W13 43 diseases of ageing Flashcards
What are geriatric giants?
A group of conditions that lead to significant mortality and morbidity and contribute to complexity in treating geriatric (old) patients
EXAM Q - how does multiple pathology in geriatric patients affect treatment?
Increasing age means more years in which to have acquired disease. If we treat one disease, it might affect disease B, with treatment of an potentially causing disease C, giving more drugs and causing a cycle of prescribing and diagnosing.
Multiple pathology may lead to multiple treatments and the treatment for one problem may worsen another. Multimorbidity is the biggest predictor and thus contributor to socioeconomicsm as same for frailty.
What is frailty?
A medical syndrome with multiple causes and contributors that is characterised by diminished strength, endurance, and reduced physiological function that increases an individuals vulnerability for developing increased dependency and/or death.
It is a specific phenotype of adverse ageing (ageing that’s not successful)
What are some measures of frailty?
People who are more fragile than we’d expect. Subjective.
Eg, walking stick suggesting balance difficulty or a fall; bent needs could be potential OA worsening stability; hand in pocket maybe to conceal tremor; grumpy potentially due to depression, pain or cognitive impairment; stooped posture eg suggesting osteoporosis or increased tone such as in vascular dementia or Parkinsonism
Read the clinical frailty scale
Pg426
EXAM KEY CONCEPT - How is frailty a reduced response to stressors? (GRAPH PG427!)
Frailty is about vulnerability. Graph. Someone with frailty who gets the same infection as someone without it will cause a big drop off in functional ability and will end up in hospital eg with delirium, not able to walk as much and need a lot of help. They will recover but it takes them longer to recover and not to their baseline.
EXAM KEY CONCEPT - how does frailty describe risk?
It explains the heterogeneity. If moderately or severely frail then you’re more likely to end up in a car home and more likely to die. Might describe risk of treatment failure or complication. May help with decisions about treatment (prognostication).
EXAM KEY CONCEPT - what are the risks of frailty in dentistry?
Treatment has a higher risk of failing
Drug has a higher risk of having an adverse effect
Should be thinking about it giving a treatment, the risks involved and what the benefit will be in terms of how long they have left to live etc.
Do frail people have less teeth?
The need for dental prostheses was significantly associated with frailty, independent of socioeconomic and general health status.
EXAM KEY CONCEPT - what is the relevance of poly pharmacy?
A lot of tablets can cause:
Xerostomia
Gingival enlargement (sometimes recession)
Postural hypotension (elderly response is dulled)
Anticoagulation (beware NOACs, antibiotics)
Bisphosphonates (ONJ)
What are the 5 features of geriatric giants?
Intellectual failure - eg delirium, dementia
Incontinece
Immobility - eg falls
Instability
Iatrogenic disease
Inability to look after oneself - functional decline, neglect etc
What are the consequences of instability and falls?
Hip, wrist or vertebrae fracture
Fear of falling (post fall syndrome)
Reduced function - anxiety depression, institutionalisation
Why do people fall?
Sensory information about environment - vision, vestibular, proprioception
Understand and interpret - cognition, higher level reflexes
Generate forces to control movement
What is dementia, it’s causes and intervention? - EXAM KEY CONCEPT
Chronic syndrome of global impairment (not just memory), affecting everyday function
Caused by Alzheimer’s disease, vascular disease, Lewy body dementia, frontotemporal dementia, posterior cortisol atrophy
Interventions - diagnosis (underdiagnosed), drugs, support
What is delirium?
Acute neuropsychiatric condition. Affects attention, alertness and cognition. Most common post-surgical complication. Causes confusion.
It is under recognised, increased mortality and institutionalisation.
