week 5 Flashcards
Outline the concepts of frailty and multiple morbidity
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.
Describe the pathogenesis of frailty
multi system dysregulation
failure of homeostasis
maladaptive response to stressors
vulnerability for morbidity and mortality.
Identify the screening tools to detect frailty
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.
Describe the consequences of the frailty syndrome
poor outcomes. increased bed occupancy.
Outline the evidence-based management of frailty
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.
Demonstrate awareness of the underlying statutory legislation that underpins adult safeguarding practice – Care Act 2014
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.
Understand how to recognise symptoms of neglect and abuse and how to respond and report in a person centred manner
balance of probability is important.
Recognise that severe or significant self-neglect could trigger safeguarding procedures
can be done without someones consent if needed, if at significant risks. or public health risk.
mental capacity act is important with neglect
Explain why disease presentations may be atypical in the older adult
reduction in physiological reserve meaning that homeostasis is harder to regulate.
numerous underlying conditions. interactions between these and polypharmacy
Describe the five most common atypical disease presentations
geriatric giants
immobility- off legs, weakness etc.
instability- falls
intellectual impairment- delirium or dementia.
incontinence- not a normal part of ageing.
iatrogenic- polypharmacy
Describe the age-related changes to the structure and function of the skin and the functional consequences
Culumative UV damage to skin causes it to wrinkle.
reduced elastin with more calcification of it.
Explain why older people are more prone to infection
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.
describe how hypoglycaemia, PE, TB and covid would present in an older person.
Describe the age-related functional changes to the pituitary, thyroid, and adrenal glands and how these may alter disease presentations
more disorderly patterns of hormonal release, reduced amplitude. blunted 24 hour secretion.
Define ageing
progressive generalised impairment of function.
loss of adaptive response to stress.
Define Strehler’s criteria for an ageing process, providing examples for each criterion
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.
what is cell senecence
due to multiple factors cell no longer turning over.
Describe how pharmacokinetics and pharmacodynamics can be affected in old age
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.
Explain what factors can affect medication compliance in the older person including polypharmacy
polypharmacy- taking 5 or more medications
Describe the principles for safe prescribing in the older patient
right drug right dose right person
non pharmacological management if at all possible.
review risk/ benefits.
Identify common risk factors for falls in the older population
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.
Describe key factors in the clinical approach to falls prevention
specific exercise including specific falls prevention exercises.
not all exercises are effective.
thai chi, danding, gardening.
Describe the age-related structural and physiological changes in the cardiovascular (and relate to their functional consequences)
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.
