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Flashcards in Ageing Deck (31)
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1

Define ageing

Ageing is the process of growing older:

  • Biological
  • Psychological/cognitive
  • Social

2

Define life expectancy

Life expectancy is a statistical measure of how long a person can expect to live

3

What are the biological theories of ageing?

  1. Programmed ageing – the idea that ageing is genetically programmed to occur with time, and this process of deterioration eventually leads to death
  2. Damage or error theories – the idea that external or environmental forces gradually damage cells and organs, leading to ageing and death.

4

What are the theories explaining the programmed ageing theory?

  • Genetic life-span theory
  • Genetic predisposition theory
  • Telomere theory
  • Specific system theories (Neuroendocrine theory)

5

What are the theories explaining the damage/error theory of ageing?

  • Wear and tear theory
  • Rate of living theory
  • Waste product accumulation theory
  • Cross-linking theory
  • Free radical theory
  • Autoimmune theory
  • Error theories
  • Order to disorder theory

6

What challenges does society face as a result of population ageing?

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  • Outdated and ageist beliefs/assumptions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

7

How does disease presentation change with age?

  • Frailty 
  • Non-specific presentations

8

What are the difficulties with managing disease in older people?

  • Multimorbidity
  • Polypharmacy
  • Iatrogenic harm (caused by medical examination or treatment)
  • Comprehensive geriatric assessment
  • 5Rehabilitation

9

What is frailty?

A physiologic syndrome characterized by decreased reserve and resistance to stressors, resulting from cumulative decline across multiple physiologic systems, and causing vulnerability to adverse outcomes

10

How does frailty develop?

  1. Genetic and environmental factors
  2. Time
    • Cumulative molecular and cellular damage 
  3. Reduced physiological reserve
  4. Physical activity and nutritional factors
  5. Frailty

11

What are the "geriatric syndromes"?

Non-specific presentations:

  • Falls
  • Delirium/confusion
  • Fluctuating disability
  • reduced mobility
  • Weight loss
  • Iatrogenic harm
  • "Not coping"

 

12

Why is frailty a problem?

  • Minor illnesses cause more pronounced changes in health
  • Increased hospital admissions
  • Increased duration of hospital stay
  • Increased care needs and dependence 

13

Can frailty be treated?

  • Not really
  • Prevention rather than sure is best
  • Prevention through exercise, nutrition, lack of smoking and drinking is the best way

14

Using MI and PE as examples, what are the issues with the elderly's non-specific presentation?

  • A wide variety of diseases can present as the same thing i.e. falls
  • Less likely to have the textbook symptoms e.g.
    • MI - less likely yo have chest pain
    • PE - less likely to have pleuritic chest pain or haemoptysis
  • More likely to have other symptoms
    • MI -  more likely to be short of breath
    • PE - more likely to have syncope

15

Why is multimorbidity an issue?

  • Conditions impact on one another
  • Treatment for one condition may impact on another
  • Negative impacts
    • Worse QoL - more likely to be depressed
    • Increased functional impairment
    • Burden of treatment
    • Polypharmacy

16

Why is polypharmacy an issue?

  • Associated with bad outcomes:
    • Falls
    • Increased length of stay
    • Delirium
    • Mortality
  • Increased risk of adverse drug reactions

17

Why are older people at increased risk of harm?

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

18

How can outcomes be improved for people with frailty?

  • Comprehensive Geriatric Assessment (CGA)
    •  A multidimensional, interdisciplinary assessment that leads to an individualised, goal based plan

19

What are the benefits of CGA in the community and inpatients?

CGA in the community

  • Reduce admissions to institutional care
  • Reduce falls
  • Most benefit in mild or moderate frailty 

CGA for frail inpatients

  • Reduces inpatient mortality
  • Reduces functional and cognitive decline
  • Reduces admission to institutional care

20

What are the physical changes that occur in the brain with ageing?

  • Atrophy
  • Cerebrovascular disease - furring up of the small vessels in the brain

21

What are the normal cognitive changes in older people?

  • Processing speed slows
  • Working memory slightly reduced
  • Simple attention ability preserved, but reduction in divided attention
  • Executive functions generally reduced

22

What cognitive changes shouldn't occur in normal people as they age?

  • No change in nondeclarative/implicit memory (memory that doesn't take conscious effort to remember)
  • No change in visuospatial abilities
  • No overall change in language (some reduction in verbal fluency)

23

What are the 2 components of higher brain function and which one does dementia effect?

  1. Level of consciousness - alertness
  2. Content of consciousness - cognition
  • Affected by dementia

24

What are the features of dementia?

  • Progressive decline in all domains of cognition
  • Not just memory impairment
    • Loss of executive function
    • Functional impairment
    • Behavioural and psychological changes
    • Lack of insight
  • Impairment of function
  • Progressive
  • Degenerative
  • Irreversible

25

What are the main types of dementia?

Alzheimer's

Vascular

26

What is delirium?

  • An acute, global failure of higher brain function
  • i.e. affecting level and content of consciousness
  • i.e. alertness and cognition
  • Acute Brain Failure = A medical emergency

27

How do you distinguish between dementia and delirium?

Patient history vital

Dementia:

  • Chronic (months-years)
  • Gradual progression
  • No change in conscious level
  • Irreversible

Delirium:

  • Acute (hours-days)
  • Fluctuating
  • Main problem with alertness and attention
  • Usually reversible
  • Usually precipitated by something

28

What are the screening tests for cognitive impairment?

  • 4AT score
  • MOCA

29

What are the components of the 4AT score?

  1. Alertness
  2. AMT 4 (age, DOB, location, current year)
  3. Attention (months in backwards order)
  4. Acute changes/fluctuating course

Note:

The higher the score the more likely delirium

30

What are the advantages of the MOCA score?

  • 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