Tutorial 4: Ageing and Multi-Morbidity

Question 1

What happens to homeostatic reserve in later life?

Answer 1

Decreases

Question 2

What is ageism?

Answer 2

A process of systematic stereotyping and discrimination against people because of their age.

Question 3

Demographics of old people

Answer 3

2000 - 11% of population over 60
2050 - 22% of population over 60
2000-2050: 4-fold increase in population over 80
By 2050 80% of over 60s will live in lower or middle income countries
From 2000-2050 number of people unable to care for themselves will increase 4-fold

Question 4

What features make up a population demographics charts?

Answer 4

X-Axis: Percentage
Y-Axis: Age
2000 looks like a labia majora
2050 looks like a penis
Less young people
More old people

Question 5

Why are we undergoing a change in population demographics?

Answer 5

Low levels of fertility

Low levels of mortality

Question 6

By 2050 what significant event is to have happened?

Answer 6

Number of old people (>60) is to have surpassed the number of young people (<15)

Question 7

What is the fastest growing age group?

Answer 7

Over 80s

Question 8

…

Answer 8

Between 2004 and 2031:
Age groups between 0-49 are projected to decrease
Age groups 50+ are projected to increase

This is due to baby boomers born post WW-II will be reaching their 80s whilst mortality rates remain to fall and life expectancy increases

Question 9

What effect does an ageing population have on health?

Answer 9

• Increased number of geriatricians
• Increased facilities for care of the elderly required
• Care of long-term conditions moving from secondary to primary care
• Prevalence of chronic disease will increase
• Increase in specific health promotion campaigns aimed at the elderly

Question 10

What are the social effects of an ageing population?

Answer 10

• Increasing dependence of elderly relatives on families
• The demand for home carers and nursing home places increasing
• Increasing emphasis on provision of social activities for the elderly
• Role between grandparents and grandchildren likely to change - grandchildren acting as carers
• Housing demands are likely to change as an increased number of elderly people live alone

Question 11

What are the economic effects of an ageing population?

Answer 11

• Retirement/pension ages increasing
• More difficulty in finding employment for younger people
• Proportionately less people paying taxes and into pension funds
• Elderly people who haven’t contributed to a private pension fund may find that the state pension is inadequate, resulting in poverty
• Increasing cost of ‘free personal care for the elderly’ policy

Question 12

What are the political effects of an ageing population?

Answer 12

• Current decision-making and workforce planning has to take the ageing population into account
• Increased proportion of elderly people could potentially have the power to influence political decision making in relation to their specific concerns

Question 13

What is ‘multi-morbidity’?

Answer 13

The co-existence of two or more long-term conditions in an individual

Question 14

What are the options for care in elderly patients who are unable to care for themselves at home?

Answer 14

Own home with support from family
Own home with support from social services 
Sheltered housing
Residential home
Nursing care home

Question 15

What is an anticipatory care plan?

Answer 15

Advance and anticipatory care planning, as a philosophy, promotes discussion in which individuals, their care providers and often those close to them, make decisions with respect to their future health or personal and practical aspects of care.

Question 16

When should an anticipatory care plan be organised?

Answer 16

Any time that it seems appropriate

Continuously

Question 17

Who should be involved in an anticipatory care plan?

Answer 17

Anyone with an appropriate relationship

Question 18

How should an anticipatory care plan be made?

Answer 18

Thinking ahead and making plans

It should be written

Question 19

How can it be shared amongst the relevant care providers?

Answer 19

Key information summary

Question 20

What aspects are there to an anticipatory care plan?

Answer 20

Legal:

• Power of attourney
• Guardianship

Personal:

• Statement of values
• Preferences and priorities
• Advance decision to refuse treatment
• Who else to consult

Medical

Question 21

List some of the stages of a reactive care journey

Answer 21

• GPs, district nurses, ad hoc arrangements
• No discussion with family on condition, outlook anticipated problems, place of care
• Problems with pain, sickness, constipation, anxiety
• Crisis call to Out of Hours Service
• Admission to hospital
• Death in hospital post CPR
• Family given minimal support in grief
• No reflection by professional care team

Question 22

List some of the stages of a proactive care journey

Answer 22

• On GP register - discussed at team meeting
• Social, financial support and information given to patient and carers
• Usual GP and DN proactive support visits
• Assessment of symptoms, partnership with specialists - customised care for patient needs
• Care assessed including respite and psychosocial needs
• Preferred place of care noted and organised
• Care plan and medication issued for home
• End of life pathway
• Dies in preferred place, family bereavement support
• Staff reflect SEA, audit gaps improve care