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Define ageism.

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


Describe the demographic changes in populations in both developed and developing countries.

- Developed countries: population pyramid = equal
- Transitioning to developed: population pyramid = middle wide (more young people than old)
- Developing countries: population pyramid = bottom wide (high fertility rate)


Describe general trends in life expectancy in the UK (data from England).

- Some studies show that rise in life expectancy is slowing down (could be due to austerity measures - confounding factor perhaps).
- Healthy life expectancy: 63.4 for M, 64.1 for females
- Life expectancy increased > healthy life expectancy so the no. of poor health years have also increased. This combined with long-term conditions and ageing population puts strain on healthcare system.
- Socioeconomic status affects both overall life and healthy life expectancy (lower in deprived areas).


What are the social challenges posed by ageing populations in the UK and globally?

- 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.


What are the health care challenges posed by ageing populations in the UK and globally?

- 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.
- Specific health promotion campaigns aimed at the elderly.
- Prevalence of long-term conditions whose end stage will require as much palliative care as cancer will increase with ageing population.


What are the economic challenges posed by ageing populations in the UK and globally?

- 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)


What are the political challenges posed by ageing populations in the UK and globally?

- 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.


What are the common causes of mortality in females and males in England?

Females: Dementia and Alzheimer's
Males: Heart disease


Define multimorbidity.

The co-existence of two or more long-term conditions in an individual.


What adds complexity to management of elderly?

Older patients may have more than one chronic health condition. For example the preferred treatment for one condition may worsen another. Multimorbidity leads to polypharmacy.


What are the options for care for the elderly population?

- Living in own home with support from family
- Living in own home with support from social services
- Sheltered Housing (might not provide the care needed)
- Residential Home (24hr care but no medical cover)
- Nursing Home Care (can be expensive if private)


What is anticipatory care plans (ACP)?

ACP 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.
- When? At any time in life that seems appropriate
- Who? By anyone with an appropriate relationship
- How? Written down.
- Sharing? using KIS (key info summary), other communication etc.


What legal considerations needs to be taken with respect to ACP?

- Welfare power of attorney
- Financial power of attorney
- Guardianship


What personal considerations needs to be taken with respect to ACP?

- 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


What medical considerations needs to be taken with respect to ACP?

- 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)


True or False:
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.
2. Disease always presents in the same way in the elderly as it does in younger adults.
3. In 2000, the proportion of the world’s population over 60years was 11%. By 2050, it is expected to be 22%.

1. False
2. False
3. True


1. Normal ranges e.g. peak flow rate, are affected by age.
2. Drug handling alters with age.

1. True
2. True


1. Treatable disease in the elderly is frequently ascribed to “normal ageing”.
2. Lifestyle changes in old age are not worthwhile as
3. Older people in low-income and middle-income countries carry a greater disease burden than those in the rich world.

1. True
2. False
3. True


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

B) Heart disease, stroke, chronic lung disease.


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

D) 4 fold