ageing

Question 1

what are the barriers to adherence?

Answer 1

1. medication- specific barrier
   (too much med, different timings, difficult to remember)
2. illness-specific barrier
   (cognitive decline, peripheral neuropathy)
3. patient- specific barrier
   (personal taste/ disgust)
4. logistical and financial barrier (too expensive)

Question 2

proposed mechanisms for depression

Answer 2

1. monoamine hypothesis: decreased neurotransmitter concentrations e.g. serotonin, norepinephrine, dopamine
2. cytokine g. IL-1B
3. Neuropeptides e.g. substance P and corticotropin releasing factor

Question 3

causes of delirium

Answer 3

Drugs
Eye/ears
Low o2 states due to AMI, stroke, GI bleed

Infection
Retention of urine/faeces
Ictal
Under hydration
Undernutrition
Metabolic
Subdural

Question 4

causes of dementia

Answer 4

Reversible
Drugs (anticholinergics, H2 blockers, Benzodiazepines)

Emotions (depression)
Metabolic (hypothyroidism, hypercalcemia)

Eyes/ears (sensory isolation)
Normal pressure hydrocephalus

Tumour/space occupying lesions
Infection (syphilis, HIV)
Anaemia (vit. B12 deficiency)/ alcoholism

irreversible
- Degenerative brain disease e.g. Alzheimer’s disease, Parkinson’s disease, Lewy body dementia, progressive supranuclear palsy, frontotemporal dementia, genetic

vascular dementia
prion diseases

Question 5

Risk factors of dementia

Answer 5

female
gender
genetic factors
down’s syndrome
family history

early AD gene mutation rare but deterministic: amyloid, precursor protein, Presenilin-1, Presenilin-2

late onset AD gene mutatio. are common and risk conferring: APOE gene (19)

Question 6

Immobility results in?

Answer 6

MSK: contractures, decreased strengths, pressure ulcers, bone loss, increased fracture risk

Resp: pneumonia, decreased ventilation

CVS: DVT, postural hypotension, decreased work capacity

CNS: deterioration in balance and coordination

Genitourinary: urinary incontinence, incomplete bladder emptying

GI: decrease appetite, constipation

Question 7

predisposing factors to adverse drug effects

Answer 7

1. polypharmacy due to co-morbidities
2. decline in liver function
3. decline in renal function
4. cognitive impairment (under/overconsume medications)
5. Poor eyesight (under/overconsome med)
6. physical limitations : might not be able to pack pills properly, not able to break pills into halves

Question 8

drug classes that increases fall risk

Answer 8

1. benzodiazepines and anti-psychotics - cause sedation, dizziness, altered gaits and balances, impaired cognition
2. any hypertensives (ABCD) - postural hypotension
3. insulin and oral hypoglycemic agents - hypoglycemia

Question 9

causes of acute functional decline

Answer 9

1. worsening of known conditions/ illness
2. new illness e.g. stroke, infections, falls, delirium
3. initiation of new medications
4. electrolyte disturbances
5. dehydration
6. hypoglycemia
7. poor med compliance
8. underlying dementia

Question 10

strategies to prevent functional decline

Answer 10

mindful of likelihood

identify and assess general body system specific high risk indicators

implement preventive management strategies targeting one or more relevant domains

managing cognition, emotional health, self-care, continence, nutrition and skin-integrity