter
      No loss in neurones, loss in connections and neurones shrink

Question 7

2. What are the cognitive changes with the ageing brain

Answer 7

1. Processing speed slows
   
   2. Working memory slightly reduced
   3. Simple attention ability preserved but reduction in divided attention (multitask)
   4. Executive functions generally reduced (plan, organise, monitor something, adaptable, flexible)
   5. No change in nondeclarative memory (how to do tasks, get to places etc -> not facts)
   6. No change in visuospatial abilities
   7. No overall change in language (maybe some reduction in verbal fluency)
   8. No change in short-term memory

Question 8

3. What is dementia

Answer 8

1. Decline in all cognitive functions not just memory

2. Progressive, degenerative, irreversible

Question 9

4. Diff between dementia and delirium?

Answer 9

1. Delirium is acute, fluctuating, usually reversible and main problem and alertness and attention
   
   2. Dementia is chronic, gradual progression, no change in conscious level, irreversible

Question 10

1. What are the key issues with the cognitive assessment of older adults

Answer 10

1. Education level
   
   2. Language level
   3. Floor and ceiling effect
   4. Poorly administered
   5. Practice/coaching effects
   6. Must be interpreted in context

Question 11

2. What is the social and MDT management of the ageing population

Answer 11

1. Medical
   
   2. Functional
   3. Social
   4. Psychological/psychiatric
   5. Problem list
   6. Plan