Preventative Approaches to Ageing I

Question 1

What are the effects of more older people on health and social care?

Answer 1

Increased prevalence of age-related conditions

Increased demand for health and social care - increased cost

Question 2

What is healthy ageing?

Answer 2

Maintaining functional ability for wellbeing in old age

Question 3

What is functional ability?

Answer 3

Having capabilities that enable people to be and do what they have reason to value
Capabilities vary between individuals and cultures

Question 4

What do functional abilities typically include?

Answer 4

Meeting basic needs
Learning and making decisions
Mobility
Relationships
Contributing to society

Question 5

What are the stages of the life-course approach taken to decrease frailty and dementia risk?

Answer 5

Whole life - address inequalities
Mid-late life - prevent disease, early identification
Late/very late life - maintain health and function

Question 6

How can inequality be addressed?

Answer 6

Population-level interventions - across lifespan - e.g. opportunities, education, accessible healthcare

Question 7

Which inequalities are specific to later life?

Answer 7

Ageism

Fewer psychological therapy referrals for depression

Question 8

Name 6 key risk factors in mid-life

Answer 8

Physical activity
Diet
Weight
Smoking
Alcohol
Leisure, cognitive, social activities

Question 9

How does mid-late life physical activity affect late-life health?

Answer 9

Decreases mortality, dementia, disability, CVD, T2D

Question 10

How does mid-late life diet affect late-life health?

Answer 10

Decreases CVD

Question 11

How does mid-late life weight affect late-life health?

Answer 11

Obesity linked to CVD, T2D, arthritis, depression

Question 12

How does mid-late life smoking affect late-life health?

Answer 12

Decreases motility

Increases dementia, mortality, CVD, T2D, some cancers

Question 13

How do mid-late life leisure, cognitive, social activities affect late-life health?

Answer 13

May reduce cognitive decline

Question 14

Name 5 key interventions in mid-late life

Answer 14

Mental health support groups
Tobacco and alcohol taxation
Screening
Exercise groups
Social prescribing

Question 15

Why is a person-centred approach to ageing needed?

Answer 15

Ageing is diverse experience

Variation in abilities and experiences of old people

Question 16

What is Fried’s measure of frailty?

Answer 16

Physiological measure - does not consider mental health and support mechanisms
Frail if >=3 traits

Question 17

Can frailty be reversible?

Answer 17

Yes

Question 18

What are the frailty trait’s in Fried’s measure?

Answer 18

Slow gait
Weakness
Weight loss
Low activity levels

Question 19

What is the main method to prevent frailty progression in older people?

Answer 19

Exercise

Question 20

What is the effect of exercise on physical abilities in prefrail individuals?

Answer 20

Improves balance, muscle strength

No effect on self-reported functioning, gait speed

Question 21

What is the best form of exercise to decrease falling risk in older people?

Answer 21

Strength and balance exercises

Question 22

Are group or individual exercise sessions most effective for older people?

Answer 22

Combined - group and individual

Question 23

Which form of exercise is best for the very frail and why?

Answer 23

Individually-tailored approach

To decrease falling risk during exercise

Question 24

Name 2 interventions that decrease falling risk in older people

Answer 24

Tai chi

Home safety assessment and modification

Question 25

What are the reasons that malnutrition is common in the elderly?

Answer 25

Lifelong eating habits/views Physical frailty and lack of time - unable to cook Lack of motivation/confidence - could be due to bereavement

Question 26

Which dietary interventions are useful in older people?

Answer 26

Dietary education - change behaviours Multi-nutrient supplements - increase handgrip strength, decrease chair rise time Mediterranean diet - decreases frailty risk

Question 27

Which mental health conditions are common amongst the elderly?

Answer 27

Anxiety | Depression

Question 28

What is the link between frailty and depression?

Answer 28

Frail more likely to be depressed | Depression increases frailty risk

Question 29

How do medical professional responses to depression and anxiety differ in older patients?

Answer 29

Fewer psychological service referrals | Increased antidepressant and sleeping tablet prescriptions

Question 30

Why do medical professional responses to depression and anxiety differ in older patients?

Answer 30

Older people and medical professionals prioritise physical over mental health Older people prefer self-management - do not recognise mental illness or seek help Stereotyping of older people - assuming they do not want mental health support

Question 31

What is the most effective therapy for depression in frail older people?

Answer 31

Problem-solving therapy

Question 32

How does loneliness effect health outcomes in older people?

Answer 32

Increases risk of mortality, depression, CVD

Question 33

What is an intervention for loneliness in older patients?

Answer 33

Shared interest groups | Marketing important - many do not like idea of groups for 'lonely old people'

Question 34

Which intervention reduced cognitive decline in older people and what is a limitation of this?

Answer 34

Intensive long-term diet, exercise, vascular risk monitoring, cognitive training programme Intensive interventions hard to maintain - not practical for widespread use

Question 35

How does smoking in old age affect frailty risk and how can this be altered?

Answer 35

Increases frailty risk - mainly via COPD | Stopping smoking in old age can decrease frailty risk

Question 36

How is alcohol consumption in old age linked to frailty risk and what is a possible limitation of this?

Answer 36

Increases frailty risk No evidence that decreasing alcohol decreases frailty risk Probably reverse causality - reducing alcohol as become unwell

Question 37

What are the challenges in later life health promotion?

Answer 37

Health promotion in late life and prefrailty recent idea - lack of policy and evidence Different goals - different old people already have different long-term conditions Engaging elderly in health promotion Addressing multiple interacting risk factors - most services targeted to single conditions

Question 38

Why is it difficult to engage the elderly in health promotion and how could these issues be overcome?

Answer 38

Not motivated by increasing lifespan as feel not possible - phrase interventions as improving independence and wellbeing Unaware of benefits of making changes Difficult to reach - could access via GP

Question 39

What did a quantitative study of health promotion for prefrail older people find their goals and motivating factors are?

Answer 39

Maintenance more important than change Fear of dependency, memory problems, care homes 'Teachable moments' - triggers for change - e.g. health scare

Question 40

What did a quantitative study of health promotion for prefrail older people suggest would be a good approach?

Answer 40

Multidomain interventions - e.g. HomeHealth | Sessions with social worker - address mood, socialising, mobility, nutrition

Question 41

What are the aims of long-term condition management?

Answer 41

Secondary prevention - e.g. falls, stroke Rehabilitation Self-management Avoid polypharmacy - linked to increased frailty risk

Question 42

Which mid-late life risk factors are key modifiable factors to reduce the risk of late-life negative outcomes?

Answer 42

Physical activity | Smoking