Ageing

Question 1

define ageing

Answer 1

biological process of growing old,

with associated changes in physiology and increased susceptibility to disease and increased likelihood of dying.

Question 2

Theories why organisms

age:

Answer 2

Damage or error theory
- accumulation of damage to DNA,

Programmed ageing theoriy

Question 3

give some examples of damage or error and what the theory could mean for ageing

Answer 3

loss of telomeres or oxidative damage as the cause of ageing.

If
we could prevent or repair this damage, we could prevent ageing.

Question 4

describe Programmed ageing theories and what the theory could mean for ageing

Answer 4

genetic, hormonal and immunological
changes over the lifetime of an organism lead to the cumulative deficits we see as
ageing.

inescapable biological
timetable

Question 5

define Life expectancy

Answer 5

statistical measure of the number of years a person can expect to live.

Rising continuously for many year

Question 6

Challenges society face due to ageing population:

Answer 6

Outdated and ageist beliefs/ assumptions

Working life/ retirement balance

Medical system designed for single acute diseases

Extending healthy old and not just life expectancy

Inadequate or absent services

Question 7

what does an ageing population reflect

Answer 7

the successes of public health policies, education

and socioeconomic development,

Question 8

Social care in England includes…..

Answer 8

home carers, sheltered housing, care homes (residential and

nursing), personal budgets.

Question 9

identify the altered presentation of disease with age

Answer 9

Older people are more likely to have an atypical or non-specific presentation of disease;

where the underlying pathology is not immediately obvious or clearly linked to the
presentation.

Question 10

what are common reasons or old

people to seek medical attention

Answer 10

falls, delirium and reduced mobility

may be due to a variety of underlying problems
such as stroke, MI or infection.

Question 11

what is an issue with these non specific presentations

Answer 11

can lead to delays in treatment when

the underlying problem is not recognised.

Question 12

what are Iatrogenic problems

Answer 12

illnesses caused by healthcare treatments and are more common in
older people.

include mistakes in providing care, and known complications of
treatment.

ADRs + cognitive damage

Question 13

define frailty

Answer 13

loss of functional reserve which causes and resistance to stressors resulting from
cumulative decline

Question 14

what is the significance of frailty give example

Answer 14

increases the likelihood of adverse events
and deterioration when faced with a minor stressor

example: a frail, older person with
mild pneumonia may end up in hospital because the pneumonia causes delirium and
reduced mobility.

Question 15

what is another difficulty of presentation with elderly people (number of problems…..)

Answer 15

often present with multiple problems which all need to be managed
simultaneously (multi-morbidity).

conditions/treatment may impact one another

Question 16

Negative impacts of Multimorbidity

Answer 16

-Worse QoL, more likely to be depressed
– Increased functional impairment
– Burden of treatment
– Polypharmacy

Question 17

Why do older people take more drugs?

Answer 17

Multimorbidity
• Guidelines/QOF/NICE
• Undetected non adherence
• Infrequent review
• Poor communication

Question 18

Polypharmacy is associated with bad

outcomes……

Answer 18

Falls
– Increased length of stay
– Delirium
– Mortality
- ADRs

Question 19

why is treatment evidence not always applicable to older people

Answer 19

Drug trials tend to use younger people

Changes in pharmacokinetics and pharmacodynamics can make drug treatments in older
people cause harm.

Question 20

what assessment can be used to make things better for people with frailty

Answer 20

Comprehensive Geriatric
Assessment (CGA)

multidimensional interdisciplinary assessment that leads to an individualised goal based plan

requires MDT

– Medical
– Functional
– Social
– Psychological/psychiatric
• Problem list
• Plan

Question 21

Changes in the ageing brain

Answer 21

Volume of CSF within the surrounding brain increases with age, the ventricles enlarge and
the gaps between the major gyri widen.

Question 22

how does brain size change over lifetime

Answer 22

Brain reaches a maximum weight at around 20 years and remains the same till around 40-45 years, after which it decreases in weight at a rate of 2-3% per decade.

Question 23

Normal cognitive changes in older people

Answer 23

Processing speed slows
• Working memory
slightly reduced

• Simple attention ability preserved, but reduction in divided attention
• Executive functions generally reduced
• No change in non declarative/implicit memory
• No change in visuospatial abilities
• No overall change in language (some reduction in verbal fluency)

Question 24

define Alertness

Answer 24

Level of consciousness

Question 25

define Cognition

Answer 25

Content of consciousness •

Question 26

what is dementia

Answer 26

chronic, progressive, degenerative disease which cause a decline in cognition.

Question 27

what do most common types fo dementia start withy symptom wise

Answer 27

The most common types (Alzheimer’s and vascular) often start with memory problems, but over time include all cognitive functions Loss of executive function – Functional impairment – Behavioural and psychological changes – Lack of insight

Question 28

what us delirium and what are consequences

Answer 28

an acute episode of confusion/ brain failure, usually with a clear precipitant such as infection or medication changes. It usually resolves, but can leave people with residual problems such as dementia affects alertness and cognition

Question 29

in which group of people is delirium more likely to occur

Answer 29

much more common in people who already heave dementia.

Question 30

give 2 examples of Cognitive assessments

Answer 30

Mini Mental State Examination (MMSE) Montreal Cognitive Assessment (MOCA)

Question 31

dvantages of the MOCA

Answer 31

Covers a variety of domains of cognitive function * Brief to administer (10 mins) * Validated in a range of populations * Available in translated versions * Widely used

Question 32

problems with cognitive assessments in general

Answer 32

Hearing and visual impairment limit testing * Physical problems may limit testing * Most assume numeracy/ literacy/cultural knowledge * Normal cognitive changes (slower processing speed, slower reaction times) may affect administration * Depression can masquerade as dementia * Not valid in acute illness

Question 33

What are the disadvantages of the MOCA?

Answer 33

``` Education level will affect results • Language level will affect results • Floor and ceiling effects • Can be poorly administered • Possibly practice/coaching effects ```