Ageing

Question 1

Define ageing/senescence

Answer 1

biological process of growing old, with associated changes in physiology and increased susceptibility to disease and increased likelihood of dying.

Question 2

Why do organisms age. 2 theories

Answer 2

1. DAMAGE THEORY

2. PROGRAMMED AGEING THEORY

Question 3

Outline damage theory of ageing

Answer 3

Accumulation of DNA damage. Loss of telomeres/oxidative damage. Ageing could be prevented if the damage could be repaired

Question 4

Outline programmed ageing theory

Answer 4

genetic, hormonal and immunological changes over the lifetime of an organism lead to the cumulative deficits –> ageing

part of an inescapable biological timetable, just as growth and puberty are programmed to occur

Question 5

Define population ageing

Answer 5

increasing age of an entire country, due to increasing life spans, and falling fertility rates.

Question 6

How will UK population change

Answer 6

’s predicted there will be small increases in the number of younger people, but the largest increase will be in older people

Question 7

Older patients are more likely to come with what presentation

Answer 7

A non-specific presentation means presentations where the underlying pathology is not immediately obvious, or clearly linked to the presentation

e.g. alls, delirium and reduced mobility

Question 8

Giants of geriatric medicine (the 5Is)

Answer 8

immobility, intellectual impairment, instability, incontinence and iatrogenic problems.

Question 9

Why can old people have delayed treatment

Answer 9

they attribute symptoms to another cause or “old age”, and lead to delays in treatment.

Atypical and non-specific presentations can lead to delays in treatment when the underlying problem is not recognised.

Question 10

Frail definition

Answer 10

loss of functional reserve among older people which causes impairment of their ability to manage every day activities, and increases the likelihood of adverse events and deterioration when they are faced with a minor stressor.

Question 11

Give an example of frailty

Answer 11

young person with mild pneumonia may need treatment with antibiotics at home

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

Question 12

What is the problem with drug treatment for older people

Answer 12

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

Many drug trials have low numbers of older people, so the evidence for treatment is often extrapolated from younger people. In the past it was common to exclude older people from drug trials altogether.

Question 13

What happens to the brain tissue with age

Answer 13

1. Increased CSF, widened ventricles, gaps between the major gyri widen.
2. White matter changes.
3. Weight of brain changes

Question 14

What happens to brain weight across life

Answer 14

maximum weight occurs at 20, stays until 40-50

Then reduces 2-3% each decade until 80, when you have 10% lower brain weight

Question 15

t/f impairment of cognitive funciton is normal process associated with ageing

Answer 15

F. Some aspects of cognition change as a person ages, but significant impairment of cognitive function is not normal, even in the oldest old, and indicates that there is a problem.

Question 16

Why have rates of dementia diagnosis been low historically

Answer 16

1. Misinterpretation (thinking it’s normal for old people to have reduced cognition)
2. Fatalism (there’s nothing we can do about it anyway)
3. Social isolation of some older people, such that they have no one to notice any problems

Question 17

What proportion of those with dementia have a diagnosis

Answer 17

70%

Question 18

What is dementia and what are the main types

Answer 18

Dementia is a chronic, progressive, degenerative disease which causes a decline in cognition. The most common types of dementia (Alzheimer’s and vascular)

Question 19

What is the progresion of dementia

Answer 19

Often start with memory problems, but over time will include all cognitive functions.

Question 20

What is mild cognitive impairment

Answer 20

a specific term used to refer to people who have mild problems which do not interfere with their day-to-day life and don’t meet the diagnostic criteria for dementia

Question 21

Differentiate dementia with delirium

Answer 21

Dementia= chronic progresive degenerative disease

Delirium- acute episode of confusion, usually with a clear precipitant such as infection or medication changes.

Dementia just affects cognition i.e. content (not alertness), whereas delirium affects both level and content (i.e. alertness and cognition)

Question 22

T/F there is no link between delirium and dementa

Answer 22

F

Delirium usually resolves, but can leave some people with residual problems (ie dementia). Delirium is much more common in people who already have dementia.

