Term
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Definition
| It is a complex syndrome of increased vulnerability and inadequate response to stressors leading to adverse outcomes (falls, disability, etc.) |
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Term
| What is the last stage in the frailty process? |
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Definition
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Term
| __________ = vulnerability and inadequate response to stressors |
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Definition
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Term
| Symptoms of frailty syndrome... |
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Definition
Weakness
Weight Loss
Fatigue
Inactivity
Decreased food intake/anorexia |
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Term
| For the frailty phenotype, need at least 3 of... |
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Definition
Low grip strength - <20% in dom hand
Exhaustion
Poor physical activity - <20% phys expenditure
Slow Gait - <1m/s
Unintentional weight loss (5kg/yr) |
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Term
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Definition
Part of the frailty model/syndrome
Multi-system reduction in reserve capacity close to threshold for failure |
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Term
| _________ is one of the crucial aspects of the primary pathway of "frailty" development? |
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Definition
| SARCOPENIA - caused by immobility, decreased anabolic hormones, increased cytokines, atherosclerosis, etc. |
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Term
| Two of the biggest factors leading to sarcopenia in frail individuals are.... |
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Definition
Neuroendocrine dysfunction - depletion of anabolic hormones
Immune dysfunction - increased catabolic cytokines |
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Term
| What is typically missing from a medical assessment in the "frail elderly"? |
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Definition
Medications
Cognition/Mood
Function
Socioeconomic status
Formal/Informal supports |
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Term
| What was the thrust of the Gait Velocity study? |
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Definition
| To see whether a single measurement, Gait Velocity, could predict adverse events such as hospitalization, need for caregiver, fractures, death, etc. (prediction of poor outcomes in the elderly) |
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Term
| Is Gait Velocity in a population of "well functioning elderly" useful as a predictor for adverse events? |
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Definition
| YES - saw increased # of any adverse events, and specifically - new fall, hospitalization and need for a caregiver with increased slowing of gait |
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Term
| What was shown that could be an early marker of frailty in a cohort study? |
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Definition
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Term
| When are additional driving tests required for elderly individuals? |
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Definition
Required at age 80 and every 2 yrs - vision/knowledge test + group education
****DOES NOT predict on road performance or safety |
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Term
| Approach to Medical Fitness to Drive |
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Definition
CANDRIVE
Cognition
Acute Condition/fluctuating condition
Neurlogic
Drugs
Record
In car experience
Vision
Ethanol |
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Term
| What is an immediate contra-indication in regards to VISION for a driver? |
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Definition
| Visual acuity with correction less than 20/50 (IMMEDIATE contraindication, get that fucker off the road) |
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Term
| What are the 4 components of "Total Pain"? |
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Definition
Physical
Psychological
Social
Spiritual |
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Term
| In palliative care, what does a Goals of Care meeting seek to establish? |
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Definition
| Common understanding between physician and patient |
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Term
| Higher lifetime risk of stroke and dementia higher in which gender? |
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Definition
FEMALES (1 to 3)
*Vs. males (1 to 4) |
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Term
| Most common causes of dementia (top 3) |
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Definition
Alzheimers
Vascular dementia
Dementia w/ Lewy Bodies
**AD and VaD are most significant |
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Term
| In terms of neurodegeneration that predisposes an individual to dementia risk, what is the underlying cause? |
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Definition
| INSULIN RESISTANCE - fatty liver often leads to insulin resistance, creating cytokines and toxic lipids which wreak havoc on the brain |
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Term
| 1st areas of pathology in pathogenesis of Alzheimer's? |
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Definition
Cortical atrophy
Enlarged ventricles
Atrophy of hippocamp |
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Term
| _______ plaques often seen in Alzheimer's |
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Definition
| AMYLOID (amyloid precursor protein) |
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Term
| What is the cyclical pattern of neuroinflammation in the early pathogenesis of AD? |
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Definition
AB1-42 plaques increase oxidation and inflammation leading to impaired neural function
Leading to neural death, microglia and astrocytes are activated which increase plaque formation... |
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Term
| Activation of which glial CNS cells increases plaque formation in AD? |
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Definition
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Term
| 3 main reasons for stroke occurrence? |
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Definition
Ruptured aneurysm
Embolus
Thrombus |
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Term
| Which metabolic syndromes have been associated with vascular dementia and Alzheimer's? |
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Definition
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Term
