How will Australian population have changed in 20 years time?
Many more people above the ages of 65 and 80
Increased pressure on healthcare services
Briefly describe factors that have led to the compression of mortality over time?
PICTURE SLIDE 7
Many medical factors: immunisation, combatting childbirht mortality
Many environmental factors: altering the resources available, conditions in which people live
Describe why compression of morbidity is just as important as compression of mortality?
Don't want people living longer with disabilities and poor health outcomes
So, need to delay onset of disability as well as mortality
Quality of life vs quantity of life
Total of all changes an organism undergoes from conception to death
Define cellular and organismal senescence?
Cellular senescence: phenomenon where cells lose their ability to divide
Organismal senescence: the ageing of whole organisms
How can disease and deconditioning affect ageing?
Accelerate the ageing process
Describe how we cope with responding to challenges during ageing?
Decreased reserve to respond to challenges
Describe the difference between successful ageing and usual ageing?
Successful ageing: changes due solely to the ageing process, unaffected by disease, environmental or lifestyle factors
Usual ageing: changes associated with the combined effects of the ageing process, disease and adverse environment and lifestlye factors
What is frailty?
Distinct clinical syndrome with underlying biological processes that are not yet well understood
Which biomarkers are associated with frailty?
Frailty is associtaed with chronic, low-grade activation of the immune system
So, biomarkers such as IL6, TNFa and CRP are associated with frailty
Describe the factors which contribute to the development of sarcopenia?
Altered CNS and PNS innervation
Altered hormonal status
Altered caloric and protein intake
Describe the effect of sarcopenia?
Decline in strength of muscles, especially limbs
Huge muscle loss and weakness
Which muscle fibres are most affected by sarcopenia?
Type 2 fibre loss > Type 1 fibre loss
(Type 2 = fast twitch)
Describe Fried's criteria for diagnosing frailty?
1) Unintentional weight loss
4) Slow walking speed
5) Low physical activity
Pre-frail: 1-2 criteria
Frail: >3 criteria
Describe the difference between co-morbidity, disability and frailty?
How do they overlap?
Co-morbidity: concurrent presence of 2 or more chronic diseases (refers to how many chronic diseases a person has)
Disability: physical or mental impairment that limits 1 or more major ADL (what a person cannot do, limitations)
Frailty: stage of high vulnerability for adverse health outcomes
Describe the health care implications for co-morbidity?
Complexity of treating concurrent diseases
Potential for preventing diseases or minimising severity
Fragmentation of services
Minimise risk of disability and frailty
Describe the health care implications for disability?
Social integration and community services
Aim to decrease dependency
Potential for primary, secondary and tertiary prevention
Describe the health care implications for frailty?
Vulnerable to stressors
Risk of geriatric syndrome
Treat concomitant issues
Progressive but potnetial for primary and secondary prevention
What is a geriatric syndrome?
How does it differ from a medical syndrome?
Accumulated effect of impairments in multiple domains that together result in a particular adverse outcome
What are the 'giants of geriatric medicine'?