week 5

Question 1

Outline the concepts of frailty and multiple morbidity

Answer 1

health state related to the ageing process in which multiple body systems gradually lose their in build reserves

change assoc with age that lead to a vulnerability to physiological insults and an inability to maintain independence.

related to ageing but not a normal part.

Question 2

Describe the pathogenesis of frailty

Answer 2

multi system dysregulation
failure of homeostasis
maladaptive response to stressors
vulnerability for morbidity and mortality.

Question 3

Identify the screening tools to detect frailty

Answer 3

phenotype model, or cumulative deficit model (by rockwood)- these are for diagnosing.

screening is large scale - electronic frailty index (GP record 0.36 or greater is considered significantly frail)
rockwood or PRISMA screening.

rockwood is 2 weeks before they came in not at point of care.

Question 4

Describe the consequences of the frailty syndrome

Answer 4

poor outcomes. increased bed occupancy.

Question 5

Outline the evidence-based management of frailty

Answer 5

identify early, prevent progression, avoid unnecessary harm.

need a Comprehensive geriatric assessment (CGA)- create a care plan and long term follow up plan. MDT

problem list and share it with multiple agency.

Question 6

Demonstrate awareness of the underlying statutory legislation that underpins adult safeguarding practice – Care Act 2014

Answer 6

applies to any adult who has care + support needs. is experiencing risk

need substantial difficulty and nobody able to meet their needs to get care.

focus on prevention rather than reaction. multi agency , response, personal.

Question 7

Understand how to recognise symptoms of neglect and abuse and how to respond and report in a person centred manner

Answer 7

balance of probability is important.

Question 8

Recognise that severe or significant self-neglect could trigger safeguarding procedures

Answer 8

can be done without someones consent if needed, if at significant risks. or public health risk.

mental capacity act is important with neglect

Question 9

Explain why disease presentations may be atypical in the older adult

Answer 9

reduction in physiological reserve meaning that homeostasis is harder to regulate.

numerous underlying conditions. interactions between these and polypharmacy

Question 10

Describe the five most common atypical disease presentations

Answer 10

geriatric giants
immobility- off legs, weakness etc.

instability- falls

intellectual impairment- delirium or dementia.

incontinence- not a normal part of ageing.

iatrogenic- polypharmacy

Question 11

Describe the age-related changes to the structure and function of the skin and the functional consequences

Answer 11

Culumative UV damage to skin causes it to wrinkle.
reduced elastin with more calcification of it.

Question 12

Explain why older people are more prone to infection

Answer 12

inc in autoantibodies and memory T cells
decreased proliferation of helper T cells
decreased IL production
dec activation of compliment.

vaccines less effective

less immunosurveilance means higher risk of cancer.

Question 13

describe how hypoglycaemia, PE, TB and covid would present in an older person.

Answer 13

Question 14

Describe the age-related functional changes to the pituitary, thyroid, and adrenal glands and how these may alter disease presentations

Answer 14

more disorderly patterns of hormonal release, reduced amplitude. blunted 24 hour secretion.

Question 15

Define ageing

Answer 15

progressive generalised impairment of function.
loss of adaptive response to stress.

Question 16

Define Strehler’s criteria for an ageing process, providing examples for each criterion

Answer 16

universal- collagen cross links. calcium from bone

intrinsic- skin in axilla, hair loss

progressive- greying of hair, loss of muscle power.

deleterious- eventually harmful to organism. reduced visual acuity, loss of hearing.

Question 17

Consider the changing age demographics in the UK over the past 150 years and explain the possible consequences of these changes in the context of healthcare

Answer 17

240% increase in over 80s over first 50 years of the nhs.

massive increase needing structural changes.

over 85s is the fastest growing segment of population. no money for pensions! length of retirements increased 4-8 fold. all due to life expectancy.

exponential relationship between age and chronic disability.

Question 18

Outline the following theories of why we age: wear and tear, evolutionary, non-adaptive evolutionary, disposable soma theories

Answer 18

wear and tear- machine that wears out (e.g elephants teeth, weddell seal) BUT sea anemone doesn’t age. cant be whole answer

adaptive evolutionary- developed through natural selection, selectively advantages to species (removes old from food pool). however darwinian is individual fittest not communism.

non-adaptive- ageing is a byeproduct of development. (mutation accumulation) late acting deleterious genes. OR same genes initially good but then has a negative effect - more evidenced.

disposable soma theory- body not important hand the germ line on. old mice get eaten, young mice with 15 children pass it on. play off between energy usage vs reproduction. depends on ecological niche occupied by that organism.

