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Year 4 - OPIC > 1. Older Persons Medicine > Flashcards

1. Older Persons Medicine Flashcards

1
Q

Describe the trend in the population of over-65s since 1950.

A

Exponential increase in over-65s.

In 2017, number of people older than 65 outnumbered under-5 year olds.

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2
Q

What is meant by the terms ‘intrinsic ageing’ and ‘stressed ageing’?

A

Intrinsic ageing: the functional decline that comes with ageing despite optimal conditions.

Stressed ageing: the real-life development of frailty syndromes, reflecting inactivity, stress and exposure.

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3
Q

What is sarcopenia?

A

The progressive and generalised loss of skeletal muscle mass in and function with age.

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4
Q

What is frailty?

A

The reduced biological reserves across a range of physiological systems, that increase vulnerability to adverse outcomes following minor stressor events.

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5
Q

What is the clinical impact of sarcopenia?

A

Low grip strength = increased falls risk.

Slower gait speed = increase falls risk and risk of future disability.

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6
Q

What is the SARC-F questionnaire?

A

A survery used to predict poor muscle function, based upon ability to rise from a chair, walk, climb stairs, carry heavy loads and number of falls.

Score ≥4 = symptomatic sarcopenia.

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7
Q

What are the causes of sarcopenia?

A

Primary sarcopenia = ageing process

Secondary sarcopenia = inactivity or malnutrition.

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8
Q

How can frailty be identified?

A

Gait speed - takes longer than 5 seconds to walk 4m.

Timed-up-and-go test: takes longer than 10 seconds to stand from a chair, walk 3, turn around, and walk back again.

PRISMA 7 questionnaire: score ≥3 = frailty.

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9
Q

How can frailty be clinically assessed?

A

Usually identified within a complex geriatric assessment, and severity of frailty is categorised using clinical frailty score (CFS).

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10
Q

How can frailty be treated?

A
  • promote physical activity
  • exercise
  • medication review
  • social network supports
  • home adaptations
  • carer support
  • nutritional optimisation
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11
Q

What is healthy ageing? (WHO, 2015)

A

The process of developing and maintaining functional ability that enables wellbeing in older aage.

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12
Q

How can healthy ageing be promoted?

A
  • physical activity
  • nutritional optimisation
  • mental health support
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13
Q

What are the weekly recommendations for physical activity in older people?

A
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14
Q

How can nutrition be optimised in the elderly?

A

Mediterranean diet is associated with slower decline of mobility in older people.

Westernised diet is associated in older people with weight loss and slow walking speed.

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15
Q

How can cognition be assessed?

A

AMT-4
AMTS
MMSE

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16
Q

Outline how to perform the AMT-4.

A

Ask the patient to state each of the following:
- age
- date of birth
- place
- year

Any score <4 is abnormal cognition.

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17
Q

Outline how to perform AMTS.

A
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18
Q

Outline how to perform MMSE.

A
19
Q

When would you typically assess a patient’s cognition?

A

Screening tool for patients experiencing cognitive impairment (e.g. delirium) or dementia.

20
Q

When should delirium be suspected?

A

ANY change of mental state or behaviour in older people. Characteristic signs of delirium, which help distinguish cognitive decline from dementia, are:

  • clouding of consciousness
  • reduced attention and concentration
  • fluctuating pattern of symptoms and signs
21
Q

Why do older people usually present to hospital?

A

A crisis, which is a sudden change in health, function or circumstances that cause worry, distress, or overwhelms independence or care provision.

22
Q

How do older patients differ from younger patients?

A
  • multiple pathologies
  • nonspecific presentations
  • rapid loss of abilities
  • proneness to complications
  • need for rehabilitation
23
Q

What is a comprehensive geriatric assessment (CGA)?

A

An interdisciplinary diagnostic process to determine the medical, psychological and functional capability of someone who is frail and old, aiming to develop a plan for treatment and long-term support.

24
Q

The presence of one or more of the following in older people should trigger a CGA:

A
  • falls
  • immobility
  • delirium
  • dementia
  • polypharmacy
  • incontinence
  • end of life care
25
Q

What are the four components of a CGA?

A
  1. Physical assessment
  2. Functional, social and environmental assessment
  3. Psychological components
  4. Medication review
26
Q

What is delirium?

A

An acute confusional state, with fluctuating course, characterised by disturbed consciousness, cognitive function or perception.

27
Q

Risk factors for delirium:

A
  • age over 65 years
  • pre-existing cognitive impairment (e.g. dementia)
  • severe illness
  • current hip fracture
28
Q

Presentation of delirium:

A
  • acute confusional state
  • change in perception (e.g. hallucinations)
  • change in physical function
  • change in social behaviour
29
Q

The Single Question in Delirium (SQiD) test can pick up 80% of patients with delirium by asking the question:

A

Do you think [patient’s name] has been more confused lately?

30
Q

How is delirium managed?

A

Must identify and treat the underlying cause (e.g. infection, constipation, urinary retention).

Patients should be encouraged to mobilise as much as possible.

NB: Sedative medications should be avoided at all costs if possible.

31
Q

What are healthcare-associated harms?

A

The consequences of judgements made, and risks taken, that may result in unintended harm.

32
Q

Give some examples of healthcare-associated harms common in older hospitalised patients.

A
  • falls
  • pressure sores
  • hospital-acquired infection
  • venous thromboembolism
  • malnutrition
  • delirium
  • depression
33
Q

What are pressure sores?

A

Breakdown of tissues due to continued pressure of a hard surface against a bony prominence, resulting in ischaemia.

The sacrum, trochanters and heels are the sites at greatest risk.

34
Q

How can pressure sores be prevented?

A

Pressure-relieving mattresses

Patients education and reminded or helped to change position regularly.

35
Q

How are pressure sores treated?

A
  • pressure-relieving support surfaces
  • local wound management
  • pain relief
  • infection control, including tissue debridement

Pressure sores take a LONG time to heal and are largely preventable IF the right interventions are put into place.

36
Q

What are the risk factors for venous thromboembolism (VTE) in the elderly?

A

Immobility and increased age are the biggest risk factors.

Prophylaxis with LMWH is important to prevent VTE.

37
Q

What is the STOPP/START criteria?

A

Screening Tool of Older Persons Prescriptions (STOPP)

Screening Tool to Alert Right Treatment (START)

It is a medication review tool designed to identify medication where the risks outweigh the benefits in the elderly, and vice versa.

https://www.cgakit.com/_files/ugd/2a1cfa_bcf4d63c427e4e18963c64e74663728e.pdf

38
Q

What is elder abuse (WHO)?

A

A single or repeated act or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person.

39
Q

Give some types of elder abuse.

A
  • physical abuse
  • psychological abuse
  • sexual assault
  • financial abuse
  • neglect
40
Q

Give some risk factors for elder abuse.

A
  • living with others
  • dementia
  • social isolation
  • mental illness (especially depression)
  • financial reliance
41
Q

Explain how to test someone for postural hypotension.

A

Measure lying and standing blood pressure after asking the patient to lie down for 5 minutes. Repeat BP measurements while standing for 3 minutes to assess for postural hypotension.

Note a fall ≥20mmHg systolic or ≥10mmHg diastolic WITH symptoms required to diagnose postural hypotension.

42
Q

What are healthcare acquired infections (HCAIs)?

A

Infections that develop either as a direct result of healthcare interventions such as medical or surgical treatment, or from being in contact with a healthcare setting.

HCAIs pose a serious risk to patients, staff and visitors.

43
Q

Give some examples of HCAIs.

A
  • MRSA
  • C. difficile

Year 4 - OPIC (11 decks)

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