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Ageing Flashcards

1
Q

Causes of acute functional decline

A

About 4ish should be enough

  • Worsening of known medical conditions
    - New medical conditions e.g. stroke, infections, falls, delirium
    - Initiation of new medications
    - Electrolyte disturbances
    - Acute kidney injury / dehydration
    - Hypoglycaemia from glipizide with worsening renal function / poor oral intake
    - Poor medication compliance
    - Underlying dementia, frailty, caregiver / support issues
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2
Q

Strategies to prevent functional decline

A

Know all

- Being mindful of its likelihood
- Identifying and comprehensively assessing both general and body system specific high risk indicators
- Implementing preventive management strategies targeting ≥1 relevant domains, especially 
    - Cognition
    - Emotional health
    - Mobility
    - Self-care
    - Continence
    - Nutrition
    - Skin integrity
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3
Q

Determinants of Active Ageing

A

Know ALL

  • Social
    • Economic
    • Health and Social services
    • Behavioural
    • Personal
    • Physical
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4
Q

Determinants of Active Ageing

A

Know ALL

  • Social
    • Economic
    • Health and Social services
    • Behavioural
    • Personal
    • Physical
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5
Q

Health strategies in the management of function in the elderly

A

Know ALL

  • Preventive - prevent health condition, reduce incidence
  • Curative - cure, control disease and consequences
  • Rehabilitative - restore full, or optimise function
  • Supportive - preserve independence and autonomy, optimise QoL
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6
Q

Components of Rehabilitation Goal Setting

A

Memorise a few

  • Ascertain what is important to the patient and family
  • Explain likely degree of restoration of activity (acknowledge uncertainty)
  • Explain what is required from the patient
  • Discharge planning starts early
  • Review goals as patient progresses
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7
Q

Factors predisposing to ADRs

A

Know a few

  • Polypharmacy - more health conditions so more meds, DDIs
  • Decline in renal and liver function - reduced clearance and excretion of drugs
  • Cognitive impairment - under consume, over consume drugs
  • Poor eyesight - under consume, over consume drugs
  • Physical limitations - May not pack pills properly, break pills in half etc.
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8
Q

Complications of immobility

A

Know a few, at least 6

  • Complications
    • Muscles: decreased muscle strength, contractures (weakness)
    • Skin: pressure ulcers
    • Deconditioning
    • Cardiovascular: decreased work capacity, DVT, postural hypotension
    • Respiratory: decreased ventilation, V/Q mismatch, hypostasis pneumonia
    • Joint: loss of full range of motion
    • CNS: deterioration in balance and coordination
    • Genitourinary: incomplete bladder emptying, incontinence
    • GI: decreased appetite, constipation, GER & aspiration
    • Metabolic: insulin Resistance, hypercalcemia
    • Bone: bone loss, increased fracture risk
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9
Q

Predisposing factors for fall

A
  • Neuromuscular change - e.g. old stroke, age
  • Multiple comorbidities - polypharmacy, diabetes
  • Age - increased sway, slower righting reflex
  • Poor vision - age, DM
  • Knee osteoarthritis
  • Inactivity
  • All lead to impaired strength and balance
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10
Q

Precipitating factors for fall

A
  • Poor lighting
  • Home hazard
  • Medications
  • Increased fall risk
  • Intercurrent illness
    • Hypotensive
    • Tired / distracted
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11
Q

Broad reasons why elderly are prone to falls

A

Physiological changes with ageing
Pathological changes with ageing
Medications
Environment

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12
Q

Physiological changes with ageing

A

Know a few
- Loss of accommodation
- Loss of contrast acuity
- Increased postural sway
- Decreased proprioception
- Decreased muscle tone
- Slower righting reflex
- Slower reaction time
- (Reduced pulmonary vital capacity, GFR)
- Increased risk of postural hypotension
- Blunted baroreceptor response
- Decreased cardiac response to sympathetic stimulation
- Diuretic use and age-related changes to renal function
- Nocturia from decreased nocturnal ADH

