Reproduction 7 - Ageing Flashcards
1
Q
What is ageing?
A
Ageing or senescence is the biological process of growing old, with associated changes in physiology and increased susceptibility to disease and increased likelihood of dying.
2
Q
What are the two main theories of why organisms age?
A
- Damage or error theories (the idea that external or environmental forces gradually damage cells and organs, leading to ageing and death)
- Programmed ageing theories (the idea that ageing is genetically programmed to occur with time, and this process of deterioration eventually leads to death)
3
Q
Define population ageing
A
The increasing age of an entire country, due to increasing life spans, and falling fertility rates (mainly due to better public health)
4
Q
What are the consequences of population ageing?
A
- Working life/ retirement balance
- Caring for older people, the sandwich generation
- Extending healthy old age, not just life expectancy
- Inadequate or absent services
- Outdated and ageist beliefs/ assumptions
- Medical system designed for single acute diseases
- Limited accessibility for those with disabilities
5
Q
What is life expectancy, and how has it been changing?
A
- Life expectancy is a statistical measure of the number of years a person can expect to live.
- Life expectancy has been rising continuously for many years; for a baby girl born today it is around 83 years, compared with 80 years for a baby girl born in 1998 (79 and 75 for a baby boy).
- Life expectancy has not plateaued
6
Q
How is disease different in older people?
A
Older people are more likely to have an atypical or non-specific presentation of disease
7
Q
Define non-specific presentation
A
A non-specific presentation means presentations where the underlying pathology is not immediately obvious, or clearly linked to the presentation.
8
Q
What do older people seek medical attention for?
A
- Falls, delirium and reduced mobility are all very common reasons for older people seeking medical attention
- Can be due to stroke, myocardial infarction, infections and changes to medications.
9
Q
What are the giants of geriatric medicine?
A
- Immobility
- Intellectual impairment
- Instability
- Incontinence
- Iatrogenic problems.
10
Q
What are iatrogenic problems?
A
- Iatrogenic problems are illnesses caused by receiving healthcare treatments and are more common in older people.
- They include mistakes in providing care, and known complications of treatment.
11
Q
Define fraility, and give an example
A
- Loss of biological reserve across multiple organ systems, leading to vulnerability to physiological decompensation and functional decline after a stressor event
- Eg. young people with pneumonia can recover at home with antibiotics, while a frail older person may end up in hospital due to delirium and reduced mobility
12
Q
What are the challenges of medicine for the elderly?
A
- Atypical and non-specific presentations can lead to delays in treatment
- Older people often present with multiple problems which need to be managed simultaneously (hence MDT needed)
- Changes in pharmacokinetics and pharmacodynamics can make drug treatments in older people more likely to cause harm (doctors must think carefully before prescribing)
- Many drug trials have low numbers of older people, so treatment evidence is extrapolated from younger people
13
Q
Describe the ageing brain
A
- CT and MRI show increased CSF, enlarged ventricles and gaps between gyri
- Loss of connections between neurons
- 50% normal elderly people show some degree of white matter changes
- Decreases in weight at a rate of 2-3% per decade from 40-50 years
14
Q
Why have rates of diagnosis of dementia been low historically?
A
- Misinterpretation (believing it is normal for older people to have poor memory)
- Fatalism (can’t do anything about it so no point diagnosing it)
- Social isolation (so no one notices any problems)
15
Q
What proportion of people with dementia have a diagnosis?
A
Around 70%
16
Q
What is dementia?
A
- A chronic, progressive, degenerative, irreversible disease which causes a decline in all cognitive functions.
- The most common types of dementia (Alzheimer’s and vascular) often start with memory problems, but over time will include all cognitive functions.
- Dementia is more common with increasing age.
17
Q
Define mild cognitive impairment
A
A specific term used to refer to people who have mild problems which do not interfere with their day-to-day life and don’t meet the diagnostic criteria for dementia.
18
Q
What is delirium?
A
- An acute episode of confusion, usually with a clear precipitant such as infection or medication changes.
- Delirium usually resolves, but can leave some people with residual problems (ie dementia).
- Delirium is much more common in people who already have dementia.
19
Q
List common forms of cognitive assessment
A
- Abbreviated Mental Test (AMT) and clock drawing tests are brief screening tests for cognitive impairment
- Montreal Cognitive Assessment (MOCA) is a more detailed examination in wide general use
- Mini Mental State Examination (MMSE) is a slightly outdated assessment which is less widely used than previously.
- Confusion Assessment Method (CAM) and 4AT are tools to help distinguish between delirium and dementia
- Addenbrookes cognitive examination (ACE) is diagnostic
20
Q
List the theories of programmed ageing
A
- Genetic life span theory
- Genetic predisposition theory
- Telomere theory
- Specific system theories (neuroendocrine theory)
21
Q
List theories of damage or error
A
- Wear and tear theory
- Rate of living theory
- Waste product
accumulation theory - Cross-linking theory
- Free radical theory
- Autoimmune theory
- Error theories
- Order to disorder
theory
22
Q
What are the issues of multimorbidity?
