FPC2 Tutorial 3 Ageing Well or Not so Well

Question 1

Homeostatic reserve (the ability of an organism to stabilise its normal internal environment) is the same in the elderly as in early and middle adult life: True or False

Answer 1

false

Question 2

Disease always presents in the same way in the elderly as it does in younger adults: True or False

Answer 2

false

Question 3

Normal ranges e.g. peak flow rate, are affected by age: True or False

Answer 3

true

Question 4

Drug handling alters with age: True or False

Answer 4

true

Question 5

Treatable disease in the elderly is frequently ascribed to “normal ageing”: True or False

Answer 5

true

Question 6

Define “Ageism”

Answer 6

A process of systematic stereotyping and discrimination against people just because they are old.

Question 7

Lifestyle changes in old age are not worthwhile as they produce no significant health benefits: True or False

Answer 7

false

Question 8

In 2000, the proportion of the world’s population over 60years was 11%. By 2050, it is expected to be:

A 8% B 15% C 22% D 40%

Answer 8

C

22%

Question 9

In the period 2000 to 2050, the number of people aged 80 and older will increase:

A 2-fold B 3-fold C 4-fold D 5-fold

Answer 9

C

4-fold

Question 10

By 2050, what percentage of older people will live in low-income and middle-income countries?

A 80% B 65% C 50% D 35%

Answer 10

A 80%

Question 11

In the world’s poorest countries, the “biggest killers” are:

A) Cholera and dysentery

B) Heart disease, stroke and chronic lung disease

C) Malaria

D) Sleeping sickness

Answer 11

B Heart disease, stroke and chronic lung disease

Question 12

Older people in low-income and middle-income countries carry a greater disease burden than those in the rich world: True or false?

Answer 12

true

Question 13

By 2050, the number of older people who are no longer able to look after themselves is forecast to increase:

A Not at all B Two-fold C Three-fold D Four-fold

Answer 13

D

4-fold

Question 14

Worldwide, most training for health professionals includes instruction about specific care for older people: True or False

Answer 14

false

Question 15

Creating “age-friendly” physical and social environments does not improve the active participation and independence of older people: True or False

Answer 15

false

Question 16

A 63 year old patient who gives up smoking will decrease their risk of premature death by:

A 50% B 40% C 30% D 20%

Answer 16

A

50%

Question 17

what are happening to the shape of population pyramids?

Answer 17

beocming more top heavy as the numbers of the eldery population is increasing

Question 18

what is the fastest growing age group in the world?

Answer 18

80+ age group

Question 19

Scotland 2004-2031:

The number of children aged under 16 is projected to decrease by 15%

The number of people aged 16-29 is projected to fall by 12%

The number of people aged 30-49 is projected to decrease by 17%

The number of people aged 50 and over is projected to increase by 28%

The number of people aged 65 and over is projected to rise by 58% and the number aged 75 and over is projected to rise by 75%.

what are some health implications of this demographic change?

Answer 19

Increased numbers of geriatricians and health professionals involved in care of the elderly will be required

Increased facilities for elderly health care will be required

The care of many long term conditions e.g. diabetes, CVD, neurological conditions, renal disease is moving from secondary care to primary/community care. The end stage of these diseases requires as much palliative care as cancer. The prevalence of such diseases will increase as the population ages

Specific health promotion campaigns aimed at the elderly

Question 20

Scotland 2004-2031:

The number of children aged under 16 is projected to decrease by 15%

The number of people aged 16-29 is projected to fall by 12%

The number of people aged 30-49 is projected to decrease by 17%

The number of people aged 50 and over is projected to increase by 28%

The number of people aged 65 and over is projected to rise by 58% and the number aged 75 and over is projected to rise by 75%.

What are some social implications of this demographic change?

Answer 20

As the population ages, they will be increasingly dependent on families and/or carers who are also ageing

The demand for home carers and nursing home places is likely to increase

Within local communities, there will be increasing emphasis on providing social activities for the elderly

The role of the elderly as grandparents and carers of grandchildren is likely to change

Housing demands are likely to change as more elderly people live alone

Question 21

Scotland 2004-2031:

The number of children aged under 16 is projected to decrease by 15%

The number of people aged 16-29 is projected to fall by 12%

The number of people aged 30-49 is projected to decrease by 17%

The number of people aged 50 and over is projected to increase by 28%

The number of people aged 65 and over is projected to rise by 58% and the number aged 75 and over is projected to rise by 75%.