| What are the 4 major components of pharmacokinetics? |
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Definition
Absorption
Distribution
Metabolism
Excretion |
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Term
| In terms of pharmacokinetics in the elderly, what happens to ABSORPTION with increasing age? |
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Definition
It is NOT AFFECTED by NORMAL AGING
**Interactions with drugs, disease processes doe |
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Term
| What happens to total body water and total body fat with aging? What effect does this have on pharmacokinetics? |
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Definition
Decrease in total body water = higher concentrations of water soluble drugs (decreased volume of distrib)
Increase in total body fat = prolonged action of fat soluble drugs (increased volume of distribution) |
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Term
| What happens to the volume of distribution of fat soluble vs. water soluble drugs with aging? |
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Definition
Fat soluble = increases (more body fat)
Water soluble = decreases (less body water; so drug becomes more concentrated) |
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Term
| There is a __________ in the concentration of unbound drug in the plasma with aging |
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Definition
| INCREASE (because fewer plasma proteins to bind it) |
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Term
| What happens to phase I vs. phase II rxns in the liver with aging (pharmacokinetics)? |
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Definition
Phase I - reactions slowed (P450)
Phase II - not affected (actylation, methylation) |
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Term
| What happens to the GFR of the kidney with aging? |
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Definition
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Term
| What happens to serum creatinine levels with aging? How does this reflect renal function? |
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Definition
They stay in normal range (becuase lower lean body mass)
BUT have lower GFR (poorer kidney function), despite normal creatinine - therefore, it masks the change in creatinine clearance |
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Term
| Difference between adverse drug rxns and events |
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Definition
ADRs - ANY undesirable/noxious drug effect at STANDARD treatment dosing
ADEs - ADR + error in administration |
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Term
| What is the most important risk factor for adverse drug rxns? |
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Definition
The # of meds being taken
Risk increases exponentially with # being taken |
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Term
| What is polypharmacy in the elderly? |
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Definition
Use of "many drugs"; more medications than clinically indicated or warranted
5 or more
7 or more (incl OTC) |
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Term
| In individuals older in life, before you make a new dx "think ________" |
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Definition
DRUGS
Avoid the "prescribing cascade" |
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Term
| What happens to drug excretion with age? |
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Definition
| POORER - impaired renal function (decreased GFR) |
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Term
| What are the 4 principles to adhere to when considering the prescription of drugs to the elderly? |
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Definition
1. LESS IS MORE
2. THINK DRUGS (before new dx)
3. Start low, go slow
4. Assess adherence |
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Term
| What is "healthy ageing"? |
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Definition
| A lifelong process of optimizing opportunities for improving & preserving health & physical, social and mental wellness, independence and QoL |
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Term
| What is happening to the population pyramid in Canada right now? |
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Definition
It is beginning to "rectangularize" - starting to even out, not really peaks & valleys anymore
By 2036, about 1/4 of the population will be >65 |
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Term
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Definition
| The MAXIMUM obtainable age for a species, defined by its oldest individual (for humans = 122 yrs) |
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Term
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Definition
| The avg # of years a person can expect to live based on age, year of birth and mortality rate |
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Term
| What 3 factors does "life expectancy" depend on? |
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Definition
Year of birth
Given Age
Mortality rate |
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Term
| What is the difference between Life Span and Life Expectancy? |
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Definition
Life Span = max attainable age for a species (122 yrs for us)
Life Expectancy = the average # of yrs a person can expect to live given their age, DoB, mortality rate |
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Term
| What has happened to life expectancy and life span over the past 100 yrs? |
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Definition
Life span = same
Life expectancy = almost doubled |
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Term
| What is a centenarian? Super-centenarian? |
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Definition
Centenarian = person who has lived to or past their 100th birthday
Super-Centenarian = lived to or past their 110 birthday |
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Term
| What was the hypothesis of the New England Centenarian Study? |
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Definition
| Centenarians age relatively slowly and have increased resistance to chronic disease |
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Term
| What are the factors associated with reaching 100 (in NE Centenarian) |
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Definition
Lean muscle
No/little smoking
Women who naturally have a child after 40
Close relatives lived to old age
Low neuroticism/high extraversion |
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Term
| How are neuroticism and extraversion related to becoming a centenarian? |
