AGEING AND DISEASE

EDUCATIONAL BLOGS

The following factors can be considered as Ageing and Disease.

NUTRITION – Body mass index (Height calculated from arm demispan or knee height to compensate for the loss of vertebral height) Recent weight loss, e.g. loose skin folds Dentition/oral hygiene.

Hydration- Skin turgor Oedema

Pulse Atrial fibrillation

Erect and supine blood pressure Postural hypotension

Hearing Wax Hearing aid used

Vision Visual acuity Glasses worn/present Cataract

Cognitive function Mini-mental state examination

Muscle Wasting Strength

Per rectum-Faecal impaction Prostate size/consistency in men Anal tone

Skin Wounds/ulcers Infection Swelling

Joints-Deformity Pain Swelling Range of movement

Aging can be defined as a progressive accumulation through the life of random molecular defects that build up within tissues and cells.

Many genes probably contribute to aging, with those that determine durability and maintenance of somatic cell lines particularly important. However, genetic factors only account for around 25% of the variance in human lifespan; nutritional and environmental factors determine the rest.

A major contribution to random molecular damage is made by reactive oxygen species produced during the metabolism of oxygen to produce cellular energy. These cause oxidative damage at a number of sites

Chronic inflammation also plays an important role, again in part by driving the production of reactive oxygen species

PHYSIOLOGICAL CHANGES OF AGEING

some genetic influences contribute to heterogeneity, environmental factors, such as poverty,

nutrition, exercise, cigarette smoking and alcohol misuse, play a large part, and a healthy lifestyle should be encouraged even when old age has been reached. The effects of aging are usually not enough to interfere with organ function under normal conditions, but reserve capacity is significantly reduced. Some changes of aging, such as depigmentation of the hair, are of no clinical significance.

FRAILTY

Frailty is defined as the loss of an individual’s ability to withstand minor stresses because the reserves in the function of several organ systems are so severely reduced that even a trivial illness or adverse drug reaction may result in organ failure and death. The same stresses would cause little upset in a fit person of the same age.

FALLS

Around 30% of those over 65 years of age fall each year, this figure rising to more than 40% in those aged over 80. Although only 10–15% of falls result in serious injury, they are the cause of more than 90% of hip fractures in this age group, compounded by the rising prevalence of osteoporosis.

Falls also lead to loss of confidence and fear and are frequently the ‘final straw’ that makes an

older person decide to move to institutional care. Management will vary according to the underlying cause.

DIZZINESS

Dizziness is very common, affecting at least 30% of those aged over 65 years in community surveys. Dizziness can be disabling in its own right and is also a risk factor for falls. Acute dizziness is relatively straightforward and common causes include:

hypotension due to arrhythmia, myocardial infarction, gastrointestinal bleed, or pulmonary embolism
the onset of posterior fossa stroke

• vestibular neuronitis

URINARY INCONTINENCE

Urinary incontinence is defined as the involuntary loss of urine and comes to medical attention when sufficiently severe to cause a social or hygiene problem. It occurs in all age groups but becomes more prevalent in old age, affecting about 15% of women and 10% of men aged over 65. It may lead to skin damage if severe and can be socially restricting. While age-dependent changes in the lower urinary tract predispose older people to incontinence, it is not an inevitable consequence of aging and requires investigation and appropriate treatment. Urinary incontinence is frequently precipitated by acute illness in old age and is commonly multifactorial.

COMMON ADVERSE DRUG REACTIONS IN OLD AGE

NSAIDs Gastrointestinal bleeding and peptic ulceration Renal impairment

Diuretics Renal impairment, electrolyte disturbance Gout Hypotension, postural hypotension

Warfarin Bleeding

ACE inhibitors Renal impairment, electrolyte disturbance Hypotension, postural hypotension

β-blockers Bradycardia, heart block Hypotension, postural hypotension

Opiates Constipation, vomiting Delirium Urinary retention

Antidepressants Delirium Hyponatraemia (SSRIs) Hypotension, postural hypotension Falls

Benzodiazepines Delirium Falls

Anticholinergics Delirium Urinary retention Constipation

Aging can be defined as a progressive accumulation through the life of random molecular defects that build up within tissues and cells.