Unit 3: Illness and Ageing

Unit 3 examines the health challenges specific to older adults, the experience of transitioning to residential aged care, and the importance of addressing spiritual and existential concerns in the context of illness and approaching death. Understanding frailty, common geriatric syndromes, and how to communicate with older patients forms a core competency for all clinicians.

Frailty is defined as a clinically recognisable state of increased vulnerability resulting from ageing-associated decline in reserve and function across multiple physiological systems, such that the ability to cope with everyday or acute stressors is compromised. It is characterised by three or more of five criteria: low grip strength, low energy, slowed walking speed, low physical activity, and unintentional weight loss. Frailty is not an inevitable consequence of ageing but is strongly associated with falls and fractures, disability, hospitalisation, reduced quality of life, and increased mortality. Management is tailored to individual risk factors via comprehensive geriatric assessment, targeting reversible causes through exercise, deprescribing, nutrition optimisation, and weight management.

Sarcopenia — the gradual, age-related loss of skeletal muscle mass, strength, and function — begins around age 40 and accelerates after 75. It is a key determinant of frailty and a risk factor for falls, loss of functional independence, and admission to residential care. Resistance training and balance exercises, provided in most residential aged care facilities (RACFs), help slow decline and reduce falls. Falls are a leading cause of morbidity and mortality in people over 75, accounting for 40% of injury-related deaths and 50% of all falls occurring at home.

Common health problems in the elderly include osteoporosis, osteoarthritis, cardiac pathology, arrhythmias, and hypertension. Geriatric-specific syndromes include frailty, sarcopenia, falls, urinary incontinence, polypharmacy, dementia, and delirium.

Polypharmacy (five or more medications) is common in older adults with multiple comorbidities. The more medications a patient takes, the greater the risk of adverse drug interactions, falls, constipation, dehydration, renal problems, hypoglycaemia, malnutrition, delirium, and dental problems (dry mouth from anticholinergics).

Dementia is a group of progressive disorders of cognition causing changes in memory, thinking, language, behaviour, personality, and emotion that progressively impair activities of daily living. Communication strategies include minimising hearing and visual impairment, using non-verbal communication (tone, facial expressions, gestures), pictures, and taking time. Delirium is an acute confusional state (DSM-IV: acute change or fluctuation in mental status with inattention and disordered thinking or altered consciousness) that differs from dementia in its rapid onset (hours to days) and reversible cause (infection, urinary retention, medication). Delirium is life-threatening if untreated; management targets the underlying cause, ensures patient safety, and uses non-pharmacological strategies (familiar persons, low-stimulus environment).

Spirituality — whatever gives a person meaning, purpose, and values — is an important but often neglected dimension of holistic care, especially in the elderly and at end of life. The FICA tool guides spiritual assessment: Faith and belief, Importance, Community, and Address in care. Losses commonly associated with ageing and transition to residential care include death of spouse and friends, inability to continue valued activities, loss of independence and autonomy, loss of physical capacity, loss of memory, loss of home and familiar environments, and loss of identity and social roles.