Ageing and healthcare

Question 1

Describe the molecular theory of ageing.

Answer 1

• Age related “programmed” genetic regulation
• Epigenetic modifications eg gene methylation (turns off genes e.g. turns off tumor suppressor gene, happens more in age) and histone modification (gene expression dependent on histones looking after DNA and allowing it to be
expressed. Histones will change in older age, so will affect how genes are expressed/translated )
• Cumulative random DNA damage
• Errors in gene expression or translation (methylation above gene happens less, so less accurate gene expression)

Question 2

Describe the cellular theory of ageing.

Answer 2

• Telomere shortening- progressive loss of chromosome
“caps” (protective of ends of chromosome, shorten as get older, until get too short at which point genes may get damaged)
• Free radical damage (e.g. oxygen free radical- DNA damaging)
• Apoptosis- programmed cell death (accelerates in older age)

Question 3

Describe the environmental and evolutionary theory of ageing.

Answer 3

• “Wear and tear” ie (in)ability to regenerate damaged tissue
• Cumulative uv and ionising radiation damage
• “Disposable soma” ie no evolutionary advantage in survival beyond reproduction and rearing children

Question 4

Identify tests for frailty.

Answer 4

-Edmonton frail-scale- out of 17 points
or
-TUG test- “timed up and go”- rise from
a chair, walk 3m, return to chair - ideally
<10sec
-PRIMA 7 questions (more than 85? Male ? Limited by health probs ? Need someone to help you on regular basis ? Health problems require you to stay home ? If needed, is someone available to help you ? Use walking aid ?)

Question 5

Comment on the following clinical case, including diagnosis, prognosis and treatment.
• 85 year old man admitted after collapse in supermarket
• Increasingly unwell for several weeks
• Main carer for wife who has dementia and osteoporosis
• He has past history of diabetes, decline in renal function and COPD

• Hb 75 g/l WBC 50 x109/l pl 25 x109/l Blasts ++ in blood film
• Creat 200 umol/l (baseline 150)

Answer 5

• Anaemia (because low Hb) (acute, because blasts +++ in blood films)
• Diagnosis: acute myeloid leukaemia (poor risk cytogenetics)
• Likely life expectancy- few months
• Treatment: supportive care, transfusions, antibiotics (IV then oral) + family and social services + discharge if possible

Question 6

Define realistic medicine.

Answer 6

A more thoughtful identification and compassionate use made of a patient’s predicaments, rights and preferences. It’s about:

• Holistic approach
• Involving patient in decisions
• Health literacy (e.g. risks/benefits)
• Decision making
• Potential harm in over- or under- investigation and treatment

Question 7

Identify the main factors which come into mutlifactorial decision making in medicine.

Answer 7

Relevant scientific evidence
Clinical judgement
Patient values and preferences

Which all overlap to give, evidence-based practice

Question 8

Identify the main theories of aging.

Answer 8

• Multifactorial

• genetic/cellular
• environmental
• evolutionary theory

Question 9

Graph change in sprinting, vs endurance ability with age.

Answer 9

Endurance based activities, slower decline in performance (refer to slide 10)

Question 10

Graph change in kidney, and cardiac function with age.

Answer 10

Refer to slide 11.

Kidney function progressive decline
Cardiac function increases to peak in teenage years, then gradually decline due to ischemic disease/cardiac myopathies

Question 11

Graph the change in organ function in normal health, chronic disease, acute disease.

Answer 11

Refer to slide 12

Question 12

Graph the changes in nerve conducting velocity, max HR, kidney BF, max breathing capacity, and max work rate, and female fertility over time.

Answer 12

Refer to slide 12

Question 13

To what extent is there organ function decline with age ? Is this life threatening ?

Answer 13

• Age related decline in every organ/system

* Not life-limiting but declining reserves

Question 14

Describe changing demographics in Scotland. Compare this with India’s demographics.

Answer 14

Modest rise till 1950s- little overall change since

Largest proportion of the population is 20s and 50s (baby boomers)

In India, lots of younger people, fewer older people.

Question 15

What age group is projected to increase the most in the next few years in Scotland ?

Answer 15

75+ (centenarians is fastest growing age group)

Question 16

To what extent are health issues more common with increasing age ?

Answer 16

With the exceptions of accident/suicide, most health issues are more common with increasing age

Question 17

Describe impact of increasing disease incidence with age.

Answer 17

• With increasing age, many will have several chronic conditions
• Each condition may have several medications prescribed-
polypharmacy
• Medications may be for symptoms or “risk reduction”
• Be aware of relative and absolute risk reduction
• Hard to measure benefit for one individual

Question 18

Describe the pattern of medicine-taking and mutlimorbidity with age.

Answer 18

With increasing age, higher proportion of people take at least one prescribed medicine, and higher rate of multimorbidity

Question 19

Describe the relationship between health costs and age.

Answer 19

• Health and social care costs rise with increasing age
• Burden of disease links to deprivation index
• smoking
• alcohol
• diet and obesity
• housing

Question 20

Describe the main features of a holistic approach in medicine.

Answer 20

In general, trying to see the “whole person” ie physical, psychological, social, functional well being

• Previously secondary care “general medicine”
• Now acute medicine and specialties

• Elderly care

• acute hospitals
• community hospitals and day care
• ”hospital at home”

Question 21

Describe the main features of comprehensive geriatric assessments.

Answer 21

• medical and medication review
• environmental hazards
• functional capacity
• psycological assessment
• balance- assessment of falls risk

Question 22

Define frailty. Graph this.

Answer 22

A clinically recognizable state of increased vulnerability resulting from aging-associated decline in reserve and function across multiple physiologic systems such that the ability to cope with everyday or acute stressors is comprised.

Refer to slid 23

Question 23

Define aging.

Answer 23

Physiological process of decline in organ function