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Flashcards in Ageing and Frailty Deck (30)

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?

  1. Unintentional weight loss
  2. Weakness
  3. Exhaustion
  4. Slow walking speed
  5. Low physical activity
  6. Pre-frail 1 or 2 criteria
  7. 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 balance

Impaired cognition (delirium & dementia)

Iatrogenic illness


How are geriatric syndromes linked to frailty?

See image


How are molecular diseases, impaired physiology and clinical outcomes linked in frailty?

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