Are people living longer?
No, they’re just living out their natural life expectancy
What is ageing?
The total of all changes an organism undergoes from conception to death
What is cellular senescence?
The phenomenon where cells lose the ability to divide
What do cells do in response to DNA damage (including shortened telomeres)?
Cells either senesce or self-destruct (apoptosis) if the damage cannot be repaired
What is organismal senescence?
Ageing of whole organisms
What does diversity increase with?
What is successful aging?
Changes due solely to the ageing process, unaffected by disease, environmental or lifestyle factors.
What is usual aging?
Changes associated with the combined effects of the ageing process, disease and adverse environment and lifestyle factors.
What is frailty?
Diminished ability to carry out the important practical and social activities of daily living.
Excess demand imposed upon reduced capacity.
A precarious balance easily perturbed.
At risk for adverse health outcomes.
Unable to integrate responses in the face of stress
What is frailty associated with?
A low-grade, chronic activation of the immune system with abnormalities of the endocrine and coagulation systems.
What is the role of the immune system in frailty?
Cytokine levels increase 2-4x with age.
Can predict functional decline, onset of disability and mortality in the elderly.
Inflammatory cytokines have a direct catabolic effect on muscle mass and strength and some (IL6 and TNFα) have been shown to cause anorexia
What happens to CRP in frailty?
CRP concentrations are higher in healthy older persons compared to younger
Higher values associated with baseline and incident frailty after adjustment for co-morbidities such as DM and CVD
Less clear that CRP is associated with mortality in the elderly
What happens with IL-6 in frailty?
Higher levels of IL6 are associated with mortality in the elderly and are associated with poor survival in institutionalised elderly
Higher levels are associated with lower muscle mass and lower strength in healthy community dwelling elderly, even after adjustment for confounders
Predictive of functional decline independent of disease states
What happens with TNFa in frailty?
Higher levels with ageing
Independent marker of mortality in the very old
Mixed results with regard to its association with frailty and frailty related outcomes
Postulated that it is produced locally in tissues (where its role is to upregulate IL6) and that serum levels may not adequately reflect immune activation
What happens with sarcopenia in aging?
Altered CNS and PNS innervation (neuronal loss of anterior horn cells and ventral root fibres)
Altered hormonal status (decrease GH, IGF-1, oestrogen & testosterone)
Inflammatory effects (Increase in IL-1 and IL-6 receptor antagonist)
Altered caloric and protein intake
What does muscle weakness in aging correlate with?
Loss of muscle mass
When does decline in muscle mass occur?
Decline in skeletal muscle mass commences at the beginning of 3rd decade but does not become substantial until the end of the 5th decade (MRI study)
How are muscle fibre types lost?
Type 2 (fast-twitch) fibre loss >> Type 1 (slow-twitch) fibre loss.
What are Fried's criteria for frailty?
- Unintentional weight loss
- Slow walking speed
- Low physical activity
- Pre-frail 1 or 2 criteria
- Frail ≥ 3 criteria
What is co-morbidity?
Concurrent presence of ≥ 2 chronic disease
What is disability?
Physical or mental impairment that limits ≥ 1 major ADL
What is frailty?
State of high vulnerability for adverse health outcomes
What are the health care implications for co-morbidity?
Complexity of treating concurrent diseases
Disease interaction → adverse outcomes
Treatment priority o Polypharmacy
Potential for preventing diseases or minimising severity
Fragmentation of services
Minimise risk of disability and frailty
What are the health care implications for disability?
Social integration & community services
Aim to decrease dependency
Potential for primary, secondary and tertiary prevention
What are the health care implications for frailty?
Vulnerable to stressors
Risk of geriatric syndromes
Treat concomitant issues e.g. Malnutrition, weakness
Progressive but potential for primary and secondary prevention
What is a medical syndrome?
The grouping together of multiple symptoms that have a single pathogenetic pathway.
Aggregate of symptoms and signs associated with any morbid process, and constituting together the picture of the disease.
What is a geriatric syndrome?
The accumulated effect of impairments in multiple domains that together result in a particular adverse outcome.
One symptom or a complex of symptoms with high prevalence in geriatrics, resulting from multiple diseases and multiple risk factors.
Which geriatric syndromes are the giants of geriatric medicine?
Impaired cognition (delirium & dementia)
How are geriatric syndromes linked to frailty?
How are molecular diseases, impaired physiology and clinical outcomes linked in frailty?