Question 19

Describe, with examples, how ageing may occur at the following levels i) genetic, ii) genomic stability, iii) cellular, including cell senescence and iv) systems

Answer 19

neuroendocrine theory- dec pulsatile GH in ageing. ? death hormone but never been found.

cellular/ mollecular- higher basal metabolic rate short lifespan. cold longer than warm blooded. heat shock proteins, reduced production in age, dec ability to cope with stress.

genetic- twin studies, long lived families, species specific longevity. can get a doubling of lifespan with a mutation in some bug thing.

genomic stability- if you keep the information on how to repair you can keep repairing. fault leads to cascading cell death.

Question 20

what is cell senecence

Answer 20

due to multiple factors cell no longer turning over.

Question 21

Describe how pharmacokinetics and pharmacodynamics can be affected in old age

Answer 21

pharmacokinetics- mvt of drug through body. absorbed, distributed, metabolised, inhibited
swallowing diffs, slower gastric emptying, higher PH.
distribution- inc in body fat, less muscle. dec plasma albumin.
decreased hepatic blood flow and volume. phase 1 reaction (CYP) more affected than phase 2.
decreased gfr

pharmacodynamics- effect of the drug on body. - increased sensitivity to sedation. increase risk adverse events (neuroleptic medication) sensitivity to anti-cholinergic effects.

Question 22

Explain what factors can affect medication compliance in the older person including polypharmacy

Answer 22

polypharmacy- taking 5 or more medications

Question 23

Describe the principles for safe prescribing in the older patient

Answer 23

right drug right dose right person

non pharmacological management if at all possible.

review risk/ benefits.

Question 24

Identify common risk factors for falls in the older population

Answer 24

Age related changes- muscle mass. loss of neurons and reduced synaptic transmission.

co-morbidities- hearing loss is very big fro increasing falls. sight also important

environment.

Question 25

Identify the changes to posture and gait in normal ageing

Answer 25

increase in lordosises and kyphoseses reduced stride length, reduced speed and reduced hip flexion and extension. wide based gait

Question 26

Describe key factors in the clinical approach to falls prevention

Answer 26

specific exercise including specific falls prevention exercises. not all exercises are effective. thai chi, danding, gardening.

Question 27

Briefly describe key steps in the management of hip fracture in the elderly, appreciating both surgical and non-surgical aspects

Answer 27

30 day mortality- 10% 1 year mortality of 33% medical- resus, analgesia, optimise for surgery, ax osteoporosis, assess and r underlying cause of fall conservative or operative surgery

Question 28

Describe the age-related structural and physiological changes in the cardiovascular (and relate to their functional consequences)

Answer 28

muscles- inc in left vent wall thickness, inc in myocite size, deposits of amyloid and fibrous tissue. left vent chamber volume increase valves- inc thickness, dec flexibility, calcification. conduction pathways- dec no of pacemaker cells (50-75% lost by 50) fibrous infiltrates. AV node maintained. vessels- loose elasticity and compliance with age. veins dilate and stretch. intima and muscular wall thickens and less elasticated.

Question 29

Explain the functional consequences to the cardiovascular and respiratory systems in relation to age-related changes

Answer 29

decreaced contractile strength decreased CO, + Cardiac reserve pre/afterload changes. deceased cardiac responsiveness. longer to return to baseline rate linear dec in maximal HR during exercise BP rises systolic higher than diastolic.

Question 30

Describe the age-related structural and physiological changes in the respiratory system (and relate to their functional consequences)

Answer 30

increased alveolar size and air trapping loss of support of lung parenchyma, decreased elasticity. reduction in chest wall compliance, reduced thickness of vertebral discs + kyphosis. premature closure of alveolar on expiration decreases fast twitch, dec volume and strength

Question 31

Differentiate between age-related and pathological anatomical changes (macroscopic and microscopic) which can be identified in the ageing brain

Answer 31

decreasing cerebral volume loss of neural circuits neuronal morphology change vascular ageing. myelin sheath deterioration. occipital region is least affected. decrease in dendrite spine number chemical changes in dopamine(10% decade), serotonin, glutamate. interfere with normal day to day vs able to manage day to day.

Question 32

Describe the age-related changes in the function of the neurological system

Answer 32

slower processing, slower multitasking routine memory skills can improve.

Question 33

Differentiate between delirium and dementia in relation to the clinical presentation

Answer 33

dementia diagnosed chornic disease based on history exam and investigations + cognitive test. rapid decline is more of an acute issue.

Question 34

Recognise the risk factors, potential causative factors and adverse consequences for delirium

Answer 34

infection dehydration constipation disorientation

Question 35

Outline the basic management for delirium

Answer 35

remove cause as much as possible then wait