Define ageing
Process of growing older
Define life expectancy
Statistical measure of the number of years a person can expect to live
How is the older population changing?
Living longer bc better public health
What challenges does society face as a result of population ageing?
- Working life/retirement balance
- Caring for older people, the sandwich generation
- Extending healthy old age not just life expectancy
- Inadequate or absent services
- Outdated and ageist beliefs/assumptions
- Medical system designed for single acute diseases
- Limited accessibility for those with disabilities
How does disease presentation change with age?
- Non-specific presentation
- Multi-morbidity
- Frailty
What are the difficulties in managing disease in older people?
- Multimorbidity
- Polypharmacy
- Iatrogenic harm
- Comprehensive geriatric assessment
- Rehabilitation
What are the key physical changes associated with the ageing brain?
- Neurones shrink
- Decreased connections between neurones
- Ventricles enlarge
- Gaps between major gyri widen
- More CSF surrounding brain
- Decrease in grey + white matter
What are the key issues associated with cognitive assessment of alder adults?
- Most assessments assume numeracy and literacy
- Not valid in acute illness
- Not all cover all cognitive functions
- Need tests in many different languages
- Education + language levels
- Practice/coaching effects
- Floor + ceiling effects - if highly educated, SKIP
- Blind/deaf
- Ideally, want multidisciplinary assessment –> problem list –> plan
How is the demography of society changing?
- Population is ageing
- Increase in average life expectancy
- Fertility rates are dropping
- People are living longer bc better public health
What are the key cognitive changes associated with the ageing brain?
- Slightly decrease in problem solving ability
- Decreased processing speed
- Slight decrease in working memory
- Decrease in divided attention
- Decrease in executive functions: plan, adapt
- Dementia = decrease in all cognitive functions, not just memory
- No change in nondeclarative memory, visuospatial abilities, language (some reduction in verbal fluency)
What are some non-specific signs/symptoms of disease in the elderly?
- Weight loss
- Confusion
- “Not coping”
- Iatrogenic harm
- Recurrent infections
- Reduced mobility
- Falls
What are the main causes and theories of ageing?
Multiple theories about why organisms age fall into 2 broad categories:
- Programmed ageing theories
- Describe how genetic, hormonal + immunological changes over lifetime lead to cumulative deficits we see as ageing
- Theories tend to suggest this is part of an inescapable biological timetable, just as growth and puberty are programmed to occur
- Hayflick limit to no. of divisions (telomeres + telomerase counts)
- Allows cell to divide if it needs to - prevents cancer
- Insulin + IGF1 - Damage/error theories
- Describe accumulation of damage to DNA, cells and tissues, e.g. loss of telomeres or oxidative damage, as cause for ageing
- implicitly hold that if we could prevent or repair this damage then we could prevent ageing
a) Smoking, HIV, RA
- Free radicals generated by mitochondria
- NO, O2, H2
- Damage mio
- Damage mito DNA
- No repair mechanism for mito DNA
damaged - cells can’t make energy –> cell death
b) Protein cross-linking –> damage –> non-functional
What is frailty?
- Loss of functional reserve among older people
- Causes impairment of ability to manage every day activities
- Increases likelihood of adverse events + deterioration when faced w/minor stressor
