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Year 3 random facts to know > ageing > Flashcards

ageing Flashcards

1
Q

State the main components that comprise the CGA?

A

Medical (Problem list, co-morbidities, medication review, nutritional status)
Functioning (Basic and extended ADLs, activity status, gait and balance)
Psychological (mental status, mood testing)
Social/ environment (Informal needs, social circle, care eligibility, safety)

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2
Q

State what delirium encompasses (AAID)

A

altered level of consciousness
Acute and fluctuating
inattention
disorganised thinking

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3
Q

What are the two broad categories of delirium?

A

Hypoactive (drowsy, reduced consciousness, withdrawn, apathetic, sleepy, coma increased risk of pressure sores) 2x mortality

Hyperactive (agitated, aggressive, wandering  increased falls risk)

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4
Q

Suggest two tools that can be used to assess the risk of the patient having delirium

A

4AT + CAM

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5
Q

componenets of 4AT

A
  • alertness
  • AMT4 (age, DOB, place, current year)
  • attention (months backward)
  • acute of fluctuating course
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6
Q

What dual medication therapy commonly used in UTIs should be avoided in a possible delirium

A

Trimethoprim and haloperidol

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7
Q

Why might you want to stop co-codamol in a patient with possible delirium and pain that isn’t too severe?

A

It can precipitate her delirium and codeine can be constipating

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8
Q

Why might you want to stop Bendroflumethiazide?

A

low Bp and cause falls

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9
Q

Scoring system for determining if there has been a stroke

A

ROSIER score

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10
Q

3 subcategories of stroke

A

Haemorrhage, Infarct, SAH

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11
Q

stroke symptoms Less than 24 hours =

A

TIA

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12
Q

Medications used in secondary prevention of stroke

A 
Anticoagulants if cardioembolic/ AF 
Antiplatelets if not cardioembolic (first line Clopidogrel)
Stop smoking
Statins
Manage blood pressure
Diet and lifestyle advice
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13
Q

CHADSVASC score

A 
Congestive HF
Hypertension
Age >75 - 2
Diabetes
Stroke/TIA/thromboembolism - 2
Vascular disease
Age 65-74
Sex Category - Female
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14
Q

If CHADSVASC greater than 1 then recommend

A

Warfarin/NOAC

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15
Q

What scoring system is used to weigh up the risk of bleeding on anticoagulants?

A

HASBLED - It assesses 1-year risk of majorbleedingin patients taking anticoagulants with atrial fibrillation

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16
Q

Which type of ischaemic stroke should not be treated with aspirin?

A

Cardioembolic (fibrin rich > anticoagulant required)

17
Q

worse prognosis stroke =

A

TACI

18
Q

how are telomeres the biological marker of ageing?

A

They progressively shorten with each cell replication, and eventually become too short to sustain cell replications (then leading to cell senescence)  shorter telomeres = shorter life expectancy

19
Q

What is meant by ‘frailty’?

A

Loss of homeostasis and resilience

Increased vulnerability to decompensation after a stressor event

Increased risk of falls, delirium, disability, death

20
Q

What physiological factors increase risk of falls in elderly?

A
  • vision: smaller pupils, lens thickening = ↓light
  • central processing and cognition = ↓reaction time
  • ↓cardiorespiratory fitness
  • sarcopenia (loss of muscle mass and function)
  • ↓peripheral sensation and proprioception, ↑postural sway
21
Q

causes of falls and syncope in elderly

A 
Arrythmias
Orthostatic hypotension
Neurogenic (vasovagal)
Carotid sinus hypersensitivity
Valvular heart disease (Aortic stenosis)
22
Q

orthostatic hypotension is defined as

A

a fall in SBP >20mmHg or a fall in DBP >10mmHg after 3 minutes of standing

23
Q

how does cervical myelopathy present?

A

High stepping gait

+ve romberg test

24
Q

how does peripheral neuropathy present?

A

altered sensation

wide-based gait

25
Q

there is strongest evidence for what intervention following a fall?

A

Strength and balance training

26
Q

What should be stopped and started in med review following falls?

A

STOP
>4 meds (independent risk factor for falls)
psychoactive medication priority

START
Calcium/ vitamin D (best evidence in longerm care setting/ proven vit D deficiency)
Fracture risk assessment/ osteoporosis treatment

27
Q

Acidic drugs require an ______ environment for absorption

A

Acidic e.g. phenytoin, aspirin, penicillin

Basic drugs require a basic environment for absorption (pH > 7.35) e.g. diazepam, morphine

28
Q

Two main proteins for absorption in older people?

A

Albumin - acidic drugs

Alpha-1-Glycoprotein - basic drugs (more of this in elderly)

29
Q

old people absorb basic drugs better due to

A

decreased gastric secretions

Higher levels of Alpha-1-Glycoprotein

30
Q

What implication does decreased body water in old people have on the distribution of hydrophilic drugs? (e.g. Lithium, digoxin)

A

Lower Vd

31
Q

side effects of opioids, steroids + levothyroxine in elderly?

A

Opioids – constipation (begin lactulose or senna prophylactically) impaired psychomotor, falls and confusion
Steroids – osteoporosis prevention if long term. Steroid induced diabetes
Levothyroxine – calcium interferes with absorption

32
Q

Side effects of NSAIDS + Antibitoics

A

NSAIDS - GI haemorrage, decline in GFR, decreased diuretic effectiveness
Antibiotics - resistance and CDiff

33
Q

START drug rules

A

Antihypertensive: treat where systolic BP consistently > 160
ACEI: with chronic heart failure or post MI
PPI: with aspirin and warfarin in combination
Warfarin/ DOACs: chronic atrial fibrillation, following diagnosis of DVT or PE

34
Q

how much morphine given for breakthrough pain?

A

1/6 of total background dose

35
Q

What is sarcopenia?

A

Definition requires at least 1 + either 2 or 3
1) low muscle mass
2) low muscle strength
3) low physical performance
muscle mass starts to decrease @ 30 then accelerates at 60

36
Q

what drugs should be stopped in the following:
Bleeding ulcer
Kidney failure
Hyponatraemia

A
  • stop NSAID
  • stop ACEi
  • stop antidepressant
37
Q

Meds given at end of life

A

Morphine injection 2mg subcutaneously hourly as required,
midazolam injection 2mg hourly subcutaneously as required,
hyoscine butylbromide (buscopan) injection 20mg hourly as required, [anti-muscarinic used for drying up resp secretions.]
levomepromazine 2.5 mg injection 8 hourly subcutaneously as required. [broad spectrum anti-emetic].

Year 3 random facts to know (18 decks)

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