Ageing

Question 1

Define ageing

Answer 1

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

Question 2

What are the two theories of ageing?

Answer 2

THe damage theory- That the internal and surrounding environmental forces cause damage ( wear and tear).

The programmed ageing theory- That it is a genetically encoded time line of deterioration, in the same way as puberty.

Question 3

Define life expectancy

Answer 3

Statistical measure of the number of years a person can expect to live.

Question 4

What lifestyle choices can increase your life expectancy?

Answer 4

No smoking
No alcohol
Balanced diet
Exercise.

Question 5

Name the 7 challenges faced by society due to an ageing population

Answer 5

Working vs retirement (funds and poverty)
Caring for the elderly and the sandwich generation.
Extended health > lifespan
Access and isolation
inadequate services
The healthcare system is designed for young people
Stereotypes

Question 6

Define frailty

Answer 6

Syndrome which decreases and individuals reserve and resistance to stress eg having multiple morbidity.

Question 7

What does an ageing population reflect the success of?

Answer 7

Public health policies, education and socioeconomic development.

Question 8

Describe one way in which the current healthcare system isn@t designed for elderly patients?

Answer 8

There is very little research done on therapies and drugs on elderly people, comorbidities or polypharmacy.

There are little NICE guidelines on pharmacy adherence and depresciption which are often wise options for elderly patients.

Question 9

What stereotypes are there about elderly patients?

Answer 9

Assumed frailty and dependence.
Assuming the opposite. Bedblockers
Forgetting elderly patients are becoming more diverse as the population does.
Blamed for getting old.

Question 10

What social care is available in england

Answer 10

Home carers, sheltered housing, care homes (residential and nursing) and personal budgets.

Question 11

What are the geriatric giants?

Answer 11

Falls, immobility, delirium, incontinence, iatrogenic problems, fluctuating disability and weight loss.

Question 12

In general how can presentation in the elderly differ to that of the young?

Answer 12

Elderly patients often present with more general symptoms
eg falls and confusion

This can make it difficult accurately diagnose conditions such as infection.

Question 13

What are iatrogenic issues

Answer 13

Issues that have been caused as a result of health care eg

ADRs, falls, psychological harm.

Question 14

Describe the brain changes that occur with ageing

Answer 14

Increased CSF
Enlarged ventricles
and widened sulci between the major gyri

Question 15

When does brain mass peak?

Answer 15

20 years old

Question 16

After this peak in brain mass what happens?

Answer 16

Remains stable until around 40-45 years old and then gradually decreases by 2-3% each year

Question 17

Define dementia

Answer 17

A chronic, progressive, degenerative neurological disease that causes a decrease in cognition.

Question 18

Define delirium

Answer 18

An acute episode of confusion, usually with a clear precipitant such as an infection or medication. It can resolve but can at times leave people with residual problems.
(Increased frequency in those that have dementia)

Question 19

What are the two common forms of dementia?

Answer 19

Alzheimer’s disease and vascular dementia.

Question 20

What MDT may be involved in the rehabilitation of a patient after a heart attack or stroke?

Answer 20

Speech and language therapists, physiotherapists, occupational therapists, nurses, carers, follow up neuro or cardiac consultation. Social serves potentially.

Question 21

What are the areas that a comprehensive geriatric assessment covers?

Answer 21

Physical health, Mental health, Functionality, social and environmental.

Question 22

Give examples for each of the areas of the CGA

Answer 22

Physical- comorbidity management, diagnosis, nutrition, vision and hearing, review meds.
Mental- dementia, delirium, mood and capacity.
Functionality- mobility, balance and ADLS
Social-formal and informal carers, community and legal
environment- housing, safety, equipment and transport.

Question 23

What neurological deficit symptoms are often put down to normal ageing by patient but are definitely not normal ageing?

Answer 23

Language deficit, long term memory issues.

Question 24

Name 4 cognitive screening tests

Answer 24

AMTS- (abreviated mental test score)
4AT-
MoCA- Montreal cognitive assesment
MMSE- mini mental state evaluation

Question 25

What are some critisms of the MoCA

Answer 25

It is fairly brief so doesn’t really give a good context for how bad the deficit is.
The patient needs English skills, so scores need to be taken into context.