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RDA - reproduction, development and aging > aging > Flashcards

aging Flashcards

1
Q

define aging *

A

it is the process of growing older - biological, psychological/cognitive, social

the biological process of growing old, with associated changes in physiology and increased susceptibility to disease and increased likelihood of dying.

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2
Q

define life expectancy *

A

a statistical measure of how long a person is expected to live

can define at different points eg LE at birth and LE at 65 might differ because of the things that have influenced your health

LE for baby girl in england is 83

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3
Q

describe the trend of age in the population *

A

worldwide population is aging - increasing LE and falling fertility rates

because of better nutrition, better public health, reduced violence, advances in medicine and better education

improved public health is the main factor

advance in medicine is one of the smaller contributers

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4
Q

describe the changing natyre of the older population *

A

Increasing numbers of BAME older people (ethnic minority)

Increasing education of older people - people reaching older age are better educated now - protective against dementia, predictions of high levels of dementia with aging pop hasnt happened

Reduction in poverty

More people are working for longer

More complex/nuanced retirement process - people leave and come back, come back part-time/to a different job

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5
Q

what are the 2 theories of aging *

A

programmed aging

damage or error theories

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6
Q

describe programmed aging *

A

aging is built into DNA - influenced by genetic, hormonal and immunological changes

cells in vitro divide for a certain time then stop - this is the hayflick limit - ie the number of times a cell divides before it stops

it is because of telomeres

cells count the number of times they divide and age, then cant make new cells - this is to protect them against cancer

if we could alter genes, improve telomerase or stop degradation of telomers could in theory increase LE

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7
Q

describe damage or error theories *

A

cells accumulate damage from radiation. radicals, DNA damage and misrepair and loss of telomeres

if we could stop DNA damage - could stop aging

mice on calorie restricted diets produce less free radicals = longer lives

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8
Q

summarise the theory of aging *

A

there are no proven anti-aging therapies in humans

people age at different rates - have the chronological and biological age - chronological is the actual age, biological is the age because of health behaviours - if unhealthy you will have a higher biological age than chronological age

unhealthy people more likely to die younger

both programmed and damage/error theories of aging probably contribute

20-20% of age is genetic - if have relatives that live until old age you will probably age slower - appear younger and have better organ function

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9
Q

can we prevent aging *

A

by stopping smoking, drinking excessively, doing more exercise and eating healthily

can stop protein glycation and free radical production

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10
Q

what challenges does population aging cause society *

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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11
Q

describe the working life/retirement balance problem *

A

as a society we are not saving enough for retirement

there is autoenrolement when people get jobs into government pesion scheme but this is underfunded

pension was set at 65 because that was the LE - therefore pension was affordable for the government because they were only paying to 50% population

now people are living longer so people have to work longer - not unreasonable because people are more healthy at 65 - influences the complex move into retirement eg people working part time

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12
Q

what is the dependancy ratio *

A

the number of dependants (children, students and retired) compared to people of working age

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13
Q

describe the problem of extending healthy old age not just LE *

A

there has been an increase in LE for people of all classes - this is tailing off - perhaps because of austerity and the cut in social care and pension poverty - there is a decrease in LE in the most deprived women

we have been doing life extension - ie increasing LE but not affecting the onset of health problems so people are living longer in poor health - implications on the health service

we want to compress morbidity so people are living longer healthy lives

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14
Q

what effects health in old age *

A

genetic inheritance

where we live - noise/air pollution, job and stress

health behaviour

access to health care

the more well off = longer healthy LE

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15
Q

describe the problem of caring for older people *

A

social care budgets are cut - most councils have reduced the amount that they are spending in social care

3% of >65s are in care homes

care workers are paid minimum wage and do skilled jobs - many people who do these jobs are immegrants - people in UK dont want these jobs - therefore heathcare will be effected by effects on immegration

social care is means tested - if have assets or >£23000 asked to pay for your social care - people dont want to/cant afford it so they sell homes/go without

there is market fragility - care services are private and are commissioned by councils - they are going out of business because they cant afford it - council give less money to care businesses so people paying private subsidise it so that the care homes dont make a loss

there is disjointed care - delayed transfer of care and lack of integration with health

postcode lottery

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16
Q

what is meant by care home

A

nursing home - nurses present all the time - pts are bedbound and need tube feeding etc

residential homes - have carers that are less trained than nurses - the pts have dementia and need prompting etc but physically more capable than in nursing homes

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17
Q

what is the sandwich generation *

A

people who care for an older relative and bring up children <16yrs

1.25million in UK

68% women

78% also in paid work

88 000 (84% women) provide more than 35h of care/week

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18
Q

describe the problem with the design of the NHS for the aging population *

A

it was designed for single acute diseaes

not for people with multiple comorbidities

there are projects in primary care to improve care for older people - however have to think about the payment system for GP and hospital - this doesnt help us with reform