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13
Q

Factors to consider when prescribing in elderly

A

Patient factors
- Physiological function
- Underlying illness
- Accurate clinical diagnosis

Drug factors
- Pharmacology
- MoA, Efficacy
- Safety - ADR, DDIs
- Suitability

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14
Q

Dealing with communication issues

A
  • Hearing
    • Face patient in bright room
    • Lower tone, DO NOT SHOUT
    • Eliminate noise
    • Amplification device
    • Dementia / confused, use simple commands
  • Come up with more, generally should be intuitive - use visual aids, write down, shorter sentences etc.
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15
Q

Comprehensive Geriatric Assessment components

A
  • Multidimensional
  • Determine medical, functional, psychological capabilities
  • To develop coordinated, integrated plan for treatment and long-term follow up
  • Components
    • Medical Assessment
      • Problem list
      • Comorbidities, disease severity
      • Medications
      • Nutritional status
    • Function Assessment
      • ADLs, IADLs
      • Activity and exercise
      • Gait and balance
    • Psychological Assessment
      • Mental status (cognitive) testing
      • Mood/depression testing
    • Social Assessment
      • Informed support needs and assets
      • Eligibility / financial assessment
    • Environment Assessment
      • Home safety
      • Transportation
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16
Q

ADLs and IADLs

A
  • ADLs
    • Dressing
    • Eating
    • Ambulating
    • Toileting
    • Hygiene
    • Swallowing
  • IADLs
    • Shopping
    • Housekeeping
    • Accounting
    • Food prep
    • Take meds
    • Transport
    • Telephone
17
Q

Physiological vs Pathological Ageing

A

Physiological - normal physiological processes that occur with ageing; typically begins in the third decade and is progressive (e.g. age related GFR and Vital Capacity declines)

Pathological - cumulative effects of age-associated diseases over time (e.g. BPH, cataracts)

18
Q

Demography vs Epidemiology

A

Demography - The statistical study of populations

Epidemiology - Factors affecting the patterns of health and illness of populations

19
Q

Life Course Approach to maintaining functional capacity

A

Early life - growth and development

Adult life - maintaining highest possible level of function

Older age - maintaining independence and preventing disability

(i.e. postpone chronic diseases and disability as much as possible by increasing and maintaining physiological reserves, above the disability threshold)

20
Q

What is frailty

A

A complex, multidimensional and cyclical state of diminished physiological reserve

Increase vulnerability to adverse clinical outcomes such as disability, delirium, falls, and death

Increased vulnerability to stressors

Is a dynamic process and may be reversible

21
Q

Age-related cognitive changes

A

Non-uniform (Affects some domains more than others)

Slowed speed of processing (“bottleneck”; decreased ability to reason well and quickly in novel situations)

Compensated for by gains in experiential-based (crystalline) intelligence

Large individual differences in cognitive function

Forgetfulness is inconsistent and non-progressive

Absence of significant effects on one’s accustomed community, home and self care functioning

22
Q

Dementia risk factors

A

Non-modifiable
- Age
- Female gender
- Genetic factors
- Down’s syndrome
- Family history

Modifiable
- Hearing loss
- Traumatic brain injury
- Hypertension
- A lot of alcohol
- Obesity
- Smoking
- Depression
- Social isolation
- Physical inactivity
- Air pollution
- Diabetes

23
Q

What is dementia

A

An ACQUIRED syndrome of decline in memory and other cognitive domains SUFFICIENT TO AFFECT DAILY FUNCTIONING

Progressive and disabling

Not an inherent aspect of aging

Different from normal cognitive lapses

A clinical diagnosis

24
Q

Alzheimer’s Disease diagnosis

A

Amnesia + at least one of Apraxia, Aphasia, Agnosia or Executive dysfunction

Decline from baseline, impact on occupational and/or social functioning

(May see medial temporal lobe atrophy and small hippocampal volumes, and neurofibrillary tangles and amyloid plaques)

