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Hello, everybody. Um, my name is Catherine Thatcher. I'm an ST six Geriatrics registrar. I'm in West Yorkshire and I'm currently working in the Mid York's Trust at Pinder Feld. Um I've been interested in geriatrics for a really long time. I've done it for, um, in and out throughout, um, my career. Um, and at the moment, I would say that my special interest or passion is in acute frailty or front door frailty. Um, so I thought that this evening I would talk to you about um, biological aging and frailty and in this sort of short talk, I just want to go through and define what aging and frailty are and discuss why they're important to yourselves as fifth years or fy ones and why they're important generally and discuss different methods that we can use to recognize frailty. And then really think about, um, how do we recognize frailty? Is there any treatment for it? Is there a prevention or is there even a cure? And I guess that's a cure to aging rather than frailty. Um I'm planning to talk for probably about 45 minutes and I've tried to include um, one interactive case as well. So, um, when we come to it, it would be good if people could just join in and we could have a little bit of chat. That would be great. Um So what is biological aging? So, what do I mean by that? Um, I mean, it's quite straightforward, essentially. It's not just a number, so it's different from your chronological age. Um, and a lot of the definitions have come to the consensus that it's increasing frailty of an organism with the time um that reduces the ability to deal with stress and an increased chance of disease and death. And if we think about that, in terms of um graphical representation, some of you might have seen this before and it's from a paper of all, it was published in the Lancet in 2013. Um And you've got um functional abilities and then you've got um sort of thinking about if you're independent. So we'd say non frail versus dependent or living with frailty. Um And you can see that there's two separate lines there. So there's a sort of one that looks greenish on my screen and one that's red and the red one is if you're living with frailty, so you might have a minor illness or stress or event. And the example that they used was a urinary tract infection. Um And that gives you quite a big um dip down in terms of your level of dependence. And then you can see compared to people that aren't living with frailty in the green line, it takes you a long time to return to what we would consider your normal function or previous function. And often for a lot of people living with frailty or who are biologically older, um We would say that you sometimes often don't return to your previous level of function. So you can see there that the, the red line after the minor stress or event isn't at the same level as it was beforehand. So that's sometimes just a nice um graphical or, or pictorial representation to have in your head of what we mean by biological aging or frailty. Um Why is it important? So currently in the UK, we do have quite a significantly aging population. So um according to the National Office for statistics, by 2034 they predict that around 23% of the population will be 65 and over and about 5% of the population will be aged 85 and over. Um And again, I've just tried to think of a, an interesting or fun way to represent that. And so the picture on the left hand side is um George the fifth. And then the picture on the right hand side is obviously Queen Elizabeth the second and George the fifth was the monarch in 1917. And he is the chap that introduced the system where when you turned 100 the monarch wrote a letter to you to say well done. You are 100 which is a big achievement. Um And in, in 1917, he issued nine letters um within what is relatively, quite a short space of time. So 100 years later, um in 2017, Queen Elizabeth, the second issued 13,500 letters. So you can see there just how um rapidly and the picture of our population has changed and how many older people um there will be. And as we know, the older you get and the more chronological years you have lived, um you have a higher chance of being biologically older and therefore multimorbid um and living with frailty. So that's why it's important because our population is changing and this is gonna be quite significant for both work in the community and work in hospitals and the need for geriatricians, I guess. Really. Um So how does aging happen? Um It is cellular if you think about it quite a complex process and there is still some disagreement amongst the um sort of more biochemical um community. Um But most of the bio gerontologists would agree that is a, a build up of damaged constituents. And that's either as a failure to remove them, prevent their production, um repair any damaged cause um or the failure to replace lost cells um as a result of any damage. Um and that can be through through lots of um different um processes at a cellular level, which I don't think is relevant to your level of training now. So I think as long as you recognize that chronological and biological age are different and have a think about some of the ways in which they happen that would, would be enough. Um So thinking about aging well, and what might be the factors that would affect the difference between your chronological and your biological age because you might chronologically be 65 but biologically you might present more as a a 75 potentially 80 year old. Um So again, this picture just tries to represent that. So the the sort of boxes with the arrows that are in red or more. Um Thinking about the, the negative aspects that might influence why you would biologically age in advance of your chronological age. Um So thinking about adverse genetic um variants, interestingly, um there is a representation in terms of how, what environment your mother was living in when you were conceived and growing in us in terms of how well you age as well. But the majority of majority of um what affects how well we age is high risk lifestyle and adverse exposures. So that accounts for about 75% of how we think aging is influenced by um additional factors. So worldwide, um thinking about lifestyle and adverse exposure um and improvement in terms of life expectancy and how well people are living in their older age would be things like improvement to sewer systems and sewage, um access and availability to clean drinking water, um, vaccinations and widespread vaccination programs and just um a general um consensus that in most places, we are living with improved health care. If we think about the UK specifically and think more about um negative high risk lifestyle and adverse exposures, um that would be things like living in areas with pollution, um having a sedentary lifestyle, smoking, um and diet. So when we think about diet, the adverse features of that are high calorie, um and often what you might see um or read about being described as food deserts where people don't live within easy access to and fresh produce and fresh fruit and vegetables and all of that can have a negative impact on how well you biologically age. So those are important factors. Um to think about when we think about how well patients um are aging biologically and thinking about the demographics of the places or the environment of the like near the hospitals that we work in. Um This is just um again, trying to represent the variability of life expectancy. So I live in leeds. So this is just using leads as an example. Um I don't know if you can see my arrow on screen but towards the top and the middle um appear where it says a number 28 there's an area called a um and in the sort of leeds um, area that has got the highest um, life expectancy for men at 83 years old. Um And then if you hop on your, that represents, um, a bus route by the way. So if you hop on your number 28 get off and lead city center and then get the 29 and come and get off quite close out of the city center at HS. Um, your life expectancy for a meal is actually 73. So.