1 - General Elderly Med

Question 1

What is frailty?

Answer 1

• decreased reserve & diminished resistance to stressors
• from cumulative decline across multiple physiological systems
• causes vulnerability to adverse outcomes

Question 2

Why is disease more challenging to diagnose in elderly Ps?

Answer 2

Classic symptoms are often absent - Ps will present with non-specific symptoms

Question 3

Name the 5 Geriatric Giants

Answer 3

Intellectual impairment
Incontinence
Instability and falls
Immobility
Iatrogenic

Question 4

What can be the cause of acute confusion in elderly Ps?

Answer 4

Delirium
Encephalitis

Question 5

What can be the cause of chronic confusion in elderly Ps?

Answer 5

Dementia
Pseudodementia

Question 6

What is the difference between dementia and pseudo dementia?

Answer 6

Pseudodementia, also known as depressive pseudodementia, is a mental or cognitive decline that appears similar to other forms of neurodegenerative dementia, but it’s really a result of another psychiatric condition — usually depression. Therefore it doesn’t have changes on brain scans like dementia.

Question 7

What is the most commonest presenting complaint and cause of injury related death in over 75s?

Answer 7

Falls

Question 8

What illnesses are associated with immobility?

Answer 8

Malnutrition
Deconditioning
Pressure damage
Oedema
Dehydration

Question 9

What is the most common cause of hospital admission in elderly Ps?

Answer 9

Adverse Drug Reactions

Question 10

Why are people living longer?

Answer 10

Decreased infant mortality
Increased standards of living
Improvements in public health

Question 11

What is compression of morbidity?

Answer 11

That life expectancy increases whilst morbidity reduces due to ever improving healthcare. Therefore Ps live longer, but require care for a shorter time (cheaper)

Question 12

How can length of morbidity be decreased?

Answer 12

Increased exercise
Decreased social isolation
Housing support that aids independence
Better treatments
MDT interventions

Question 13

What is the wear and tear theory of ageing?

Answer 13

That there is an accumulation of physical damage and oxidative stress that contributes to ageing

Question 14

What does the adaptive evolutionary theory state?

Answer 14

That ageing genes have evolved to program the end of life

Question 15

What happens to hormones in menopause?
What does this cause?

Answer 15

Oestrogen production decreases and FSH increases.

Causes bone mineral density loss.

Question 16

What happens to hormones in andropause?

What can this cause?

Answer 16

Testosterone levels fall in men >65
Loss of pulsatile release of LH

Can cause sarcopenia, low libido and reduced bone mineral density

Question 17

What is cellular senescence?

Answer 17

Cellular ageing = that cells can undergo a limited amount of mitotic division before they go into permanent arrest = cellular senscence.

Question 18

What is the limit of the number of mitotic divisions a cell can go through called?

Answer 18

Hayflick limit

Question 19

What do senescent cells do?

Answer 19

They accumulate in organs over time - depletes the cellular function of that organ and contributes to ageing,

Question 20

What can protect stem cells from senscence?

Answer 20

Telomerase - stops the telomeres shortening during mitosis.

Question 21

What endogenous substance can damage cellular DNA?

Answer 21

ROS

Question 22

What counteracts ROS in the body?

Answer 22

Antioxidants

Question 23

What produces the most ROS in the body?
What implication does this have?

Answer 23

Mitochondria

That mitochondrial DNA has a higher propensity to mutations