Ageing Flashcards
What is sarcopenia?
The age-related loss of muscle massand function
What percentage of over 65s in the UK report elder abuse?
3%
What proportion of older people have no chest pain in MI?
One third
How might sepsis present differently in an older person?
BP drops early
Low temp rather than high
Lack of tachycardiac response
Delirium
Which features distinguish delirium from dementia?
Acute nature and fluctuating course
Predisposing factors for delirium
Age Sensory impairment Dementia Polypharmacy Comorbidity Depression Alcohol dependence Malnutrition Post-op state (esp. hip fracture)
Precipitating factors for delirium
Infection Urinary retention Hypoxia Medication use Alcohol Catheterisation MI Glycaemic disturbances Changes in environment
Features of hyperactive delirium
Agitation, aggression
Features of hypoactive delirium
Withdrawn behaviour, apathy, sleepiness
Which type of delirium has the highest mortality rate?
Hypoactive - twice as high as hyperactive
Which screening tool can be used at the bedside to identify potential delirium?
4AT
What score on the 4AT is suspicious of delirium?
4+
What are the four components of the 4AT?
Alertness
AMT
Attention
Acute course
Which type of diuretic can contribute to delirium?
Thiazides
Which drug is used to manage agitation in delirium?
Haloperidol
How many people are affected by sarcopenia worldwide?
50 million
How much exercise should old people do?
Same as all adults - 150m a week moderate activity, strength and balance 2x weekly.
What percentage of older adults meet minimum activity targets?
10-15%
Which drugs have been shown to reduce immobility?
Calcium, vit D, creatine, ACE inhibitors
What percentage of over 80s fall each year?
60%
What is appropriate management for mildpain (step 1 WHO ladder)?
Paracetamol 1g 4x daily, or NSAID+adjuvant as necessary
What is appropriate management formoderatepain (step 2 WHO ladder)?
Weak opioid e.g. codeine, + adjuvant where needed
What is appropriate management forseverepain (step 3 WHO ladder)?
Strong opioid - generally morphine + paracetamol/NSAID and adjuvants as needed
How is the dose calculated when switching from codeine to morphine?
TDD/10
How are morphine doses modified for SC use?
Twice as potent, so dose is halved
How is gastric pH affected in old age?
Older people have a highergastric pH due to decreased numbers of gastric parietal cells
Which two factors increase absorption of basic drugs in the elderly?
Higher gastric pHIncreased levels of alpha-1 acid glycoprotein, which binds basic drugs
How do albumin levels change in old age?
Decrease
Why do lipophilic drugs have a greater volume of distribution and half-life in older people?
There is increased fat in proportion to muscle mass
How does the decreased body water in older people affect drug distribution?
Hydrophilic drugs (lithium, digoxin, etc.) have a lower volume of distribution
Why is reduced hepatic metabolism in older people important?
It results in a reduced first-pass metabolism, so drugs such as propranolol which are greatly effected by first-pass metabolism can be toxic in regular doses
Drugs most frequently associated with adverse reactions in the elderly
Warfarin Digoxin Insulin Benzodiazepines Diuretics NSAIDs Corticosteroids Opioids Anti-hypertensives Theophylline
Which supplements should not be taken at the same time as levothyroxine?
Calcium - it reduces levothyroxine absorption
Which intrinsic, or person, factors increase the risk of falling?
Pathologies - CVD, cognitive impairment, vision problems, vestibular diseasePhysiology of ageing - sarcopenia, lens thickening, decreased reaction time, decreased proprioception leading to postural sway
Drugs which increase fall risk
Benzodiazepines Neuroleptics Antihypertensives Antidepressants Anticholinergics Antiarrhymics
How many times can a cell divide, and what is this limit called?
Around 50 - Hayflick limit
What are the four main cellular responses to damage?
Repair
Apoptosis
Senescence
Malignant transformation
What is the disposable soma hypothesis?
Repairing and maintaining the body past reproduction uses loads of resources and not worth it, so evolution dun care.
What is antagonistic pleiotropy?
The theory that genes which are beneficial in early life can be detrimental in later life, and will be inherited but contribute to cell senescence and death
What morphine dose is used in an opioid naive patient at the end of life?
2mg sc hourly as needed
What is an appropriate dose of levomepromazine in end of life care?
2.5mg
What drug can be used for distress in end of life care?
Midazolam 2mg sc hourly
What drug can be used to decrease secretions at end of life?
Hyascine butylbromide 20mg hourly
What is the most common side effect of calcium supplementation?
GI upset
Which dementia has step-wise deterioration?
Vascular
Why do people with t21 develop alzheimer’s?
Gene dose effect of amyloid precursor protein gene on chromosome 21
Acetylcholinesterase inhibitors used in AD
Donepezil
Galantamine
Rivastigmine
Important advice for taking bisphosphonates
Take on empty stomach to ensure absorption
Remain upright for 30 mins to reduce risk of oesophageal ulceration
