ageing Flashcards
State the main components that comprise the CGA?
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)
State what delirium encompasses (AAID)
altered level of consciousness
Acute and fluctuating
inattention
disorganised thinking
What are the two broad categories of delirium?
Hypoactive (drowsy, reduced consciousness, withdrawn, apathetic, sleepy, coma increased risk of pressure sores) 2x mortality
Hyperactive (agitated, aggressive, wandering increased falls risk)
Suggest two tools that can be used to assess the risk of the patient having delirium
4AT + CAM
componenets of 4AT
- alertness
- AMT4 (age, DOB, place, current year)
- attention (months backward)
- acute of fluctuating course
What dual medication therapy commonly used in UTIs should be avoided in a possible delirium
Trimethoprim and haloperidol
Why might you want to stop co-codamol in a patient with possible delirium and pain that isn’t too severe?
It can precipitate her delirium and codeine can be constipating
Why might you want to stop Bendroflumethiazide?
low Bp and cause falls
Scoring system for determining if there has been a stroke
ROSIER score
3 subcategories of stroke
Haemorrhage, Infarct, SAH
stroke symptoms Less than 24 hours =
TIA
Medications used in secondary prevention of stroke
Anticoagulants if cardioembolic/ AF Antiplatelets if not cardioembolic (first line Clopidogrel) Stop smoking Statins Manage blood pressure Diet and lifestyle advice
CHADSVASC score
Congestive HF Hypertension Age >75 - 2 Diabetes Stroke/TIA/thromboembolism - 2 Vascular disease Age 65-74 Sex Category - Female
If CHADSVASC greater than 1 then recommend
Warfarin/NOAC
What scoring system is used to weigh up the risk of bleeding on anticoagulants?
HASBLED - It assesses 1-year risk of majorbleedingin patients taking anticoagulants with atrial fibrillation
Which type of ischaemic stroke should not be treated with aspirin?
Cardioembolic (fibrin rich > anticoagulant required)
worse prognosis stroke =
TACI
how are telomeres the biological marker of ageing?
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
What is meant by ‘frailty’?
Loss of homeostasis and resilience
Increased vulnerability to decompensation after a stressor event
Increased risk of falls, delirium, disability, death
What physiological factors increase risk of falls in elderly?
- 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
causes of falls and syncope in elderly
Arrythmias Orthostatic hypotension Neurogenic (vasovagal) Carotid sinus hypersensitivity Valvular heart disease (Aortic stenosis)
orthostatic hypotension is defined as
a fall in SBP >20mmHg or a fall in DBP >10mmHg after 3 minutes of standing
how does cervical myelopathy present?
High stepping gait
+ve romberg test
how does peripheral neuropathy present?
altered sensation
wide-based gait
there is strongest evidence for what intervention following a fall?
Strength and balance training
What should be stopped and started in med review following falls?
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
Acidic drugs require an ______ environment for absorption
Acidic e.g. phenytoin, aspirin, penicillin
Basic drugs require a basic environment for absorption (pH > 7.35) e.g. diazepam, morphine
Two main proteins for absorption in older people?
Albumin - acidic drugs
Alpha-1-Glycoprotein - basic drugs (more of this in elderly)
old people absorb basic drugs better due to
decreased gastric secretions
Higher levels of Alpha-1-Glycoprotein
What implication does decreased body water in old people have on the distribution of hydrophilic drugs? (e.g. Lithium, digoxin)
Lower Vd
side effects of opioids, steroids + levothyroxine in elderly?
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
Side effects of NSAIDS + Antibitoics
NSAIDS - GI haemorrage, decline in GFR, decreased diuretic effectiveness
Antibiotics - resistance and CDiff
START drug rules
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
how much morphine given for breakthrough pain?
1/6 of total background dose
What is sarcopenia?
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
what drugs should be stopped in the following:
Bleeding ulcer
Kidney failure
Hyponatraemia
- stop NSAID
- stop ACEi
- stop antidepressant
Meds given at end of life
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].
