Flashcards in Ageing Deck (30)
The process of growing older: this has biological, psychological and social aspects.
Define life expectancy.
A statistical measure of how long a person can expect to live.
Describe changes in life expectancy throughout the world.
Population ageing is the increase in average life expectancy. Around the world, average ages in the population are increasing. This is because people are living longer, and because fertility rates are falling. Population ageing is happening much more quickly than in the past. The primary reason for this is due to better public health.
Why do people age?
- theories for programmed ageing
- theories for damage or error
List the theory for programmed ageing.
1. Genetic life-span theory
2. Genetic predisposition theory
3. Telomere theory
4. Specific system theories (Neuroendocrine theory)
Cells in culture have a limit for how many times they can divide - Hayflick constant. This may be to do with the enzyme telomerase - there is evidence to suggest humans with more active telomerase live longer (prevention of cancer).
List the theories for damage/error.
1. Free radical theory
2. Wear and tear theory
3. Rate of living theory
4. Waste product accumulation theory
5. Cross-linking theory
6. Autoimmune theory
7. Error theories
8. Order to disorder theory
List some ways we can prevent ageing.
- not smoking
- drinking alcohol only in moderation
- exercise (best thing to prevent frailty)
- eating healthily (many fruits and vegetables)
List some challenges that society faces with an ageing population.
- working life/retirement balance (funding pensions)
- caring for older people
- extending healthy old age
- inadequate or absent services
- ageist beliefs
- limited access for those with disabilities
A loss of biological reserve across multiple organ systems, leading to vulnerability to physiological decompensation and functional decline after a stressor event.
Around 40% of over 85s are frail.
Which factors affect ageing?
1. Genetic - if parents lived to old age, you are also more likely to.
2. Environmental - smoking and alcohol consumption -> cellular damage -> reduced physiological reserves in organs -> frailty
List some factors increased frailty is associated with.
- increased risk of falls
- worsening disability
- care home admission
How can we treat frailty?
Exercise, nutrition and drugs (ACE inhibitors may be beneficial).
Prevention is better than cure.
List some non-specific presentations of frailty.
- reduced mobility
- recurrent infections
- weight loss
- 'not coping' at home
- iatrogenic harm
Older people are less likely to have common, textbook symptoms of diseases.
Multimorbidity is two or more chronic conditions.
What are the negative impacts of multimorbidity?
- worse quality of life, more likely to be depressed
- increased functional impairment
- burden of treatment
- polypharmacy – polypharmacy increases with age (up to 40% of prescriptions are inappropriate)
Why do older people take more drugs?
3. Undetected non adherence
4. Infrequent review
5. Poor communication
Describe iatrogenic harm.
- adverse reactions to medications
- nosocomial infections
- falls resulting from drugs (postural hypotension)
- psychological/cognitive damage
How many hospital admissions are due to adverse drug reactions?
Up to 17%
NSAIDs account for about 30% of adverse drug reactions that cause hospital admissions. Warfarin is the next most common drug to cause problems (10% of ADRs).
What is a comprehensive geriatric assessment?
A multidisciplinary assessment: medical, functional, social, psychological/psychiatric. It encompasses all the things that are affecting the patient at that moment.
What is the purpose of rehabilitation?
To restore or improve functionality.
Describe the changes in an ageing brain.
Much more prominent sulci and ventricles.
We lose both grey and white matter as we age. Numbers of neuronal connections reduce, as does the size of individual neurones (atrophy).
List some normal cognitive changes in an older person.
- processing speed slows
- working memory slightly reduced (e.g. digit spans)
- simple attention ability preserved, but reduction in divided attention
- executive functions generally reduced
- no change in non-declarative memory (e.g. how to do things)
- no change in visuo-spatial abilities
- no overall change in language (some reduction in verbal fluency)
Decline in all cognitive functions, not just memory (but often presents as a memory deficit disease). Dementia is progressive, degenerative and irreversible.
Name some types of dementia.
- Alzheimer's dementia
- vascular dementia
List some causes of dementia.
- progressive multifocal leukencephalopathy
- thiamine deficiency
- multiple sclerosis
- progressive supranuclear palsy (PSP)
What is the difference between dementia and delirium?
Dementia is chronic and gradually-progressing. There is no change in consciousness and it is irreversible.
Delirium is acute, fluctuating and usually reversible. The main problem is with alertness and attention. It is usually precipitated by something. Older people with dementia are at higher risk of delirium.
Name some cognitive assessments.
1. Screening tests - AMT, clock drawing test, 4AT, GP COG, 6CIT, Mini Mental State Examination (MMSE), Montreal Cognitive Assessment (MOCA)
2. Diagnostic tests - Addenbrooke’s Cognitive Examination (ACE), detailed neuropsychometric testing
List some advantages of the MOCA.
- covers any domains of cognitive function
- brief to administer
- validated in a range of populations
- available in translated versions
- widely used
List some disadvantages of the MOCA.
- education level will affect results
- language level will affect results
- floor and ceiling effects
- can be poorly administered
- possibly practice/coaching effects