Ageing Flashcards
How does the ageing process affect muscles?
Decreased muscle mass
Decreased body water
Increased fat
What is sarcopenia?
Degenerative loss of muscle mass, quality and strength associated with ageing
What changes does ageing have on the brain?
Decreased cerebral blood flow
Autoregulation becomes defective
Decreased brain weight
What changes does ageing have on the autonomic system?
Less reactive, especially BP and temperature
What effects does ageing have on bones and joints?
Gradual progressive loss of bone from age 35
Osteoarthritis
What effects does ageing have on the heart?
Decreased CO Decreased maximal HR Decreased SV Calcification of valves Ventricle hypertrophy
What effects does ageing have on the lungs?
Decreased lung capacity
Decreased vital capacity
Decreased chest wall compliance
What effects does ageing have on the GI system?
Decreased taste
Decreased large bowel motility
Dentures
What effects does ageing have on eyes and ears?
Decreased function of both (presbyopia, presbyacusis)
How does ageing affect the skin?
Becomes thinner and dryer
How does ageing affect sleep?
Sleep becomes lighter, shorter and more broken
What is frailty?
Loss of biological reserves across multiple body systems, resulting in increased vulnerability to relatively minor events leading to adverse outcomes
What investigations can you do for frailty?
Comprehensive Geriatric Assessment
Timed Up and Go Test
PRISMA 7 questionnaire
Edmonton & Rockwood fraility examination
Who falls more - women or men?
Women
What is polypharmacy?
4 or more medications
What are some common drugs that cause falls?
Benzodiazepines, neuroleptics, antidepressants, antihypertensives, opiates, anticholinergics, diuretics
What are some age related causes of falls?
Postural instability due to loss of muscle mass
Postural hypotension due to loss of autonomic drive
Decreased vision - smaller pupils, glasses
Bladder instability
Decreased cardiorespiratory fitness
Decreased peripheral sensation and proprioception
Decreased reaction times
What are cardiac causes of falls?
Arrhythmias, orthostatic hypotension, vasovagal attacks, carotid sinus hypersensitivity
What are neurological causes of falls?
Peripheral neuropathy, spinal stenosis, stroke, Parkinsons
What are vestibular causes of falls?
Vertigo and dizziness
What are cognitive causes of falls?
Dementia
What are some environmental causes of falls?
Trip hazards, stairs with no handrails, no walking aids, alcohol, inappropriate footwear
What is a good structure to take a falls history?
BEFORE the fall, DURING the fall, AFTER the fall
What are important questions to ask in a history about before the fall?
What patient was doing immediately before and 30 minutes prior, how they had felt over the previous few days.
Did they feel unwell/have any warning symptoms
What are important questions to ask in a history during the fall?
Any loss of conciousness?
Aware of any immediate injuries?
How long were they lying for?
What are important questions to ask in a history about after the fall?
How they managed to get up, what injuries they have sustained, how they feel now (confidence etc)
What other questions are important to ask about in a falls history?
Have they fallen before? How many times? Any serious consequences? Ask about mood and consequences of these falls. Ask about mobility and bones.
What are important examinations to perform in someone who has had a fall?
Full physical assessment with focus on cardio&neuro examinations. Remember to check feet and footwear Check cognition Assess gait and balance Do sitting and standing BP
What is the best management of a fall?
Strength and balance training (3 times/week for 12 weeks)
Conservative management
Medication review
What other conservative management options are there for preventing a fall?
Modify home environment
Ensure well fitting shoes
Vision optimisation
What should a medication review do in a patient who has fallen?
Focus on only keeping drugs that are needed for symptom control
Consider de-prescribing and non-drug alternatives
What is osteoporosis?
Loss of bone density resulting in thin bones with normal mineralisation
What are causes of osteoporosis?
Failure to achieve maximal bone density by 35
Hyperthyroid, hyperparathyroid, cushings, anorexia, coeliac, IBD, pancreatitis, poor calcium intake, inactivity, drugs, family history
How does osteoporosis present?
Fragility fractures, loss of height, Dowagers hump
What investigations are done for osteoporosis?
