The Elderly Patient

Question 1

What are the features of intrinsic aging?

Answer 1

-Chronological ageing
-Biochemical degenerative process
-Cortisol and hormone levels
-DNA damage
-Telomere shortening
-Oxidative stress

Question 2

What are the features of extrinsic ageing?

Answer 2

-Biochemical process
-Environmental
-Mechanical
-Lifestyle
-Behaviour

Question 3

What changes in the skin are associated with ageing?

Answer 3

-Progressive structural and functional degeneration:
-atrophy of epidermis
-destruction to dermal-epidermal junction
-dermis thickness decreases (collagen fragmentation and elastin degradation)

-Prone to conditions and diseases

Question 4

What respiratory changes are associated with ageing?

Answer 4

-Structure of chest wall:
-chest wall compliance
-lung volume: RV&FRC increase, VC decrease

-Structure of lungs
-senile hyperinflation
-lung compliance

-Gas exchange reduced (reduced SA)
-Infection susceptibility

Question 5

What cardiovascular changes are associated with ageing?

Answer 5

-Myocardial structural change:
- Ventricular hypertrophy
- Sympathetic innervation
- Aortic sclerosis

-Myocardial functional change:
- Diastolic dysfunction
- Decreased CO
- Decreased maximal HR
- Increased cardiac workload
- Baroreceptor response

Question 6

What electrophysiological changes happen to the heart?

Answer 6

-SA node atrophy
-Action potential prolongation

Question 7

What vascular structure changes happen to the heart?

Answer 7

• Large arteries dilate
• All arterial walls thicken

Question 8

What vascular function changes happen to the heart?

Answer 8

• Decrease arterial compliance
• Endothelial vasodilation is impaired

Question 9

What renal changes are associated with ageing?

Answer 9

• Decrease in volume and weight of kidneys
• Decline in total number of glomeruli per kidney
• Pharmacology changes (clearance of drugs)
• Urinary incontinence
• Prostatic hyperplasia

Question 10

What changes in the GI tract are associated with ageing?

Answer 10

Oesophagus:
- Decrease peristalsis
- Delayed transit time
- Decreased relaxation of lower sphincter on swallowing

Stomach:
- Atrophic gastritis

Colon:
- Decreased intestinal motility
- Diverticulosis

Question 11

What neurological changes are associated with ageing?

Answer 11

• Brain volume decreases as some parts shrink
• Neuronal density reduces by almost 1/3 by age 80
• Development of dementia:
  
  • Alzheimer’s, Vascular, Fronto-temporal, Lewy body

Question 12

What does ageing have an impact on prescribing medication?

Answer 12

There’s reduced renal and liver excretion of drugs

Question 13

What tool is used in Leicester to support medication reviews?

Answer 13

STOPP START Tool

Question 14

What questions should be asked/considered when prescribing older people medication?

Answer 14

• Does it need prescribing?
• Alternative strategy?
• If not, lowest possible dose?
• Does drug interact with any other medications?
• If interactions, which drug is most important?
• More suitable alternative?

Question 15

What score is used to identify patients at nutritional risk?

Answer 15

MUST - 5 steps
1) BMI
2) Weight loss
3) acute disease effect
4) overall risk of malnutrition
5) management guidelines

Question 16

What is malnutrition?

Answer 16

State of nutrition in which a deficiency or excess of energy, protein and other nutrients causes measurable adverse effects on tissue/body form and function, and clinical outcome.

Question 17

What are some consequences of malnutrition?

Answer 17

• Impaired immune response
• Reduced muscle strength
• Inactivity
• Loss of temperature regulation
• Impaired wound healing
• Impaired psycho-social function

Question 18

What are the components of compassionate care?

Answer 18

Patient centred approach:
- patients wants/needs
- patients beliefs?
- dignity
- work in accordance with best interests

Social needs?
Hospital or home care?

Question 19

What plans for the future can be considered in compassionate care?

Answer 19

• Advance care planning
• Emergency health care plans
• ReSPECT forms
• Involving family/carers/friends

Question 20

What’s the definition of Frailty?

Answer 20

Clinically recognisable state of increased vulnerability resulting from aging associated decline in reserve function and function across multiple physiologic systems such that the ability to cope with everyday or acute stressors is comprised.

Question 21

What’s the phenotypic definition of Frailty?

Answer 21

Low grip strength, low energy, slowed walking speed, low physical activity, and/or unintentional weight loss

Question 22

What indicators can clinicians use to detect frailty?

Answer 22

Clinical frailty scale:

Patients scored from 1-9, 1 being very fit, 9 being terminally ill