Question 23

What could be a cause of delirium

Answer 23

infection or medication changes

Question 24

What test can help to distinguish dementia and delirium

Answer 24

Confusion Assessment Method (CAM) and 4AT are tools to help distinguish between delirium and dementia

Question 25

What is life expectancy

Answer 25

statistical measure of how | long a person can expect to live

Question 26

What is chronoloical age vs biological age

Answer 26

Chronological is how old you actually are Biological is how old ur body is Chronological ageing is inevitable but poor biological ageing is not…

Question 27

Challenges for society of ageing populatin

Answer 27

* Working life/retirement balance * Caring for older people, the sandwich generation * Extending healthy old age not just life expectancy * Inadequate or absent services * Outdated and ageist beliefs/assumptions * Medical system designed for single acute diseases * Limited accessibility for those with disabilities

Question 28

What is compression of morbidity

Answer 28

As life expectancy increased, people were getting ill at the same point and just living with morbidity for longer That changed so that now people get ill later and live longer, so there is less time spent ill

Question 29

What is health span

Answer 29

Health span is the time before disease, and you want this to inrcrease

Question 30

What symptoms are old people more and less likely to have with PE and Acute coronary syndrome

Answer 30

``` Acute Coronary Syndrome • Less likely to have chest pain – Pulmonary Embolism • Less likely to have pleuritic chest pain • Less likely to have haemoptysis ``` – Acute Coronary Syndrome • More likely to have shortness of breath – Pulmonary Embolism • More likely to have syncope

Question 31

What proportion of over 65s and over 75s have multiple morbidity

Answer 31

The majority of over-65s have 2 or more conditions, and the majority of over-75s have 3 or more conditions

Question 32

-ve impacts of multimorbitity

Answer 32

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

Question 33

Why do older people take more drugs

Answer 33

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

Question 34

What poor outcomes is polypharmacy associated with

Answer 34

``` – Falls – Increased length of stay – Delirium – Mortality – Adverse drug reactions ```

Question 35

What is the biggest cause of hospital acquired complications for old frail people in hospital

Answer 35

1. Medication related problem

Question 36

Give an example of a prescribing cascade

Answer 36

1. Patient has high blood pressure 2. They are given amlodipine 3. That causes ankle swelling, which is mistaken for HF 4. Furesomide given 5. Patient becomes hypotensive and falls and has a fracture (Fall and Colles fracture)

Question 37

Why are old people at increased risk of harm

Answer 37

* Reduced physiological reserve * Impaired compensation mechanisms * Comorbidities * Polypharmacy * Cognitive impairment

Question 38

What is the CGA

Answer 38

``` Comprehensive Geriatric Assessment (CGA) • A multidimensional, interdisciplinary assessment that leads to an individualised, goal based plan ``` Community (reduce admissions, falls, benfit family) or for frail patients (reduce mortality, cognitive decline)

Question 39

What is rehabilitation

Answer 39

Aim is to restore or improve functionality Prevent deconditioning Prehabilitation (optimise patient before surgery so to prevent deconditioning after i.e get them as fit and prepared as possible)

Question 40

What is normal change in ageing, and what doesn't usually change

Answer 40

``` NORMAL: • Processing speed slows • Working memory slightly reduced • Simple attention ability preserved, but reduction in divided attention • Executive functions generally reduced ``` ``` No change in nondeclarative/implicit memory • No change in visuospatial abilities • No overall change in language (some reduction in verbal fluency) ```

Question 41

Components of higher brain function

Answer 41

* 1. Level of consciousness * = Alertness * 2. Content of consciousness * = Cognition

Question 42

What is dementia with regard to higher brain function

Answer 42

Progressive decline in all domains of | cognition (alertness fine)

Question 43

What are the effects of dementia

Answer 43

– Loss of executive function – Functional impairment – Behavioural and psychological changes – Lack of insight

Question 44

What is delirium

Answer 44

Acute brain failure

Question 45

What is 4AT

Answer 45

SCREENING 4AT Alertness AMT4 (abreviated mental test, i.e 4 simple questions) Attention (months of year backwards, can do it in dementia but not in delirium) Acute

Question 46

What is the MOCA

Answer 46

SCREENING Montreal Cognitive Assessment (MOCA) Looks at different parts of cognition Memory Language etc

Question 47

Advantages of the MOCA

Answer 47

Good because tests lots of domains of cognition, brief to administer (10mins), validated in a range of populations, widely used and available in translated versions Disadvantage: education level affects results, language level affects results, can be poorly administered, practice/coaching effects

Question 48

General problems with cognitive tests

Answer 48

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

Question 49

What is AMT, MOCA, MMSE and CAM?

Answer 49

Abbreviated Mental Test (AMT) and clock drawing tests are brief screening tests for cognitive impairment Montreal Cognitive Assessment (MOCA) is a more detailed examination in wide general use Mini Mental State Examination (MMSE) is a slightly outdated assessment which is less widely used that previously. Confusion Assessment Method (CAM) and 4AT are tools to help distinguish between delirium and dementia