Ageing and health care

Question 1

What are the multiple factors that goes into decision making in medicine ?

Answer 1

Multifactorial decision making;
A bit of;
- Relevant Scientific Evidence
- Patients values and preferences
- Clinical judgements

Evidence based practice is the approach that can include as much of these categories as equally as possible

Question 2

What are the different theories of ageing ?

Answer 2

Multifactorial-genetic/cellular;
- Environmental
- Evolutionary theory

Theory of ageing molecular 1;
- Age related “programmed” genetic regula5ion by epigenetic modifications (genes are being turned on and off all time in life)
- Gene methylation (to turn genes off)
- Histone modification (e.g by acetylation to promote transcription of DNA and control storage
- Accumulation of mutations

Theory of ageing cellular;
- Telomere shortening progressive loss of chromosome “caps”
- Free radical damage to DNA
- Apoptosis - programmed cell death

Theory of ageing-environmental and evolutionary;
- “Wear and tear - (in)ability to regenerate damaged tissue
- Cumulative UV and ionising radiation damage
- “Disposable soma” i.e no evolutionary advantage in survival beyond reproduction and rearing children

Question 3

What changes may you see in someone as they get older?

Answer 3

• Decline in maximal energy with age
• Organ function decline (in every organ/system)

Question 4

What will increase the decline of organ function with age?

Answer 4

Chronic disease will increase the decline of organ function with age

Question 5

How has ageing changed in Scotland since 1940’s?

Answer 5

Had a modest rise until 1950’s little overall changes since apart from a rise mainly in central belt of Scotland - The rise has even little in most ages but about 27% increase ins 60-74’s living longer and about 82% increase in 75+ living longer

Question 6

What is the general trend with disease incidence and age?

Answer 6

With the exception of accident/suicide most health issues are more common with increasing age

Question 7

How does the risk of developing a disease change with age?

Answer 7

• With increasing age, many will have several chronic conditions
• Each condition may have several medications prescribed-polypharmacy
• Medications may be for symptoms or “risk reduction”
• Be aware of relative and absolute risk reduction
• Hard to measure benefit for one individual

Question 8

How do heath costs change with age?

Answer 8

Heath and social care costs rise with increasing age

Burden of disease links to deprivation index;
- Smoking
- Alcohol
- Diet and obesity
- Housing

Question 9

What is and isn’t Realistic medicine about ?

Answer 9

Realistic medicine is about;
- Holiastic approach
- Involving the patient in decisions
- Health literacy e.g risks/benefits
- Decision making
- Potential harm in over or under investigation and treatment

It is NOT about;
- Rationing
- Ageism
- Capping/control
- Party political ideas
- The “brave new world”

Question 10

What does a Holistic approach to medicine cover ?

Answer 10

Hollistic approach;
- Previously secondary care “general medicine”
- Now acute medicine and specialities

Elderly care;
- acute hospitals
- community hospitals and day care
- “hospital at home”

Trying to see the “whole person” i.e physical, psychological, social, functional well being

Question 11

What does a comprehensive geriatric assessment include ?

Answer 11

Comprehensive geriatric assessment includes;
- Balance assessment of falls risk
- Medial and medication review
- Environmental hazards
- Functional capacity
- Psychological assessment

Question 12

What is frailty ?

Answer 12

Frailty is “a clinically recognisable state of increased vulnerability resulting from ageing-associated decline in reserve and function across multiple physiologic systems such that the ability to cope with everyday or acute stressors is comprised”

Minor illnesses (e.g UTI) can decrease a persons independence

Some people will have additional issues of poor vision/hearing, low mood, cognitive impairment

The more things they have or struggle with the more frail they become - see image

Question 13

What is covered in the Frailty assessment ?

Answer 13

PRISMA 7 questions;
- Are you more than 85?
- Male?
- Are you limited by health problems ?
- Do you need someone to help you on a regular basis ?
- Do your health problems require you to stay at home?
- If needed is someone available to help you ?
- Do you use a walking aid ?

Edmonton frail-scale - 9 aspects assessed

TUG test - “timed up and go” rise from a chair, walk 3m and return to chair - ideally <10 secs

Gait speed - 4m in < 5 seconds