What is the life expectancy of a baby girl born in England today?
83 years
Why are average ages in the world increasing?
People are living longer and fertility rates are falling
What are the 2 theories for ageing?
- Programmed ageing
* Damage or error
What do the theories for programmed ageing involve?
- Genetics
- Cells have a culture limit - Hayflick limit
- Related to telomerase
- Allows cell to reach maturity
- Benefit = prevention of cancer
- Evidence suggests more active telomerase increases lifespan
What do the theories for damage or error involve?
- Free radicals (oxygen, hydrogen peroxide, nitrous oxide)
- Generated in the body - particularly by mitochondria
- Mitochondria are damaged
- Mitochondrial DNA doesn’t have good repair mechanisms
- When they die, the cell dies
- Chronic inflammatory conditions cause faster ageing
- Constant radiation exposure - DNA damage
- Protein cross-linking over time => damage/non-functional
How is smoking related to the theory of damage/error?
- Smoking increases oxidative stress and free radical production
- Smokers age quickly
What are the challenges of an ageing society?
- Work/retirement balance
- Caring for older people
- Extending health in old age, not just life expectancy
- Inadquate servives
- Outdated ageist beliefs/assumptions
- Medical system (designed for single acute diseases)
Why is extended life not necessarily ideal?
At the moment, we have an extension of life with an extension of comorbidities - make people more impaired before they die
What is frailty?
- Loss of biological reserve across multiple organ systems
* Leading to vulnerability to physiological decompensation and functional decline after a stressor event
How do we treat frailty?
- Exercise
- Nutrition
- Drugs - particularly ACE inhibitors
(prevention > cure)
What are non-specific presentations of frailty?
- Falls
- Reduced mobility
- Recurrent infections
- Confusion
- Weight loss
- Iatrogenic (medical) harm
How do disease symptoms change in older people?
Less likely to have common symptoms, more likely to have harder symptoms to interpret e.g.
• Shortness of breath rather than chest pain for acute coronary syndrome
• Syncope rather than pleuritic chest pain and haemoptysis for PE
Why do older people take more drugs?
- Multimorbidity
- Guidelines
- Undetected non-adherence
- Infrequent review
- Poor communication
What is the term to describe uneccessary prescriptions and what are the consequences?
Potentially inappropriate polypharmacy (PIP)
• Up to 40% prescriptions are inappropriate
• Associated with bad outcomes e.g. falls, increased hospital stay, delirium, mortality
What are nosocomial infections?
Caught in a hospital • Infections • Pressure sores • Constipation • Delirium • Malnutrition etc.
What is a comprehensive geriatric assessment?
Multidisciplinary assesment - medical, functional, social, psychological
In the community:
• Reduces admissions and falls
For frail inpatients:
• Reduces mortality, functional and cognitive decline, and further admission
How does a brain CT compare in an older person?
- More prominent sulci and ventricles
* Lost grey and white matter (atrophy)
Why does grey and white matter deteriorate in ageing brains?
- Number of connections between neurones reduced
* Neurones themselves shrink
Is there a change in non-declarative memory (how to do things), visuo-spatial abilities or language in older people?
None, although they may be a reduction in verbal fluency
What is dementia?
- Decline in all cognitive functions (not just memory)
- Impairement of function
- Progressive and irreversible
What are the different types of dementia?
- Alzheimer’s - most common
* Vascular dementia
Give some examples of causes of dementia
- HIV
- Thiamine deficiency
- Alcohol
- Hypothyroidism
- MS
- Head injury
Compare dementia and delirium
Dementia • Chronic • Gradual • No change in conscious level • Irreversible
Delirium • Acute • Fluctuating • Problem with alertness • Reversible
What cognitive screening tests can be done on someone with dementia?
- AMT (abbreviated mental test)
- Clock drawing test
- Montreal Cognitive Assessment (MOCA)
