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Finals Revision > Ageing > Flashcards

Ageing Flashcards

1
Q

How does the ageing process affect muscles?

A

Decreased muscle mass
Decreased body water
Increased fat

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2
Q

What is sarcopenia?

A

Degenerative loss of muscle mass, quality and strength associated with ageing

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3
Q

What changes does ageing have on the brain?

A

Decreased cerebral blood flow
Autoregulation becomes defective
Decreased brain weight

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4
Q

What changes does ageing have on the autonomic system?

A

Less reactive, especially BP and temperature

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5
Q

What effects does ageing have on bones and joints?

A

Gradual progressive loss of bone from age 35

Osteoarthritis

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6
Q

What effects does ageing have on the heart?

A 
Decreased CO
Decreased maximal HR
Decreased SV
Calcification of valves
Ventricle hypertrophy
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7
Q

What effects does ageing have on the lungs?

A

Decreased lung capacity
Decreased vital capacity
Decreased chest wall compliance

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8
Q

What effects does ageing have on the GI system?

A

Decreased taste
Decreased large bowel motility
Dentures

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9
Q

What effects does ageing have on eyes and ears?

A

Decreased function of both (presbyopia, presbyacusis)

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10
Q

How does ageing affect the skin?

A

Becomes thinner and dryer

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11
Q

How does ageing affect sleep?

A

Sleep becomes lighter, shorter and more broken

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12
Q

What is frailty?

A

Loss of biological reserves across multiple body systems, resulting in increased vulnerability to relatively minor events leading to adverse outcomes

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13
Q

What investigations can you do for frailty?

A

Comprehensive Geriatric Assessment
Timed Up and Go Test
PRISMA 7 questionnaire
Edmonton & Rockwood fraility examination

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14
Q

Who falls more - women or men?

A

Women

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15
Q

What is polypharmacy?

A

4 or more medications

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16
Q

What are some common drugs that cause falls?

A

Benzodiazepines, neuroleptics, antidepressants, antihypertensives, opiates, anticholinergics, diuretics

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17
Q

What are some age related causes of falls?

A

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

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18
Q

What are cardiac causes of falls?

A

Arrhythmias, orthostatic hypotension, vasovagal attacks, carotid sinus hypersensitivity

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19
Q

What are neurological causes of falls?

A

Peripheral neuropathy, spinal stenosis, stroke, Parkinsons

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20
Q

What are vestibular causes of falls?

A

Vertigo and dizziness

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21
Q

What are cognitive causes of falls?

A

Dementia

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22
Q

What are some environmental causes of falls?

A

Trip hazards, stairs with no handrails, no walking aids, alcohol, inappropriate footwear

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23
Q

What is a good structure to take a falls history?

A

BEFORE the fall, DURING the fall, AFTER the fall

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24
Q

What are important questions to ask in a history about before the fall?

A

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

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25
Q

What are important questions to ask in a history during the fall?

A

Any loss of conciousness?
Aware of any immediate injuries?
How long were they lying for?

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26
Q

What are important questions to ask in a history about after the fall?

A

How they managed to get up, what injuries they have sustained, how they feel now (confidence etc)

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27
Q

What other questions are important to ask about in a falls history?

A

Have they fallen before? How many times? Any serious consequences? Ask about mood and consequences of these falls. Ask about mobility and bones.

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28
Q

What are important examinations to perform in someone who has had a fall?

A 
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
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29
Q

What is the best management of a fall?

A

Strength and balance training (3 times/week for 12 weeks)
Conservative management
Medication review

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30
Q

What other conservative management options are there for preventing a fall?

A

Modify home environment
Ensure well fitting shoes
Vision optimisation

31
Q

What should a medication review do in a patient who has fallen?

A

Focus on only keeping drugs that are needed for symptom control
Consider de-prescribing and non-drug alternatives

32
Q

What is osteoporosis?

A

Loss of bone density resulting in thin bones with normal mineralisation

33
Q

What are causes of osteoporosis?

A

Failure to achieve maximal bone density by 35
Hyperthyroid, hyperparathyroid, cushings, anorexia, coeliac, IBD, pancreatitis, poor calcium intake, inactivity, drugs, family history

34
Q

How does osteoporosis present?

A

Fragility fractures, loss of height, Dowagers hump

35
Q

What investigations are done for osteoporosis?

A

Routine bloods
TFTs
Myeloma screen
Dexa scan

36
Q

What T score is indicative of osteoporosis?