Routine bloods
TFTs
Myeloma screen
Dexa scan
What T score is indicative of osteoporosis?
Less than -2.5
What T score is indicative of osteopenia?
1 to -2.5
How is osteoporosis treated?
Calcium + vitamin D and oral bisphosphonate
Accrete D3 + Alendronate
How do bisphosphonates work?
Inhibit osteoclasts
How are bisphosphonates taken?
Taken once a week in the morning on an empty stomach with 200mls of water. Sit up for 30 mins after taking
What is the main serious side effect of bisphosphonates?
Osteonecrosis of the jaw
What is delirium?
An acute confusional state characterised by a disturbance in attention and a change in cognition that develops over a short period and fluctuates during the episode
How does hyperactive delirium present?
Agitation, aggression, wandering
How does hypoactive delirium present?
Withdrawn, apathetic, sleepy coma
Is hyper or hypo active delirium more common?
Hypoactive
What factors predispose to delirium?
Advanced age, pre-exisiting dementia, co-morbidity, post-op, terminal illness, sensory impairment, polypharmacy, depression, alcohol, dependency, malnutrition
What factors precipitate delirium?
UTI, dehydration, constipation, alcohol, fractures, hyponatraemia, drugs, chest infections, hospital
What are the hallmarks of delirium to look out for?
Acute and fluctuating course
Inattention
Altered cognition
Disorganised thinking
What are the 4 areas of the 4AT?
Alertness
AMT4
Attenton
Acute/fluctuating
How is alertness assessed in 4AT?
Normal/sleepy = 0 points
Abnormal = 4 points
How is AMT4 assessed in 4AT?
Ask patients age, DOB, current place, current year
No mistake = 0 points
1 mistake = 1 point
2 or more mistakes = 2 points
How is attention assessed in 4AT?
Ask patient to say the months of the year backwards
7 or more = 0
Less than 7 = 1
Untestable = 2
How is acute/fluctuating scored in the 4AT?
No = 0 points Yes = 4 points
What score in the 4AT is suggestive of possible delirium?
4 or more
What conservative management options are important in delirium?
Continuity of staff/familiar people Quiet/calm environment with low lighting (sideroom) Visible clock with place and date also Engage and reassure relatives Work to identify an underlying cause
What legal framework would be used if there was concerns regarding capacity?
Adults with Incapacity Act Section 47
When is sedation used in delirium?
If the patient is a danger to themselves or others
What sedation is used in delirium?
Haloperidol (0.25-0.5mg) orally. Max 5g in 24 hours
What sedation is used in patients unable to have haloperidol (e.g. Parkinsons)?
Lorazepam
Who should follow up patients who have had delirium?
Psychiatry of old age team
What is an episode of delirium a risk factor for?
Dementia and further episodes of delirium
What do potassium rich foods like bananas, oranges and green leafy vegetables interact with?
ACE inhibitors, ARBS, spironolactone
What food does warfarin interact with?
Apples, chickpeas, spinach, nuts, kiwi, broccoli (Vitamins E and K)
What do chicken, turkey, milk, soy (foods that alter pH) interact with?
Antibiotics, digoxin, diuretics
What drugs do grapefruit, apple, orange and cranberry (Cytochromone P450) interact with?
Statins
Antihistamines
What drugs most commonly precipitate delirium?
Sedatives, hypnotics, antidepressants, levodopa, codeine, digoxin, furosemide, oxybutynin
What is refeeding syndrome caused by?
Malnourished/ill patients becoming unwell due to an inappropriately high protein-calorie intake
Patients with what MUST score should be referred to the dieticians?
More than 2
How many hyperthyroidism present in the elderly?
Apathy, tiredness, muscle weakness, loss of appetite, weight loss
What is posutral hypotension defined as?
Fall of >20mmHg systolic or >10mmHg diastolic upon standing
What is the aetiology of essential tremor?
Inherited or lead/manganese exposure
What are the characteristics of essential tremor?
6-12hZ and postural
How is essential tremor treated?
Propranolol