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Definition
| NE Cent Study - showed people who lived to be 100 scored low on neuroticism and high on extraversion |
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Term
| Who participates in ageism? |
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Definition
ERRYONE SON
Elders (symptom underreporting), HCPs, media |
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Term
| What are the physical activity guidelines for old age? |
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Definition
Aerobic = 150 mins/week; moderate to vigorous intensity
Resistance = at least 2x per week; rest days
Balance = if mobility probs, PRN |
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Term
| Modifiable behaviours associated with longevity and healthy ageing? |
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Definition
Sleep 7-8 hrs a night
Avoid smoking, EtOH
Lots of plants, nuts, legumes
Normal BMI
NO snacking in between meals |
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Term
| What happens to growth hormone release with ageing? |
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Definition
IGF-1 + GH synth and release decrease with ageing
Taking recombinant GH may increase lean body mass/decrease adpose, but NO effect on strength |
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Term
| Evidence about caloric restriction in growing older? |
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Definition
NO EVIDENCE IN HUMANS
May have reduction in oxidative stress, decrease in mitochondrial free radical generation |
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Term
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Definition
Defined by Strehler
Growing old as defined by gradual biological impairment with 5 criteria:
Cumulative
Universal
Progressive
Intrinsic
Deleterious |
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Term
| 5 criteria associated with biological decline when normally ageing... |
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Definition
CUPID
Cumulative
Universal
Progressive
Intrinsic
Deleterious |
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Term
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Definition
| The CONCEPT that advanced age is assocaited with increased susceptibility to and prevalence of certain diseases |
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Term
| Stochastic Theories of Aging |
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Definition
| Aging caused by randomly accumulated damage to vital molecules (mutations, errors in translation, free radicals) |
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Term
| Developmental-Genetic Theories of Aging |
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Definition
| Aging is genetically programmed along a continuum with development and maturation (longevity genes) |
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Term
| What support is there to the "Development-Genetics" Theories of Aging? |
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Definition
| Advanced aging syndromes (Progeria) |
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Term
| Neuroendocrine Theory of Aging |
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Definition
| Functional decline in neurons and HP axis regulates aging |
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Term
| Immunologic Theory of Aging |
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Definition
Immnune decline with age
Age assocaited increase in autoimmunity
Humoral immunity decline with age |
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Term
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Definition
Neuroendocrine - neuronal death, decline of HP axes
Development-Genetics - naturally programmed to age
Stochastic - accumulation of random damage
Immune - immune decline with age |
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Term
| With age, what happens to a person's abilty to maintain a relatively constant internal state? |
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Definition
| It DECLINES - lose some homeostatic regulation normally |
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Term
| What happens to BP and volume regulation with age? |
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Definition
DROP IN BP
HIGHER RISK OF DEHYDRATION, NOCTURIA |
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Term
| What type of vision is often lost first in old age? |
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Definition
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Term
| What is the normal clinical impact on the nervous system with age? |
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Definition
| Lose # of cells and brain weight, but with NORMAL aging, no clinical impact |
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Term
| Is there a decline in breathing with normal aging? |
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Definition
| Should NOT have a clinically relevant decline in resp function |
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Term
| True or False - Elders are NOT incontinent as a consequence of normal aging? |
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Definition
| TRUE - they don't lose continence with normal aging |
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Term
| What happens to the residual capacity of the bladder with age |
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Definition
| Increases (get more residual urine) |
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Term
| Difference between ADLs and IADLs |
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Definition
ADLs - Dressing, Eating, Abumlation, Toileting, Hygiene
IADLs - "This Should Come Handy During My Finals"; Telephone, Shopping, Cooking, House Dressing, Finances |
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Term
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Definition
DEATH
Dressing
Eating
Ambulation
Toileting
Hygiene |
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Term
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Definition
SHAFT
Shopping
Housekeeping
Accounting
Food prep/meds
Telephone/travel |
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Term
With normal ageing, what happens to:
Vital Signs
Homeostasis
NS
CV
Resp
Muscular
Vision & Hearing
Renal |
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Definition
Vitals - lower BP; higher risk of under/overheating
NS - no significant changes despite neuronal death and reduction of volume
Homeostasis - lost abiilty to compensate (homeostenosis)
CV - diastolic dysfunction
Vision - lose night first
Hearing - narrower frequency range; high frequency loss
Resp - should NOT be an issue
Renal - decreased GFR despite normal creatinine |
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