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Year 3 > Ageing > Flashcards

Ageing Flashcards

1
Q

4 components of a comprehensive geriatric assessment?

A

Medical
Functioning
Psychological
Social/Environment

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2
Q

Why is acute illness in elderly likely to present in an atypical manner?

A

Co-morbidities

Impaired immune/physiological functioning

Polypharmacy

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3
Q

Criteria for sarcopenia?

A

Low muscle mass

+ 1/2 of:
Low muscle strength
Low physical performance

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4
Q

Sarcopenic obesity?

A

Loss of muscle mass with increased fat - BMI may remain the same

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5
Q

Interventions for sarcopenia?

A

Exercise - progressive resistance training and aerobic training

Reduce sedentary time

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6
Q

Rehabilitation?

Reablement?

A

Rehab - disabled by injury/disease achieve a full recovery

rebate - poor physical/mental health re-learn skills to accommodate illness

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7
Q

3 things which contribute to ageing?

A
  • Random molecular damage during cell multiplication
  • Inactivity, poor diet, inflammation etc
  • Reduced ability of body’s adaptive reserve capacity (resilience)
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8
Q

3 things frailty causes?

A

Loss of homeostasis and resilience

Increased vulnerability to decompensation after a stressor event

Increased risk of falls, delirium, disability, death

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9
Q

Any sudden decline in health?

Multimorbidity?

A

Due to disease

Higher rates of adverse events and poorer QOL

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10
Q 
Palliative care:
Pain/SOB?
Distress?
Nausea/agitation?
Res secretions?
A

Pain/SOB - morphine

Distress - midazolam

Nausea/agitation - Levomepromazine

Res secretions - Buscopan

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11
Q

AF increases stroke risk how much?

A

5x

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12
Q

Cardioembolic stroke?

Atheroembolic stroke?

A

Cardio - fibrin rich red thrombus - anticoagulant

Athero - platelet rich white thrombus - anti-platelet

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13
Q

Frontal lobe functions?

Lesion?

A

Function - personality, emotional response, social behaviour

Lesion - disinhibition, lack of initiative, antisocial behaviour, incontinence, impaired memory, grasp reflex, anosmia

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14
Q

Dominant parietal function?

Lesion?

A

Fun - calculation, language, planned movement, appreciation of size/shape/weight/texture (stereognosis)

Lesion - dyscalculia, apraxia, AGNOSIA, homonymous hemianopia - L/R DISORIENTATION

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15
Q

Non-dominant parietal function?

Lesion?

A

Function - spatial orientation, construction skills

Lesion - HEMISPATIAL NEGLECT, construction/dressing apraxia, homonymous hemianopia

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16
Q

Occipital function?

Lesion?

A

Function - Analysis of vision

Lesion - homonymous hemianopia with MACULAR SPARING, impaired facial recognition, visual hallucinations

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17
Q

Dominant temporal function?

Lesion?

A

Function - Auditory perception, speech, language, verbal memory, smell

Lesion - Wernicke’s dysphasia, dyslexia, homonymous hemianopia, poor memory, complex hallucinations (sound, smell, vision)

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18
Q

Non-dominant temporal function?

Lesion?

A

Function - auditory perception, music, tone sequences, non-verbal memory (faces, shapes, music), smell

Lesion - homonymous hemianopia, poor non-verbal memory, loss of music skills, complex hallucinations (visual, smell, sound)

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19
Q

Is delirium acute?

A

Yes

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20
Q

4 hallmark symptoms of delirium?

A

1 - acute and fluctuating
2 - inattention
3 - altered consciousness
4 - disorganised thinking

21
Q

Hyperactive delirium?

Hypoactive delirium?

A

Hyper - agitated, aggressive, wandering

Hypo - withdrawn, apathetic, sleepy (coma)
–> easily missed, 2x higher mortality

22
Q

2 Ix for delirium?

A 
4AT:
Alertness
AMT4 (age, DOB, place, year)
Attention (months of year backwards)
Acute/fluctuating course

CAM:

  1. acute/fluctuating
  2. Inattention
  3. Disorganised thinking
  4. Altered consciousness
    - -> 1 and 2 + 3 OR 4
23
Q

Conservative management of delirium?

A

Environment and supportive factors

Identify and treat underlying cause

Symptom control

24
Q

Medical management of Delirium?

A

Haloperidol - NOT IN PARKINSONS

Quetiapine - in Parkinsons/Lewy Body Dementia

Benzo - alcohol/benzo withdrawal or seizure (Lorazepam or Chlordiazepoxide) - however beware these can worsen delirium

25
Q

Predisposing factors for delirium?

