acute illness in older people Flashcards
4 I’s in geriatrics
instability
immobility
incontinence
impairment (cognitive)
questions to ask a geriatric patient
cognitively impaired feeling unwell/sick falling incontinent mobile
how do you manage at home
what’s important to you
reasons why a patient may fall
neurology
stroke (new/old)
Parkinsonism
cognitively impaired
poor vision
urinary incontinence
systemically unwell
aortic stenosis
arrhythmia
CCF
postural hypotension
alcohol
medication
footwear
OA
slipping and slower reflexes
hypoglycaemia
combination
why may a patient be immobile
sarcopenia - loss of muscle mass systemic illness SOB cardiac condition back and joint pain - OA medications neurological disease fear of falling
why might someone be incontinent
impairment, immobile, neurological
functional: visual impairment - can’t find the toilet, systemic illness, cognitive impairment - can’t remember where the toilet is
medications e.g. diuretics, sedatives
lots of fluids and caffeine
can’t get to the toilet - joint pain, neurological disease
LUTS in men (BPH), constipation, stress incontinence, overactive bladder, recurrent
why might someone be cognitively impaired
dementia vs delirium
- need collateral hx to determine
dementia - vascular, alzheimers, lewy body etc
hx taking - how do we determine what is going on
collateral hx - main carer, relatives phone calls GP letters care home letters medication SHx
examination in older people
resp, CVS, abdo
neurology - as much as you can (focused to establish what is going on)
gait
lying and standing BP
look at the skin - pressure sores etc
incontinent - PR +/- external PV to look for prolapse
causes of delirium
acute illness drugs alcohol new environment medications urinary retention recent surgery pain metabolic abnormalities subdural haematoma stroke other brain pathology
causes of dementia
stroke vascular alzheimers Lewy body tumour