A
- Two or more chronic conditions
- Conditions impact on one another
- Treatment for one condition may impact on another
- Negative impacts (worse quality of life, more likely to be depressed, increased functional impairment, burden of treatment, polypharmacy)
23
Q
Why do older people take more drugs?
A
- Multimorbidity
- Guidelines (do not take into account comorbidities)
- Undetected non-adherence (prescribing another drug without knowing the patient isn’t taking their medication)
- Infrequent review
- Poor communication
24
Q
List the normal cognitive changes in older people
A
Seen at 70 or older - Processing speed slows - Working memory slightly reduced - Simple attention ability preserved, but reduction in divided attention - Executive functions generally reduced - No change in nondeclarative/ implicit memory - No change in visuospatial abilities - No overall change in language (some reduction in verbal fluency) - Reduction in problem solving ability
25
Describe the changing nature of the older population
- Increasing numbers of BAME older people
Increasing education of older people
- Reduction in poverty
- More people are working for longer
- More complex/ nuanced retirement process
26
Compare chronological and biological age
- Chronological age is the age from the time you were born
- Biological age considers lifestyle and the effects on age of the body
- Not everyone ages at the same rate
27
How can ageing be prevented?
- Exercise
- Healthy diet
- Drink in moderation
28
How has retirement age changed?
- Previously 65 for men (life expectancy was 65 in the 1920s)
- Age has now increased
- Dependency ratio (number of people who are dependent to the number of people who are working age)
29
Compare healthy life expectancy and life expectancy
- Life expectancy is how long somebody is expected to live
| - Healthy life expectancy is life expectancy without any improvement in the age at which morbidities develop
30
What is the sandwich generation?
- Generation looking after children under 16, whilst caring for an older relative
- Mostly women
- Most of these people are in paid work
31
List implications of increased life expectancy for health care services
- Increasing demand for primary, secondary and tertiary health care
- Increasing complexity
- Navigating the health and social care divide
32
Describe development of frailty
- Genetic factors and environmental factors lead to cumulative molecular and cellular damage
- Reduced physiological reserve
- Physical activity and nutritional factors lead to frailty
- Therefore, stressor events lead to falls, delirium and fluctuating disability
33
How could frailty be treated?
- Exercise
- Nutrition
- Drugs
- Prevention is better than cure
34
List the non-specific presentations
- Falls
- Reduced mobility
- Recurrent infections
- Confusion
- Weight loss
- Not coping
- Iatrogenic harm
35
Give examples of atypical disease presentations in elderly people
Acute coronary syndrome
- Less likely to have chest pain
- More likely to have shortness of breath
PE
- Less likely to have pleuritic chest pain
- Less likely to have haemoptysis
- More likely to have other symptoms
- More likely to have syncope
36
What is polypharmacy associated with?
- Falls
- Increased length of stay
- Delirium
- Mortality
40% prescriptions inappropriate
37
Why are older people at increased risk of adverse drug reactions?
- Reduced physiological reserve
- Impaired compensation mechanisms
- Comorbidities
- Polypharmacy
- Cognitive impairment
38
List common iatrogenic harm affecting older people
- Adverse reactions to medication
- Nosocomial conditions (infections, pressure sores, constipattion, delirium, malnutrition, loss of muscle mass or deconditioning)
- Falls
- Psychological/ cognitive damage
39
How is comprehensive geriatric assessment beneficial?
- Reduce falls
- Most benefit in mild or moderate frailty
- Reduces inpatient mortality
- Reduces functional and cognitive decline
- Reduces admission to institutional care
40
What is a CGA?
```
Multidisciplinary assessment
- Medical
- Functional
- Social
- Psychological/psychiatric
Problem list is created
Plan
```
41
How is rehabilitation used?
- Aim is to restore or improve functionality
- Multidisciplinary
- Rehabilitation alongside acute illness to prevent deconditioning
- Prehabilitation (increasing fitness before surfery)
42
List advantages of MOCA
- Covers a variety of domains of cognitive function
- Brief to administer (10 mins)
- Validated in a range of populations
- Available in translated versions
- Widely used (can be used for comparison)
43
List problems with MOCA
- Education level will affect results
- Language level will affect results
- Floor and ceiling effects (educated people with dementia may score well)
- Can be poorly administered
- Possibly practice/ coaching effects
44
List the problems with cognitive assessments
- Hearing and visual impairment may limit testing
- Physical problems may limit testing
- Most assume numeracy and literacy
- Most assume some basic cultural knowledge
- Depression can masquerade as dementia
- Not valid in acute illness
- Normal cognitive changes (slower processing speed, slower reaction times) may affect administration
- Must be interpreted in context