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19
Q

what are the implications of the aging population on the health service *

A
  • Increasing demand for primary, secondary and tertiary health care - tertiary care because older people who wouldnt have been healthy enough for specialised care are now
  • Increasing complexity
  • Navigating the health and social care divide
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20
Q

what is frailty *

A

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

can have mild frailty - still see people and are independant but need a bit of help

moderately frail

severe frailty - in care homes or are bed bound, very dependant

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21
Q

what are the factors that lead to frailty *

A

genetic and env factors linked by epigenetic mechanisms, lead to molecular and cellular damage

this reduces physical reserve in organ systems, influenced by physical activity and nutritional factors that causes frailty

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22
Q

what is the effect of frailty *

A

small stressor event is more likely to have severe effects of illness - push body over the edge

lost so much reserve that the mild stressor can push them into dependancy - they cant compensate and do the things they normally do

have falls, delerium, fluctuating disability = increased care needs, admission to hospital and long term care

4-5x more likely to die then healthy older people

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23
Q

can we prevent frailty *

A

yes - stop smoking, drinking, do exercise and eat healthy

24
Q

can we treat frailty *

A

yes but difficult

through exercise which increases muscle mass and prevents loss of BMD, nutrition and possibly drugs

difficult because people who are frail need walking aidand are dependant on people

need very motivated person and support network

prevention is better than cure

25
Q

what are the non-specific presentations of frailty *

A

called the geriatric giants - symptoms, not diagnoses

  • Falls
  • Reduced mobility
  • Recurrent infections
  • Confusion
  • Weight loss
  • “Not coping”
  • Iatrogenic harm
26
Q

how do older people present *

A

either non-specifically or with non-textbook symptoms

eg for an MI - less likely to have chest pain more likely to have SOB

for PE less likely pleuritic chest pain or haemoptysis, more likely syncope

this means that the correct diagnosis and treatment can be delayed = pt gets worse

27
Q

what is multimorbidity *

A

2 or more chronic conditions

28
Q

what is the problem of multi-mobidity *

A

Conditions impact on one another - more likely to have episodes of each condition

Treatment for one condition may impact on another

Negative impacts

  • Worse QoL, more likely to be depressed
  • Increased functional impairment
  • Burden of treatment
  • Polypharmacy - drugs will interact with each other
29
Q

why do older people take more drugs *

A

Multimorbidity

Guidelines/QOF (quality outcomes framwork)/NICE - drive increase in prescription because each condition has a framework that doesnt consider other conditions

Undetected non adherence - people not adhering = unchanged symptoms on follow up so people are given more drugs (whether they take them is a different matter)

Infrequent review - deprescribing is becoming important - eg BP increases until about 80yrs so then need to remove antihypertensives

Poor communication

30
Q

describe potentially innappropriate polypharmacy (PIP)*

A

Up to 40% of prescriptions are inappropriate

eg taking long term agents for insomnia (zopiclone), long term antipsychotics for dementia, long term opiates for non-cancer pain

Polypharmacy is associated with bad outcomes eg for long term antipsychotics and opiates for pain

  • Falls
  • Increased length of stay
  • Delirium
  • Mortality
31
Q

give an example of iatrogenic harm form PIP *

A

high BP so given amlodipine - causes ankle swelling so pt given furosemide for HF

this causes postural hypotension = a fall and Colles fracture

this is the prescribing cascade - drugs given to treat the SE when actually the 1st drug should be removed and replaced

32
Q

what can be iatrogenic harm *

A

it is medical care associated harm - older people are more suseptible - include mistakes in providing care, and known complications of treatment.

  • adverse reactions to med
  • nosocomial conditions - hospital acquired
    • deconditioning
    • Infections
    • Pressure sores
    • Constipation
    • Delirium - acute delusion
    • Malnutrition - hospital meals not enough
    • Incontinence
  • falls
  • psychological/cognitive damage
33
Q

describe with constipation is a problem *

A

people are frail so have less reserve so doesnt take much to push them into problems

they dont eat or drink so at risk of renal failure and are becoming weaker

34
Q

describe deconditioning *

A

people stay in bed without moving - loss muscle mass and BMD

can lose 1Kg of muscle mass with 1 wk of bed rest

35
Q

describe why incontinance is a problem *

A

increase dependancy - need carers to change pads

skin at risk

36
Q

what is the problem with adverse drug reactions and why are older people more at risk *

A
  • Up to 17% of hospital admissions are due to drug reactions
  • The more medications taken, the greater the risk

older people more at risk:

  • Reduced physiological reserve
  • Impaired compensation mechanisms
  • Comorbidities
  • Polypharmacy
  • Cognitive impairment
37
Q

what drug is most likely to be the cause of hospital admin *

A

NSAIDS - GI bleeding, HF, renal failure

so rarely use NSAIDs in older people

38
Q

what are the benefits of comprehensive geriatric assessments *

A

CGA in the community

  • Reduce admissions to institutional care
  • Reduce falls
  • Most benefit in mild or moderate frailty

CGA for frail inpatients

  • Reduces inpatient mortality up to 6months after discharge
  • Reduces functional and cognitive decline
  • Reduces admission to institutional care
39
Q

what is involved in a comprehensive geriatric assessment *

A

MDT assessment - medical, functional, social, psychological/psychiatric

make a problem list of everything that is wrong with the pt

plan

40
Q

describe rehabilitation *

A

aim is to restore or improve functionality

MDT

rehab alongside acute illness - preventing deconditioning

prehabilitation - get people as fit as possible before operation

41
Q

what are the physical changes in the aging brain *

A

atrophy - reduction in grey and white matter

lose microglia and supportative structures

lose connections

ventricle size increase and can see the gyri (gaps between the gyri enlarge)

the volume of cerebral spinal fluid within the surrounding brain increases with age

The brain attains a maximum weight at about 20 years of age and remains at this weight until 40-50 years of age after which it decreases in weight at a rate of 2-3% per decade eventually reaching a value of some 10% below maximum by age of 80 years

42
Q

what are the normal cognitive changes in older people *

A

processing speed slows - general speed that you do things - this is the white matter

working mem is slightly reduced

simple attention ability is preserved but reduction in divided attention eg driving and talking

executive functions are generally reduced

no change in nondeclarative mem ie implicit ability to be able to do things

no change in visuospatial abilities

no overal change in language (some reduction in verbal fluency - probably to do with the reduced processing speed)

43
Q

what is dementia *

A

decline in all cognitive functions, not just memory

impairment of function

chronic

progressive

degenerative

irreversible

44
Q

can we stop dementia *

A

yes - with stopping smoking, drinking, better food and exercise

45
Q

what are the key types of dementia *

A

vascular - problem with processing speed

alzheimer’s - memory change and orientation problems

mixed

46
Q

are we diagnosing all dementia cases *

A

no

47
Q

screening tests - cognitive assessments *

A

AMT (10 point test), clock drawing test (get them to draw a clock and a time), 4AT, GP COG, 6CIT

mini mental state examination (MMSE) - not used clinically because it was designed for alzhiemer’s

Montreal cognitive assessment (MOCA) - replaced MMSE

48
Q

diagnostic tests for cognitive assessments *

A

addenbrooke’s cognitive assessment (ACE) - 100 point test, take 20mins

detailed neuropsychometric testing - takes hours, delivered by psychologist

49
Q

what are the advantages of MOCA *

A

covers a variety of domains of cognitive function

brief to administer - 10mins

validated in range of pop

available in translated versions

widely used so can compare and track change

50
Q

what are the disadvantages of MOCA *

A

education level will effect the results - add 1 point if you have <12 yrs education but in reality lack of education will reduce the score more than 1 point

language level will effect results

floor and ceiling effects - very educated people will score high even if have dementia

can be poorly administered - invented as a free test so can be performed by untrained people

possibly practice/coaching effects

51
Q

problems with cognitive assessments in general *

A
  • Hearing and visual impairment may limit testing
  • Physical problems may limit testing eg if cant hold pencil
  • Most assume numeracy and literacy
  • Most assume some basic cultural knowledge
  • Depression can masquerade as dementia
  • Not valid in acute illness
  • Normal cognitive changes (slower processing speed, slower reaction times) may affect administration
52
Q

eg of when drugs would be given for opposite effects *

A

this is potentially inappropriate polypharmacy

antihypertensive drugs and fludrocortisone to stop postural hypertension (ie to raise BP)

53
Q

why can drug treatments be more like to cause people harm *

A

there are changes in pharmacokinetics and pharmacodynamics

Many drug trials have low numbers of older people, so the evidence for treatment is often extrapolated from younger people. In the past it was common to exclude older people from drug trials altogether.

54
Q

why have diagnosises of dementia been low

A

a combination of misinterpretation (it’s normal for older people to have poor memory),

fatalism (we can’t do anything about it so what’s the point in diagnosing it)

and social isolation of some older people, such that they have no one to notice any problems.

55
Q

what is mild cognitive impairment *

A

a specific term used to refer to people who have mild problems which do not interfere with their day-to-day life and don’t meet the diagnostic criteria for dementia.

56
Q

what is delerium *

A

acute episode of confusion, usually with a clear precipitant such as infection or medication changes.

Delirium usually resolves, but can leave some people with residual problems (ie dementia).

Delirium is much more common in people who already have dementia.

RDA - reproduction, development and aging (10 decks)

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