A
  • Age
  • Pre-existing dementia
  • Co-morbidity
  • Terminal illness
  • Sensory impairment
  • Polypharmacy
  • Depression
  • Alcohol dependency
  • Malnutrition
26
Q

5 things that link falls and immobilisation?

A 
Hypothermia/Dehydration
Pressure sores
Rhabdomyolysis
VTE
Bronchopneumonia
27
Q

5 physiological changes in ageing that can lead to falls?

A
  • Central processing/cognition (reduced reaction)
  • Vision (smaller pupil, thicker lens)
  • Sarcopenia (less muscle mass and function)
  • Peripheral sensation/proprioception (increased postural sway and poor sensory awareness)
  • Reduced activity (decreased cardio fitness)
28
Q

Risk factors for falls?

CVS, central processing, MSK, neuro, vision, other

A

CVS - dizziness, postural hypotension, heart disease

Central processing - cognitive impairment, depression

MSK - pain, arthritis, sarcopenia

Neuro - parkinsonism, stroke, neuropathy, balance

Vision - acuity, depth perception, contrast sensitivity

Other - low BMI, Hx of falls, age>80, female

29
Q

What is postural hypotension?

A

Drop of >20/10mmHg on standing after 2 mins

30
Q

8 Drug classes that increase fall risk?

A
  • Benzos
  • Neuroleptics
  • Antihypertensives
  • Antidepressants (SSRI hyponatraemia, TCA antivholinergic)
  • Anticholinergics
  • Class 1a anti-arrhythmatics (disopyramide)
  • Diuretics
  • anti-epileptics
31
Q

Investigations for falls?

A
  • HR, Cardio, postural BP
  • Visual acuity
  • Gait, balance, joints
32
Q

3 Assessment tools for falls?

A

Timed get up and go

Berg Balance Test (Balance only - static and dynamic balance)

Tinetti Score (Balance AND Gait) - performance orientated mobility assessment (POMA)

33
Q

Management of falls? (5)

A
  • Risk modification
  • Strength and balance training
  • Vision optimisation
  • Footwear and foot care
  • Osteoporosis treatment
34
Q

2 principles of drug absorption?

A

1 - acidic drugs need acidic environment (e.g. Phenytoin, Aspirin, Penicillin)

2 - Basic drugs need basic environment (e.g. diazepam, morphine, pethidine)

35
Q

Pharmacodynamics in elderly?

A

Lower dose achieves same effect (e.g. alcohol)

However effects of some drugs are decreased (e.g. B-blockers and HR)

36
Q

SE of amlodipine?

A

oedema (treat with furosemide)

37
Q

SE of NSAIDs?

A

hypertension
GI bleeding
decline of GFR

Treat GI with H2 blockers, which can lead to delirium (from tiredness), which needs treated with haloperidol

38
Q

SE of metoclopramide?

A

parkinsonism (treat with sinemet (carbidopa/levodopa))

39
Q

SE of thiazides?

A

Gout (tread with NSAIDS, which may then require 2nd anti-hypertensive added)

40
Q

SE of sedafed?

pseudoephedrine - sympathomimetic, used as nasal decongestant

A

Urinary retention (then need alpha blockers)

41
Q

10 most common drugs likely to cause SE in elderly?

A 
Warfarin
Digoxin
Insulin
Benzos
Diuretics
NSAIDs
Corticosteroids
Anti-hypertensives
Opioids (confusion, falls)
Theophylline (insomnia, diarrhoea, irritability, headache, incontinence)
42
Q

Why do elderly absorb basic drugs more readily?

A

1 - less acid production therefore increased stomach pH

2 - Acidic drugs bind albumin and Basic drugs bind A1-AG - elderly have low albumin and high A1-AG

43
Q

Difference of lipophilic drugs in elderly?

A

Elderly have higher volume distribution (Vd) of lipophilic drugs

44
Q

Grapefruit juice?

A

Interacts with simvastatin - CYP450 inhibition by grapefruit juice - myalgia

45
Q

Cranberry juice?

A

Warfarin - increases INR - bleeding risk

46
Q

4 things in pharmacokinetics?

A

ADME

Absorption
Distribution
Metabolism
Excretion

47
Q

How to manage side effects?

A

Try changing to another drug - avoid treating SE with more drugs if possible

48
Q

Therapeutic index?

A

Minimum toxic dose/minimum effective conc

Year 3 (19 decks)

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