139 - Influenza/Elderly

Question 0

What is frailty?

Answer 0

A state of increased vulnerability to poor resolution of homeostasis after a stressor event - this increases the risk of adverse outcomes, including falls, delirium and disability.

Question 1

Why is illness a bigger worry in the elderly population?

Answer 1

Frail and elderly people are more vulnerable to sudden change in health status after a minor illness - they are closer to the confusion threshold, so a minor illness may be enough to dip them into the dependant state.

Question 2

How can frailty be measured?

Answer 2

Using a model - eg.

• phenotype model - 5 variables, 3+ = frail. Weight loss, self-reported exhaustion, low energy expenditure, slow gait speed, weak grip strength.
• cumulative deficit model
• CSHA clinical frailty scale

Question 3

What are the 6 ‘Geriatric Giants’?

Answer 3

Falls
Not coping
Confusion/delerium
Collapse
Incontinence
Poor mobility

Question 4

Why is it important to look at unusual presentations of conditions in the elderly?

Answer 4

You might assume someone is not coping, but they may have anaemia. They use often on many drugs that may interact, or they may have a different dosage need now then they did.

Question 5

What is delerium?

Answer 5

Confusion state, secondary to infection, drugs, post GA… People with delirium have a much higher mortality rate and complication rate. It is a disturbance of consciousness, with reduced ability to focus and hold attention.
Look for a physical cause - infection?
Treat with familiarity and minimise distractions.

Question 6

What should you use when clarking a new elderly patient?

Answer 6

Comprehensive Geriatric Assesment.

• Multidisciplinary.
  Medical, psychological, function capacity assessed

Question 7

Why does medication in elderly sometimes become an issue?

Answer 7

As you age you have altered drug responses. You have age related physiological changes.
People are often on multiple drugs started by different people - may have interactions.