25
Q

Dementia clinical features

A

Activities of daily living
- Loss of independence in accustomed ADLs

Behaviour

Cognitive
- Memory deficit (recent > remote)
- Other domains (disorientation, impaired judgement and problem solving, language, praxis, visuospatial)

26
Q

Dementia impact

A

Caregiver burden, caregiver burnout and institutionalisation as needs outweigh resources

Role strain (demands of care, social impact and control over the situation)

Personal strain (psychological impact)

Chinese ethnicity - filial piety and obligation to care leads to greater worry about performance and caregiver stress

27
Q

Depression

A

Mental disorder characterised by low mood and loss of interest and can present with affective, physical and cognitive symptoms - can become chronic or recurrent, and lead to substantial impairments in an individual’s ability to take care of one’s everyday responsibilities

28
Q

Depression mechanisms

A

Monoamine hypothesis - decreased neurotransmitter concentrations

Cytokines

Neuropeptides

29
Q

Risk factors for depression in older persons

A

Chronic pain
Impairment in physical function
Drugs (e.g. B-blockers)
Sensory deprivation (hearing, vision)
Dementia

30
Q

Clinical features of depression

A

Affective (Mood) - low mood, sadness; loss of interest of pleasure in usual activities; guilt; worthlessness; suicidal ideas

Behavioural - psychomotor slowing or agitation; fatigue or loss of energy; poor sleep; altered appetite

Cognitive - poor memory, concentration or decision-making

31
Q

Late-onset depression

A

First depression after age 65

  • Higher risk of dementia, less likely to have family history
  • Greater association with co-morbid conditions (“vascular depression” in hypertension, IHD, stroke)
  • More emphasis on physical and cognitive symptoms, fewer mood symptoms
32
Q

Why is late-onset depression under-diagnosed

A
  • Mistaken for normal ageing
  • Symptoms attributed to medical illness
  • Reluctance to stigmatise patient with psychiatric diagnosis
  • Non-specific, atypical presentation
  • Overlapping symptoms with other conditions
33
Q

Why treat depression

A
  • Over-investigation of somatic symptoms
  • Increased physician visits and hospitalisations
  • Decreased QoL
  • Can aggravate certain medical conditions (e.g. IHD)
  • Increased caregiver stress
  • Increased nursing home placement
  • Risk of suicide
34
Q

Delirium

A

Non-specific neuropsychiatric manifestation of a generalised disorder of cerebral metabolism and neurotransmission

High predisposing factors (e.g. Dementia, functional impairment) can result in less noxious precipitating factors (urinary retention, sleep deprivation) presenting as delirium

35
Q

Common causes of delirium

A

Drugs and Infection

Also consider severe stuff like AMI, GI bleed etc.

D: Drugs
E: Eyes, ears
L: Low O2 states (AMI, GI bleed)
I: Infection
R: Retention (Urine or Faeces)
I: Ictal
U: Undernutrition, underhydration
M: Metabolic
S: Subdural

36
Q

Confusion Assessment Method

CAM

A

Acute change in mental status AND Fluctuating course

AND

Inattention

AND

Either Disorganised thinking or Altered Level of Consciousness (Alert is normal, vigilant, lethargic, stupor, coma are abnormal)

37
Q

Differentiate the 3Ds

A

Delirium vs Dementia vs Depression

Onset:
Acute vs Insidious vs Variable

Course:
Fluctuating vs Steadily Progressive vs Diurnal Variation

Consciousness and Orientation:
Clouded/Disoriented vs Clear until late stages vs Generally unimpaired

Attention and Memory:
Poor STM, inattention vs Poor STM without marked inattention vs Poor attention with relatively intact memory

Psychosis:
Common vs loss common vs small subset

38
Q

Factora affecting successful rehabilitation

A
  • Assessment: medical, physical, psychological, social domains
  • Suitability: Adequate baseline physical and psychological functioning
  • Type and Place: Acute hospital, rehab hospital, nursing home, day rehab center, at home

Ageing (1 decks)

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