What are the political implications of this demographic change?

Answer 21

Current decision making and workforce planning must take account of the ageing population

The increasing elderly population will potentially have the power to influence political decision making in relation to their specific concerns

Question 22

Scotland 2004-2031:

The number of children aged under 16 is projected to decrease by 15%

The number of people aged 16-29 is projected to fall by 12%

The number of people aged 30-49 is projected to decrease by 17%

The number of people aged 50 and over is projected to increase by 28%

The number of people aged 65 and over is projected to rise by 58% and the number aged 75 and over is projected to rise by 75%.

What are the economic implications of this demographic change?

Answer 22

Retirement/Pension age is already increasing

Finding employment may become harder for young people, as older people being required to work for longer blocks the “top end” of the employment sector

Proportionately less people will be paying into tax and pension funds, making it increasingly difficult to obtain an adequate return from pension funds

Those elderly who have not contributed to a private pension fund may find that the state pension is inadequate, resulting in poverty

Increasing cost of “free personal care for the elderly” policy (Scotland)

Question 23

From 1951 to 2001, how have the births and deaths changed in scotland?

Answer 23

births decreased

deaths stayed around the same

Question 24

how have life expentancies for males and females changed over recent decades?

Answer 24

Question 25

what is the leading cause of death for women in england? 2015

Answer 25

dementia and alzheimers disease

Question 26

what is the leading cause of death of men in england? 2015

Answer 26

heart disease

Question 27

what is the life expectancy in england?

Answer 27

Provisional data for 2016 indicate that life expectancy at birth has now reached 79.5 years for males and 83.1 years for females Since 2000 to 2002, both life expectancy and healthy life expectancy have increased; the population is now living longer and spending more years in good health. Since 2000 to 2002, life expectancy has increased by more years than healthy life expectancy and therefore the number of years lived in poor health has also increased slightly; in 2013 to 2015 it was 16.1 years for males and 19.0 years for females. However, the proportion of life spent in poor health has remained stable and these data do not take into account trends in the types and severity of diseases over time

Question 28

for both sexes, have years in poor health increased?

Answer 28

Question 29

what is inequity?

Answer 29

The following graphs give an indication that not only life expectancy, but also healthy life expectancy can vary depending on the socioeconomic status of the person affected

Question 30

how is poor health related to ageing and what is its effect?

Answer 30

The combined effect of the higher prevalence of Long Term Conditions (Tutorial 1, Year 2) and a population which is proprotionately older and spending more years in poor health is placing considerable pressure on Health Care and Social Care systems in the UK

Question 31

It is important to work with _______________ such as Age Concern to help patients live healthier and better quality lives

Answer 31

Third Sector Organisations

Question 32

are the number of family/friend carers increasing or decreasing?

Answer 32

6.5 million people in the UK are carers and this number continues to rise There will be 9 million carers in the UK by 2037 Every year over 2.1 million adults become carers and almost as many people find that their caring responsibilities come to an end This ‘turnover’ means that caring will touch the lives of most of the population, as we all need or provide care or support family members caring for loved ones at some point in our lives 3 in 5 people will be carers at some point in their lives 1.4 million people provide over 50 hours of unpaid care per week The care provided unpaid, by the nations’ carers is worth an estimated £119bn per year – considerably more than total spending on the NHS in England 27% of carers were in receipt of Disability Living Allowance as a result of their own disability or ill health

Question 33

who do family/friend carers care for?

Answer 33

Most carers (40%) care for their parents or parents-in-law Over a quarter (26%) care for their spouse or partner People caring for disabled children under 18 account for 8% of carers and 5% of carers are looking after adult children A further 4% care for their grandparents and 7% care for another relative Whilst the majority care for relatives, one in ten carers (9%) care for a friend or neighbour Most carers care for just one person (83%), but 14% care for two people and 3% are caring for at least three people

Question 34

what is the impact of caring?