A

Less than -2.5

37
Q

What T score is indicative of osteopenia?

A

1 to -2.5

38
Q

How is osteoporosis treated?

A

Calcium + vitamin D and oral bisphosphonate

Accrete D3 + Alendronate

39
Q

How do bisphosphonates work?

A

Inhibit osteoclasts

40
Q

How are bisphosphonates taken?

A

Taken once a week in the morning on an empty stomach with 200mls of water. Sit up for 30 mins after taking

41
Q

What is the main serious side effect of bisphosphonates?

A

Osteonecrosis of the jaw

42
Q

What is delirium?

A

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

43
Q

How does hyperactive delirium present?

A

Agitation, aggression, wandering

44
Q

How does hypoactive delirium present?

A

Withdrawn, apathetic, sleepy coma

45
Q

Is hyper or hypo active delirium more common?

A

Hypoactive

46
Q

What factors predispose to delirium?

A

Advanced age, pre-exisiting dementia, co-morbidity, post-op, terminal illness, sensory impairment, polypharmacy, depression, alcohol, dependency, malnutrition

47
Q

What factors precipitate delirium?

A

UTI, dehydration, constipation, alcohol, fractures, hyponatraemia, drugs, chest infections, hospital

48
Q

What are the hallmarks of delirium to look out for?

A

Acute and fluctuating course
Inattention
Altered cognition
Disorganised thinking

49
Q

What are the 4 areas of the 4AT?

A

Alertness
AMT4
Attenton
Acute/fluctuating

50
Q

How is alertness assessed in 4AT?

A

Normal/sleepy = 0 points

Abnormal = 4 points

51
Q

How is AMT4 assessed in 4AT?

A

Ask patients age, DOB, current place, current year
No mistake = 0 points
1 mistake = 1 point
2 or more mistakes = 2 points

52
Q

How is attention assessed in 4AT?

A

Ask patient to say the months of the year backwards
7 or more = 0
Less than 7 = 1
Untestable = 2

53
Q

How is acute/fluctuating scored in the 4AT?

A 
No = 0 points
Yes = 4 points
54
Q

What score in the 4AT is suggestive of possible delirium?

A

4 or more

55
Q

What conservative management options are important in delirium?

A 
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
56
Q

What legal framework would be used if there was concerns regarding capacity?

A

Adults with Incapacity Act Section 47

57
Q

When is sedation used in delirium?

A

If the patient is a danger to themselves or others

58
Q

What sedation is used in delirium?

A

Haloperidol (0.25-0.5mg) orally. Max 5g in 24 hours

59
Q

What sedation is used in patients unable to have haloperidol (e.g. Parkinsons)?

A

Lorazepam

60
Q

Who should follow up patients who have had delirium?

A

Psychiatry of old age team

61
Q

What is an episode of delirium a risk factor for?

A

Dementia and further episodes of delirium

62
Q

What do potassium rich foods like bananas, oranges and green leafy vegetables interact with?

A

ACE inhibitors, ARBS, spironolactone

63
Q

What food does warfarin interact with?

A

Apples, chickpeas, spinach, nuts, kiwi, broccoli (Vitamins E and K)

64
Q

What do chicken, turkey, milk, soy (foods that alter pH) interact with?

A

Antibiotics, digoxin, diuretics

65
Q

What drugs do grapefruit, apple, orange and cranberry (Cytochromone P450) interact with?

A

Statins

Antihistamines

66
Q

What drugs most commonly precipitate delirium?

A

Sedatives, hypnotics, antidepressants, levodopa, codeine, digoxin, furosemide, oxybutynin

67
Q

What is refeeding syndrome caused by?

A

Malnourished/ill patients becoming unwell due to an inappropriately high protein-calorie intake

68
Q

Patients with what MUST score should be referred to the dieticians?

A

More than 2

69
Q

How many hyperthyroidism present in the elderly?

A

Apathy, tiredness, muscle weakness, loss of appetite, weight loss

70
Q

What is posutral hypotension defined as?

A

Fall of >20mmHg systolic or >10mmHg diastolic upon standing

71
Q

What is the aetiology of essential tremor?

A

Inherited or lead/manganese exposure

72
Q

What are the characteristics of essential tremor?

A

6-12hZ and postural

73
Q

How is essential tremor treated?

A

Propranolol

Finals Revision (22 decks)

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