Define ageing
Ageing is the process of growing older:
- Biologically
- Psychologically/cognitively
- Socially
Define life expectancy
Life expectancy is a statistical measure of how long a person can expect to live
Summarise the changing nature of the older population and the demographic changes within society
there is a gradual increase in the ageing population
over 85 + is increasing greatly
–> increase in compression of morbidity towards end of life
Summarise the challenges of ageing affecting society
- Working life/retirement balance
- -> problems with pensions
- Caring for older people
- Extending healthy old age not just life expectancy
- Inadequate services
- -> delayed transfer of care
- ageist assumptions perspectives on elderly
- current medical system = designed for single acute diseases
- Lack of accessibility for people with disabilities
- loneliness + isolation
NOTE:
- people age at different rates
there is discrepancy ebtween chronological age vs biological age
-
there is a gradual increase in the ageing population
why might this be?
- improvement in healthcare access
- improvement in awareness on healthy lifestyle + diet
- improvement in public care / social care
what is meant by fraility ?
a physiological syndrome characterised by decreased reserve and resistance to stressors, resulting from a cumulative decline across multiple physiological systems, –> causing vulnerability to adverse outcomes
How does fraility develop?
genetic factors + env factors –> lead to cumulative moelcular and cellular damage –> causes reduced reserved –> which leads to fraility –>
upon stressor event (e.g fall)
- -> they develop geriatric syndrome (e.g delirium, disability)
- -> leads to poorer outcomes (needing more care)
what are the main difficulties in managing disease in older people
- multimorbidity
- -> 2 or more chronic conditions
- -> impacts one another - polypharmacy
- -> causes adverse drug reaction
- -> due to:
- multimorbidity,
- blatantly following guidelines, - undetected non adherance,
- infrequent review
- prescription cascade (one drug –> SE –> causes prescription of another drug etc.) - Iatrogenic harm
- -> adverse drug reactions
What is Comprehensive geriatric assessment (CGA)?
what aspects does it look at?
- multidimensional interdisciplinary assessment that leads to an individualised goal based plan
looks at:
- physical health
- mental health
- functional ability
- social circumstances
- environment
- -> CGA reduces admission
- reduces inpatient mortality
- reduces functional/cognitive decline
NOTE: Frail individuals often require rehabilitation to restore functionality
- rehabilitation
- prehabilitation e.g before surgery
-
What are some Normal cognitive changes in older people
- Processing speed slows
- Working memory = slightly reduced
- Simple attention ability preserved,
- -> but reduction in divided attention
- reduction in Executive functions
delirium vs dementia
delirium
- level of consciousness
- content of consciouessnes
= cognition
dementia:
- -> progressive decline in all domains of cognition
- -> not just memory impairment
- loss of executive function
- functional impairment
- behavioural + psychological changes
- -> lack of insight
- -> progressive
- -> degenerative
- -> irreversible
What are the different types of dementia
- alzheimers’ dementia
- vascular dementia
- mixed dementia
- dementia w lewy bodies
delirium vs dementia
delirium
- an acute, global failure of higher brain function
dementia:
- -> progressive decline in all domains of cognition
- -> not just memory impairment
- loss of executive function
- functional impairment
- behavioural + psychological changes
- -> lack of insight
- -> progressive
- -> degenerative
- -> irreversible
what are the 2 higher brain functions
- consciousness
+ - cognition
delirium vs dementia
Delirium
- Acute (hours-days)
- Fluctuating
- Main problem with alertness and attention
- Usually reversible
- Usually precipitated by something
- People with dementia are at higher risk
Dementia: - Chronic (months-years) - Gradual progression - No change in conscious level Irreversible
delirium vs dementia
Delirium:
- Acute (hours-days)
- Fluctuating
- Main problem with alertness and attention
- Usually reversible
- Usually precipitated by something
- People with dementia are at higher risk
Dementia: - Chronic (months-years) - Gradual progression - No change in conscious level Irreversible --> can eventually lead to delirium
What is dementia
dementia:
- -> progressive decline in all domains of cognition
- -> not just memory impairment
- loss of executive function
- functional impairment
- behavioural + psychological changes
- -> lack of insight
- -> progressive
- -> degenerative
- -> irreversible
What are some methods of assessing cognitive function?
a) Screening tests
- -> AMT, clock drawing test
- -> Mini Mental State Examination (MMSE)
- -> Montreal Cognitive Assessment (MOCA)
- -> 4AT score
b) Diagnostic tests
- -> Addenbrooke’s Cognitive Examination (ACE)
- -> Detailed neuropsychometric testing
Montreal Cognitive Assessment (MOCA)
a) what are the advantages of MOCA?
b) what are the disadvantages of MOCA?
a) what are the advantages of MOCA?
- Covers a variety of domains of cognitive function
- Brief to administer (10 mins)
- Validated in a range of populations
- Available in translated versions
- Widely used
b) what are the disadvantages of MOCA?
- Education level will affect results
- Language level will affect results
- Floor and ceiling effects
- Can be poorly administered
- Possibly practice/coaching effects
NOTE
4AT score
4+ = possible delirum
0 = delirium
-
What are some problems with cognitive assessment in general?
- Hearing and visual impairment may limit testing
- Physical problems may limit testing
- Most assume numeracy and literacy
- Most assume some basic cultural knowledge
- Depression can masquerade as dementia
- Not valid in acute illness
- Normal cognitive changes (slower processing speed,
- slower reaction times) may affect administration
