Aged Care

Question 1

Confusion Assessment Method (CAM)

Answer 1

Acute Onset

Question 2

Features Dementia with Lewy bodies

Answer 2

1) Early appearance of Parkinsonian features
2) Visual hallucinations
3) Delusional misidentification
4) REM sleep disorder

Question 3

Dugs and Falls in the Elderly

Answer 3

The ACE inhibitor (perindopril)

• improved exercise capacity in functionally impaired elderly people
• who had no heart failure and maintained health-related quality of life.
• The degree of improvement was equivalent to that reported after 6 months of exercise training.

Question 4

The diagnostic criteria for probable DLB require

Answer 4

– The presence of dementia
# At least two of three core features:
- fluctuating attention and concentration,
- recurrent well-formed visual hallucinations
- spontaneous parkinsonian motor signs.
# Suggestive clinical features include:
- Rapid eye movement (REM) sleep behavior disorder
- Severe neuroleptic sensitivity
- Low dopamine transporter uptake in basal ganglia demonstrated by SPECT or PET imaging

Question 5

Cardiovascular changes with age

Answer 5

• No change in EF and contractility at rest.
• Increased afterload due to arterial stiffness
• Increased LV mass.
• Myocardial B-adrenergic responsiveness decreases with age.
• Basal and stimulated norepinephrine levels increase with age.
• Diastolic dysfunction also occurs with aging, with less early diastolic filling and greater dependence on atrial contraction.
• Decreased baroreceptor reflex sensitivity and therefore higher prevalence of orthostatic hypotension as there is inappropriate volume expansion with dehydration.

Question 6

Nocturnal polyuria

Answer 6

ANP

Question 7

Bladder changes with age

Answer 7

Increased:
- Detrusor hyperactivity
- Urinary incontinence
- Nocturnal polyuria
Decrease:
- Bladder capacity
- Bladder contractility
- Urethral outflow resistance in women

Question 8

Hepatic drug clearance decreases with age

Answer 8

Due to a fall in liver size and blood flow

Question 9

Reversible causes of urinary incontennace

Answer 9

• Delirium
• Restricted mobility illness, injury, gait disorder, restraint
• Infection acute, symptomatic urinary tract infection
• Inflammation atrophic vaginitis
• Impaction of feces
• Polyuria diabetes, caffeine intake, volume overload
• Pharmaceuticals diuretics, α-adrenergic agonists or antagonists, anticholinergic
  agents (psychotropics, antidepressants, anti-Parkinsonians)

Question 10

Medications causes falls in elderly

Answer 10

• sedatives and hypnotics (OR 1.47)
• neuroleptics and antipsychotics (OR 1.59),
• antidepressants (OR 1.68),
• benzodiazepines (OR 1.57)

Question 11

Which of the following is the strongest visual risk factor for falls in the elderly population?

Answer 11

Poor depth perception is the strongest visual risk factor for falls in the elderly

Question 12

HYVET trial - indapamide

Answer 12

Reduction of stroke and all cause mortality when indapamide given with or without perindopril to people over the age of 80 for the treatment of hypertension?