Answer 34

Half of working age carers live in a household where no-one is in paid work Almost 1 in 3 (30%) carers had seen a drop of £20,000 or more a year in their household income as a result of caring A third of carers had cut back on essentials like food and heating (32%) 45% of carers said their financial circumstances were affecting their health 42% of carers have missed out on financial support as a result of not getting the right information and advice Carers providing round the clock care are more than twice as likely to be in bad health than non-carers 61% of carers said that they were worried about the impact of caring on their relationships with friends and family In 2014, half of carers (49%) said they feel society does not think about them at all

Question 35

what is multimorbidity?

Answer 35

“the co-existence of two or more long-term conditions in an individual“ It is the norm, rather than the exception, in primary care patients

Question 36

what are some examples of drug classes for different conditions?

Answer 36

Question 37

what makes the management of older patients more complex?

Answer 37

Older patients may have more than one chronic health condition This adds complexity to management For example the preferred treatment for one condition may worsen another

Question 38

what are different options for care?

Answer 38

Living in own home with support from family - Different families have different levels of support they are willing or able to provide Living in own home with support from social services - Social work often can only provide care for a short spell up to three times a day, leaving her alone for long periods of time Sheltered Housing - Sheltered housing is often a useful option for people who wish to live independently, but to know there are others nearby to help when needed. Residential Home - have greater 24 hr support but no medical cover on site Nursing Home Care - have resident nurses on site. They can be extremely expensive, perhaps up to £1500 per week if funding the stay privately

Question 39

What are Anticipatory Care Plans?

Answer 39

“Advance and anticipatory care planning, as a philosophy, promotes discussion in which individuals, their care providers and often those close to them, make decisions with respect to their future health or personal and practical aspects of care”

Question 40

When should ACP be done?

Answer 40

At any time in life that seems appropriate Continuously

Question 41

Who should do the ACP?

Answer 41

by anyone with an appropriate relationship

Question 42

how should the ACP be done?

Answer 42

Thinking Ahead & Making Plans Carefully! Write it down

Question 43

How can the ACP be shared?

Answer 43

KIS (Key Information Summary) Other communication

Question 44

what is some legal information that can be in a ACP?

Answer 44

Welfare power of attorney Financial power of attorney Guardianship

Question 45

what is some personal information that can be in a ACP?

Answer 45

Statement of wishes regarding treatment/advance directive Next of kin Consent to pass on information to relevant others Preferences and priorities regarding treatment Who else to consult/inform Preferred place of death Religious and cultural beliefs re death Current level of support e.g. family/carers

Question 46

what is some medical information that can be in a ACP?

Answer 46

Potential problems Home care package Wishes re DNA CPR Scottish Palliative Care Guidelines Communication which has occurred with other professionals Details of “just-in-case” medicines Electronic care summary Assessment of capacity/competence Current aids and appliances (helps assess current functional level)

Question 47

what are some wuestions to consider in regards to home care?

Answer 47

What are the true costs of home care? Is care always available? What Care options are available? Rapid response; respite e.g. Rosewell. What is care planning? Discuss how the service has had to be redesigned

Question 48

when interviewing a patient and a carer, what is important information to gather?

Answer 48

Find out what the issues are for the carer: ## Footnote What is it like to be a carer? What help is available? What gaps are there in the service? What is the impact of being a carer on the carer’s own physical and mental health? Find out from the patient how they feel about being dependent on others for care needs? What would they like from the service that is not available? Find out from the patient how they feel about being dependent on others for care needs? Work through a scenario of patient who lives at home but is in progressive decline and requires increasing amounts of care Demonstrate what is meant by anticipatory care. How can this improve outcomes?

Question 49

what questions owuld be asked in an interview with a care manager?

Answer 49

What is the role of a care manager? (Will be discussed in Tutorial 4 also) How can they ensure that patients are receiving the appropriate level of care? How do they deal with “rationing” decisions? What can the service realistically provide? What enables them or prevents them from providing the level of care they wish to provide? What services can the access? How do they co-ordinate care?