Study sets, textbooks, questions
Upgrade to remove ads
Normal Aging and Problems of Mobility
Terms in this set (58)
How many older people (65+) live in residential facilities?
Older people are not mainly in residential homes (rest homes and private hospitals) facilities:
- Currently for the over 65 years of age population in Auckland only 3.5% are in long-term residential care
- This amount has declined over time, and the median age of residents has increased
- Dependency has increased for the populations in aged care facilities
What are the 10 priorities towards a Decade of Healthy Ageing?
2020-2030 is the decade of....?
Healthy Ageing (WHO)
When you consider "what is ageing", consider what?
- Chronological age
- Functional age
- Subjective age
Normal ageing is associated with changes that increase vulnerability to accidents or disease, but ageing itself is certainly not a disease.
Unlike disease, changes of ageing inevitably occur in every organism at a given time, and affects all species after the age of conception. Advanced age is just a risk factor for....?
As a successful, westernised society we seek for our population to not only attain longevity but also to minimise any disabling condition by doing what?
- Delaying their onset
- Minimising their impacts on function
(we are achieving this)
NZ is experiencing a significant change in the structure of its population. The number of people aged 65 and over has doubled since 1980, and is likely to double again by....?
What are some challenges and opportunities with our ageing population?
- Our regions are ageing faster than many of our cities -> need some age-friendly environments in these places
- Our older population is becoming a larger workforce and consumer market -> need some changes to the workforce
- Our older population is becoming more culturally diverse
- Our population is ageing as people live longer and have fewer children
The way we think about, talk about and write about ageing may have direct effects on health. Everyone will grow older, and if negative attitudes towards aging are carried throughout life they can have a....?
Detrimental and measurable effect on mental, physical and cognitive health:
- Older adults with negative attitudes towards aging had slower walking speeds and worse cognitive abilities two years later (compared with those with more positive attitudes towards aging, who live on average 7 years longer)
- Negative attitudes towards aging seemed to affect how different health conditions interacted: Frail participants with negative attitudes towards aging had worse cognition compared to participants who were not frail - however frail participants with positive attitudes towards aging had the same level of cognitive ability as their non-frail peers.
Societal attitudes towards aging are predominantly negative. And yet, everyone will grow older, and if these attitudes persist, they will....?
continue to diminish quality of life (so we should practice positive ageing instead)
Ageing well involves what?
The "compression of morbidity" = the total lifetime morbidity (ie disability, frailty, infirmity and impairment of ADLs) would be compressed to a shorter span of time at the end of life.
Note: we are already doing this, but have to do it more (gives us more years in optimal quality of life).
What are the four strategies for morbidity compression?
1) Primordial prevention = prevention of risk factors (smoking, childhood obesity etc) from developing
2) Primary prevention = reduction of risk factor prevalence
3) Secondary prevention = prevention of disease progression (e.g. early detection/treatment of HTN)
4) Tertiary prevention = reduction of morbid states that have already occurred
Ageing well should be a priority. What are some values of investing in the social capital of older age?
1) Older adults are the world's only natural resource (in developed countries the current generation of older adults has greater education and health than ever before)
2) They bring a unique set of accrued knowledge and problem-solving ability and the subjective judgement about what is important in life, as well as a more optimistic outlook
3) As people age, many also want to ensure a better future for generations to follow and help solve society's needs = "generativity" (important component of successful ageing)
4) Health benefits are derived from meaning, life satisfaction, structured activities and cognitive, physical and social activity.
If we want to make a meaningful impact on the challenges of reducing disability near the end of life, we need to acknowledge the determinants of many of the conditions we wish to avoid - e.g. which ones?
- Reduced mobility following falls/fractures
- Accelerated cognitive loss
(which commence in mid or early life)
E.g. with dementia there are early life risk factors you can change:
In terms of when you have to start for ageing well: activities should be a preventative treatment. What does this involve?
Creating and preserving walkable communities is a means to reduce the risk of chronic disease and maintain improved public health and quality of life.
The design of the physical environment in which older adults live and level of access to transit service determines what?
The level of accessibility they have to important destinations such as shops, services, and places to recreate.
When supportive features are prominent in places where older adults live, they can...?
Remain active and independent
So geriatricians should be consulting to....?
20 year olds
What is frailty?
The condition of being weak and delicate.
Frailty is a common clinical syndrome in older adults that carries an increased risk for poor health outcomes including....?
- Incident disability
In an attempt to standardise and operationalise the definition of frailty, Fried and colleagues proposed a clinical phenotype of frailty as a well-defined syndrome with biological underpinnings.
Frailty is theoretically defined as what?
A clinically recognisable state of increased vulnerability resulting from aging-associated decline in reserve and function across multiple physiologic systems - such that the ability to cope with everyday or acute stressors is compromised.
In the absence of a gold standard, frailty has been operationally defined by Fried et all as what?
Meeting three out of five phenotypic criteria indicating compromised energetics. They are:
- Low grip strength
- Low energy
- Slowed walking speed
- Low physical activity
- Unintentional weight loss
Frailty status can be assessed easily and the frail state predicts future....?
Disability, falls, hospitalisations, and poor surgical outcomes
Fraily is hard to change, because it requires a lot of what?
Exercise to fix (which then poses its own risks)
What are three tissues in which there are ageing associated changes (which goes hand in hand with frailty)?
- Muscle tissue
- Bone tissue
- Fat mass
What are some ageing associated changes that occur in muscle tissue?
Sarcopaenia, which is due to:
- Fast type II muscle fibres -> slow type I muscle fibres (which reduces muscle power)
- Deposition of lipids within muscle fibres (as you lose some muscle fibres, replaced with adipose tissue)
There is no net loss in body weight -> makes sarcopaenia hard to diagnose.
