Aged care Flashcards
Approach to assessing memory complaint
Multiple consults needed, longitudinal
History (colateral and patient)
PMH
Medications - Side effect?
allergies
Smoking
EtOH!! other drugs
MEMORY
loss, ?short term
Memory loss timeline
CHANGES
Functioning
- ADLs
- tool use (microwave, tv remote)
- prompting for self care
- finances
- medications
Slowing of thinking and processing
personality changes, becoming withdrawn
Judgement
Insight
Speech
MMSE
GP Cog
MOCA
Kimberly indigenous cognitive assessment (remote vs urban)
EXAM
HR, BP, temp
Weight, height, BMI
Cardiovasc, resp, abdo
Oral/dentition
Cranial nerves, symetrical face, nystagmus HINT
gross neuro with gait, rhombergs
Ix
CT brain
FBC, EUCs/LFTs, TFTs, B12, iron
selected - HIV, syphillis
DDx
Dementia, Depression, Delirium
Intracranial - CVA, Sub dural
Pharmacological - medication
Metabolic - Thyroid, B12
Substances - EtOH, other drugs
Management of patient with new dementia diagnosis
Non-pharmacological:
Stabilise comorbidities
- HTN, Diabetes, Vascular disease
SNAP - Reduced/cease EtOH
Optimise mental health - ?antidepressants
Screen for delirium with deterioration
Allied health - hearing, vision, OT, exercise physiologist (strength + balance)
Legal - AHD, EPOA, Guardianship, ACAT
Consult types - GP chronic disease managment plan, over 75 health check
Specialist review
Driving safety - consider OT driving assessment if available
Pharmacological:
Consider specialist medication commencement (phone consult with speclialist name, await in person review)
Home medicines review mbs 900
Webster packs
Carer support, offer relative appointment
