ageing Flashcards

(43 cards)

1
Q

what is ageing

A

process of growing older, involving biological, psychological/cognitive and social aspects

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2
Q

what is life expectancy

A

statistical measure of how long a person can expect to live

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3
Q

what is population ageing

A

increasing average life expectancy (happening almost everywhere in world)

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4
Q

5 changes of nature of older population

A

increasing numbers of BAME older people, increasing education of older people (protective against dementia), reduction in poverty, more people are working for longer, more complex/nuanced retirement process

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5
Q

5 reasons why are people living longer

A

better nutrition, better public health, less violence, advances in medicine, better education

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6
Q

2 reasons why people age

A

programmed ageing, damage or error theories

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7
Q

describe programmed ageing

A

due to Hayflick limit, causing cells to stop dividing (due to presence of telomeres), protecting against cancer

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8
Q

describe damage or error theories of ageing

A

all cells accumulate damage from radiation or free radical oxidative stess

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9
Q

2 types of age

A

chronological age and biological age (if live poorly, accumulate more damage, so biologically older than chronological age)

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10
Q

how to prevent ageing

A

no specific anti-ageing therapies, but start young with healthy lifestyle (exercise most important)

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11
Q

challenges society faces due to population ageing

A

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ratio), extending healthy old age not just life expectancy, caring for older people, the sandwich generation, outdated and ageist beliefs/assumptions, medical system designed for single acute diseases

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12
Q

describe working life/retirement balance (dependency ratio)

A

number of dependence in society compared to number of people in work (relevant to pensions), hence increase in pension age and retirement nuances

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13
Q

describe extending healthy old age not just life expectancy

A

want to increase both life and healthy life expectancies (compress morbidity towards end of life); influenced by health behaviour, environment, job etc., and genetics

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14
Q

describe caring for older people

A

3% of >65s live in care home; due to loss of budgets, less spent on social care (means tested); “sandwich generation” are people working, bringing up children and looking after elderly parents

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15
Q

implications of ageing population on healthcare

A

increased demand for primary, secondary and tertiary healthcare; increased complexity; navigate health and social care divide

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16
Q

define frailty

A

loss of biological reserve across multiple organ systems, leading to vulnerability to physiological decompensation and functional decline after a stressor event

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17
Q

2 classes of factors affecting frailty

A

genetic, acquired (e.g. pollution, job, etc.)

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18
Q

effect of frailty on organs

A

more likely to become infected or diseased, and fail if minor stresser event (e.g. UTI)

19
Q

3 divisions of frailty

A

mildly frail (still able to get out, independent) -> moderate -> severe (bed-bound or in hospital)

20
Q

how to treat frailty (prevention is better)

A

exercise (increase physiological reserve), nutrition

21
Q

% of >80s who are frail

22
Q

7 non-specific presentations of frailty (less likely to have common symptoms of disease)

A

falls, reduced mobility, recurrent infections, confusion, weight loss, “not coping”, iatrogenic harm

23
Q

consequence of frail patients being less likely to have common symptoms of disease

A

delayed diagnosis

24
Q

what is multimorbidity

A

2 or more chronic conditions (increases with age)

25
impacts of multimorbidity
conditions and treatment impact on one another; worse quality of life, increased depression, increased functional impairment, burden of treatment, polypharmacy (increased number of medications)
26
why do older people take more drugs
multimorbidity, guidelines (QOF, NICE), undetected non-adherence, infrequent review, poor communication
27
4 outcomes of polypharmacy (40% of prescriptions are inappropriate)
falls, increased length of stay, delirium, mortality
28
describe iatrogenic harm
caused by medical examination or treatment e.g. adverse drug reactions to medications (increases with polypharmacy), with NSAIDs being most likely to cause hospital admission
29
5 reasons why older people are at increased risk of iatrogenic harm
reduced physiological reserve, impaired compensation systems, comorbidities, polypharmacy, cognitive impairment
30
nosocomial conditions causing iatrogenic harm
infections, pressure sores, constipation, deconditioning (lose muscle mass and bone density due to bed rest), delerium, malnutrition, incontinence
31
2 other causes of iatrogenic harm
falls, psychological/cognitive damage
32
what is a comprehensive geriatric assessment
multidisciplinary assessment (medical, functional, social, psychological/psychiatric), problem list, plan
33
describe importance of rehabilitation
aims to restore or improve functionality, multidisciplinary; either alongside acute illness (e.g. prevent deconditioning), or prehabilitation (before surgery etc.)
34
changes in ageing brain
lose connections between neurones (atrophy of grey and white matter), enlarged ventricles
35
normal cognitive changes in older people
reduction in problem solving ability (reduced executive functions in frontal lobe), slow processing speed (atrophy of white matter), slightly reduced working memory, reduction in divided attention
36
3 abnormal cognitive changes in older people
changes in nondeclarative memory, visuospatial abilities and language
37
what is dementia
decline in all cognitive functions (not just memory); impairs function, progressive, degenerative, irreversible
38
majority types of dementia
Alzheimer's (early memory changes), vascular (early processing speed changes), mixed
39
cognitive assessments: screening tests
AMT, clock-drawing test, MMSE, MOCA
40
cognitive assessments: diagnostic tests
ACE, detailed neuropsychometric testing
41
advantages of MOCA over MMSE
covers variety of domains of cognitive function, brief, available in translated versions, widely used, validated in range of populations
42
disadvantages of MOCA
affected by education and language levels, floor and ceiling effects, can be poorly administered, possibly practice/coaching effects
43
general problems with cognitive assessments in general (interpret in context)
limited by hearing/visual/physical impairment, assumption of literacy, numeracy and basic cultural knowledge, not valid in acute illness, depression masquerades as dementia, normal cognitive changes may affect administration