Ageing and Frailty

Question 1

Are people living longer?

Answer 1

No, they’re just living out their natural life expectancy

Question 2

What is ageing?

Answer 2

The total of all changes an organism undergoes from conception to death

Question 3

What is cellular senescence?

Answer 3

The phenomenon where cells lose the ability to divide

Question 4

What do cells do in response to DNA damage (including shortened telomeres)?

Answer 4

Cells either senesce or self-destruct (apoptosis) if the damage cannot be repaired

Question 5

What is organismal senescence?

Answer 5

Ageing of whole organisms

Question 6

What does diversity increase with?

Answer 6

Age

Question 7

What is successful aging?

Answer 7

Changes due solely to the ageing process, unaffected by disease, environmental or lifestyle factors.

Question 8

What is usual aging?

Answer 8

Changes associated with the combined effects of the ageing process, disease and adverse environment and lifestyle factors.

Question 9

What is frailty?

Answer 9

Diminished ability to carry out the important practical and social activities of daily living.

Excess demand imposed upon reduced capacity.

A precarious balance easily perturbed.

At risk for adverse health outcomes.

Unable to integrate responses in the face of stress

Question 10

What is frailty associated with?

Answer 10

A low-grade, chronic activation of the immune system with abnormalities of the endocrine and coagulation systems.

Question 11

What is the role of the immune system in frailty?

Answer 11

Cytokine levels increase 2-4x with age.

Can predict functional decline, onset of disability and mortality in the elderly.

Inflammatory cytokines have a direct catabolic effect on muscle mass and strength and some (IL6 and TNFα) have been shown to cause anorexia

Question 12

What happens to CRP in frailty?

Answer 12

CRP concentrations are higher in healthy older persons compared to younger

Higher values associated with baseline and incident frailty after adjustment for co-morbidities such as DM and CVD

Less clear that CRP is associated with mortality in the elderly

Question 13

What happens with IL-6 in frailty?

Answer 13

Higher levels of IL6 are associated with mortality in the elderly and are associated with poor survival in institutionalised elderly

Higher levels are associated with lower muscle mass and lower strength in healthy community dwelling elderly, even after adjustment for confounders

Predictive of functional decline independent of disease states

Question 14

What happens with TNFa in frailty?

Answer 14

Higher levels with ageing

Independent marker of mortality in the very old

Mixed results with regard to its association with frailty and frailty related outcomes

Postulated that it is produced locally in tissues (where its role is to upregulate IL6) and that serum levels may not adequately reflect immune activation

Question 15

What happens with sarcopenia in aging?

Answer 15

Altered CNS and PNS innervation (neuronal loss of anterior horn cells and ventral root fibres)

Altered hormonal status (decrease GH, IGF-1, oestrogen & testosterone)

Inflammatory effects (Increase in IL-1 and IL-6 receptor antagonist)

Altered caloric and protein intake

Question 16

What does muscle weakness in aging correlate with?

Answer 16

Loss of muscle mass

Question 17

When does decline in muscle mass occur?

Answer 17

Decline in skeletal muscle mass commences at the beginning of 3rd decade but does not become substantial until the end of the 5th decade (MRI study)

Question 18

How are muscle fibre types lost?

Answer 18

Type 2 (fast-twitch) fibre loss >> Type 1 (slow-twitch) fibre loss.

Question 19

What are Fried’s criteria for frailty?

Answer 19

1. Unintentional weight loss
2. Weakness
3. Exhaustion
4. Slow walking speed
5. Low physical activity
6. Pre-frail 1 or 2 criteria
7. Frail ≥ 3 criteria

Question 20

What is co-morbidity?

Answer 20

Concurrent presence of ≥ 2 chronic disease

Question 21

What is disability?

Answer 21

Physical or mental impairment that limits ≥ 1 major ADL

Question 22

What is frailty?

Answer 22

State of high vulnerability for adverse health outcomes

Question 23

What are the health care implications for co-morbidity?

Answer 23

Complexity of treating concurrent diseases

Disease interaction → adverse outcomes

Treatment priority o Polypharmacy

Potential for preventing diseases or minimising severity

Fragmentation of services

Minimise risk of disability and frailty

Question 24

What are the health care implications for disability?

Answer 24

Rehabilitation

Social integration & community services

Aim to decrease dependency

Potential for primary, secondary and tertiary prevention

Question 25

What are the health care implications for frailty?

Answer 25

Vulnerable to stressors

Risk of geriatric syndromes

Treat concomitant issues e.g. Malnutrition, weakness

Progressive but potential for primary and secondary prevention

Question 26

What is a medical syndrome?

Answer 26

The grouping together of multiple symptoms that have a single pathogenetic pathway.

Aggregate of symptoms and signs associated with any morbid process, and constituting together the picture of the disease.

Question 27

What is a geriatric syndrome?

Answer 27

The accumulated effect of impairments in multiple domains that together result in a particular adverse outcome.

One symptom or a complex of symptoms with high prevalence in geriatrics, resulting from multiple diseases and multiple risk factors.

Question 28

Which geriatric syndromes are the giants of geriatric medicine?

Answer 28

Incontinence

Immobility

Impaired balance

Impaired cognition (delirium & dementia)

Iatrogenic illness

Question 29

How are geriatric syndromes linked to frailty?

Answer 29

See image

Question 30

How are molecular diseases, impaired physiology and clinical outcomes linked in frailty?

Answer 30

See image