7: prospectives on Ageing Flashcards
(46 cards)
What is Ageing?
Ageing is the process of growing older
It has 3 different main domains:
- Biological
- Psychological/cognitive
- Social
What is Life expectancy?
Life expectancy is a statistical measure of how long a person can expect to live
Why did life expectancy increase in the past 100 years
Many factory but mainly
- better public health (sanitation, hygene etc) but also:
- better nutrition
- less violence
- adnancaes in medicine and
- better education
How does the nature of the ageing population changes?
- Increasing numbers of BAME (black asian, minority ethnicity) older people
- Increasing education of older people
- Reduction in poverty
- More people are working for longer
- More complex/nuanced retirement process
What are the two main groups of Ageing theories?
- Programmed ageing
- Damage or error theories
But:
- no know theory/application there are no anti-ageing treatments in medicine
- people age at different rates
Explain the main thesis of “programmed ageing” theory
Aged because it is programmed in DNA
- e.g. telomers get shorther
- –> cells count the number they are deviding and at some point stop deviding
Explain the “Damage of error theories” as a rationale behind ageing
In theory: could live forever but cells get damage appears that cause ageing
What are the big challanges for society in a ageing population?
- Working life/retirement balance - dependency ratio
- Extending healthy old age not just life expectancy
- Caring for older people, the sandwich generation
- Outdated and ageist beliefs/assumptions
- Medical system designed for single acute diseases
Explain the role of the dependency ration as a challenge of ageing
Working life/retirement balance - dependency ratio
- number of depemdance of people in society (older people in pansion and children)
- vs number of people that work
- being able to pay pansion to people!
Explain the role of extending healthy old age not just life expectancy in a challange of ageing
Extending healthy old age not just life expectancy
- aim: to reduce disease time and increase life expectancy
- but currently: mainly life expectancy went up but disease free time did not
Which factors influence health and (disease free) life expectancy?
- where we live (e.g. pollution)
- genetic
- health behaviour
- access to healthcare
- who we are (gender etc.)
Explain the challenge of Caring for older people, the sandwich generation
3% of over 65 live in a carehome
- is expensive for working “sandwich” generation
- caring for an older relative
- whilst bringing up children
- not paied by government for vast majority of people
- leading to
- decreased workforce and
- underpaied workers, delayed and worse care
Explain the consequences of the increased age on the healthcare system
- Increasing demand for primary, secondary and tertiary health care
- Increasing complexity
- Navigating the health and social care divide
What is frailty?
Loss of biological reserve
- across multiple organ systems
- leading to vulnerability to physiological decompensation and
- functional decline
after a stressor event
–> having decreased resources to deal with a stressor event so that a minor stressor (e.g. mild infection) have a big impact (need for care afterwards, admission to long-term care and hospital
Which factors influence Frailty?
It is dependant on
- Environmental and
- Genetic factors
- Leading to
- accumulative damage to cells and molecular damage (Ageing)
- reduced physilogical reserve (in all organ systems)
- influenced by nutritional status and exercise
What does a stressor event in a fragile person lead to?
It leads to (more) severe response/effects like
- falls
- Delirium
- Fluctuating disability
Leading to
- increased care needs
- admission to hospital
- admission to long-term care
What are the characteristics of
- mild
- severe frailty
- Mild
- living on their own, dependant on some help
- severe
- dependant on others and help of others (often living in care home)
Can frailty be prevented?
Yes, with lifestyle choices
- exercise
- nutrition
- no smoking
- no drinking
Can frailty be treated?
Yes but it is difficult
- Exercise
- Nutrition
- Drugs (possibly)
Prevention is better than cure
What are the non-specific presentations of fraiglty?
- Falls
- Reduced mobility
- Recurrent infections
- Confusion
- Weight loss
- “Not coping”
- Iatrogenic harm
–> Not diagnosis but syndromes that make people come into hospital
How does presentation of a disease in old people change?
They are less likely to have a “textbook presentation” of symptoms but are more likely to show additional symptoms
- ACS
- Less likely to have chest pain
- More Likely to have SOB
- PE
- Less likely to have pleuritic chest pain
- Less likely to have haemoptysis
- More likely to have syncope
What is the impact of multimorbidity in age?
Because: conditions of conditions impact on one another
- directly
- viat the treatment of one condition
- Leading to
- Worse Quality of Life, more likely to be depressed
- Increased functional impairment
- Burden of treatment
- Polypharmacy
Why do older people take more drugs?
- more conditions (multimorbidity)
- infrequent review
- guidelines
- only on single condition and not on multimoriditions that might be treated differently
- undetected non-adherence
- poor communication
What is the result of Potentially inappropriate polypharmacy (PIP) ?
E.g. Long-term perscription of opioids,
- Falls
- Increased length of stay
- Delirium
- Mortality