What is sarcopaenia?
A syndrome characterised by progressive and generalised loss of skeletal muscle mass and strength with a risk of adverse outcomes such as physical disability, poor quality of life, and death.
Sarcopaenia is one of the main 4 reasons for loss of muscle mass. What are the 4 general reasons for loss of muscle mass?
When do you have to start to stop sarcopaenia?
As we can see, you start losing muscle mass from the age of 30
(drops faster and faster per decade - lose more per decade as you get older)
In those living in the community, 1/3 older adults has sarcopaenia - in long term acute care settings this is even....?
What are the health consequences that are related to sarcopaenia?
- Low health related QoL
- Type II diabetes
- Heart failure
- Early mortality
What are the functional deficits that are associated with sarcopaenia?
- Frailty (almost goes hand in hand)
- Loss of muscle power
- Loss of skeletal muscle mass
Leads to: increased fall risk -> increased fracture risk -> mobility limitation -> increased disability -> loss of independence.
Body composition classifications (phenotypes) - by % body fat and skeletal muscle mass:
1) Sarcopaenia = low % body fat and low muscle mass
2) Normal = low % body fat and normal muscle mass
3) Obese = high % body fat and normal muscle mass
4) Sarcopaenic obese = high % body fat and low muscle mass
Sections through muscle:
Left phenotype = normal
Middle phenotype = Sarcopaenic obese
Right phenotype = sarcopaenic
To measure muscle mass you don't normally do a dexa-scan. Instead you do baseline functional tests (that are highly correlated with sarcopaenia and sarcopaenic obesity) - what does this involve?
- Chair stand (5 times)
- Step test
- TUG (timed up and go = stand up, walk 3m and sit down)
So, there's a reduction in muscle mass (30-40%) after about age 30. What are the total changes that occur?
- Decreased myosin heavy chain synthesis
- Decrease in force
- Infiltration of fat into muscle tissue
- Increased fatigability
- Decrease in BMR
- Decreased innervations
- Increased number of myofibrils per motor unit
- Loss/reduced proliferation of satellite cells
- Shift towards type I fibres (slow twitch)
What are the ageing associated changes in bone tissue?
Loss in bone mass:
- After your mid-30s you lose bone mass (stops around 60s though)
- Women lose bone mass faster after menopause
What is osteoporosis?
A condition characterised by a decrease in the density of bone - decreasing its strength and resulting in fragile bones.
Osteoporosis leads to abnormally porous bone that is compressible, like a sponge. This then weakens the bone and results in what?
Frequent fractures (breaks) in the bones
What is osteopaenia?
A condition of bone that is slightly less dense than normal bone, but not to the degree of bone in osteoporosis.
What are some primary causes of osteoporosis?
- Menopause (in women)
- Age related change
What are some secondary causes of osteoporosis?
- Hypogonadism (premature ovarian failure, low T)
The burden of osteoporosis (in terms of DALYs) is second to lung cancer, and is greater than....?
Breast and colorectal cancer
Why is the burden so big? Why is so much life lost when you have osteoporosis?
Fear of falling -> limits older adults a lot (as they move less, so lose less muscle mass, so less power, and so more falls)
In terms of all fractures, what fractures have the poorest quality of life post-fracture?
Hip fractures (50% need long-term care, and 25-30% will die within 12 months)
(women's lifetime risk of hip fracture is equal to combined risk of breast, uterine and ovarian cancer)
Some statistics about falls (included in the burden of osteoporosis and fractures):
What is post-fall anxiety syndrome?
The fear of falling (very limiting)
What are some risk factors for falling?
- Previous falls
- Reduced vision
- Use of 4+ prescription meds
- Impaired balance
- Weaker muscles and stiffer joints
- Slower reaction times
- Impaired cognition
Mortality after hip fracture stats:
What are some factors associated with strength, balance and falls?
- Own environment
- External environment
- Muscles and response
- OA in the knees
- Nutrition, transport and heating
- Temperature, vitamin D
Falls screening is effective and multidisciplinary. Look out for the risk factors aforementioned. What does prevention involve?
- Individualised treatment
- Reduce medications
- Reduce obstacles/home environment
- Strength and balance programmes (if cognition is ok)
- Treat underlying conditions (e.g. PD)
What leads to prevention?
Primary care screening -> ask, assess, act (HQSC)
ACC has recently funded "lead agencies" which are what?
Home and community-based strength and balance programmes
- Otago Exercise Programme (OEP)
- Steady as you go (SAYGo)
- Tai chi
- Green prescription (GRx)
What are the ageing associated changes in fat mass?
Shift from subcutaneous to visceral fat
(you get an increase in fat mass with ageing which is distributed more specifically in the abdominal region, an area that is associated with CVD and diabetes)
Changes in body fat mass are due to what?
Alterations in energy balance - with a positive energy balance leading to weight gain, and a negative balance resulting in weight loss.
However, fat composition changes associated with ageing often occur in the absence of weight fluctuations (so weight won't tell you about changes).
So in conclusion, muscle strength and bone strength are critical to independence. Both can be affected by....?
Lifestyle and disease
Muscle weakness and osteoporosis are both amenable to....?
Prevention and treatment
Sets found in the same folder
Transition at Birth
Development of the GI and Respiratory Sy…
Other sets by this creator
Male Urogenital System
Urinary Continence and Incontinence
Recovery from Stroke
Iatrogenic Disease in Older Adults
Other Quizlet sets
criminal law questions exam
Health Assessment Final
Chapter 10 - The process of operations s…