Ageing Flashcards
What is the definition of frailty?
Distinctive health state related to ageing process
Multiple body systems gradually lose their in-built reserve
What tests can you carry out for frailty?
Rockwood Score PRISMA-7 Questionnaire Bournemouth Criteria Electronic frailty index (eFI) Timed up and go Gait speed test Grip strength Self report by patient
What are the 5 frailty syndromes?
Delirium Incontinence Medication side effects Falls Immobility
What is a comprehensive geriatric assessment(CGA)?
Multidimensional. holistic assessment of older person
Leads to formulation of individual management plan
What are some physical components of a CGA?
Nutrition - eating well, constipation, swallowing
Pain - joint examination, alternative words e.g. aches
Sensory (vision/hear) - gross visual testing e.g no fingers
Continence - med reviews, storage/voiding problems
Lying/Standing BP
Bone health
Feet + footwear
When should lying/standing BP always be taken?
Patients >65 admitted to hospital with a fall
What is a psychological component of a CGA?
Mood
What mnemonic would you use to screen and assess continence?
Screen - U - Urgency R - Regular trips I - Incontinence/UTI/Indwelling catheter N - Nocturia E - Exercise/sneeze/cough leakage Assess - D - Drugs/dementia R - Rectal exam I - Image bladder (PVRV) P - Pv (vaginal examination) S - Send urine sample
What is stress urinary incontinence?
Involuntary passive loss of urine through stress exerted on the bladder due to pelvic floor muscle weakness
What are some common causes of stress urinary incontinence?
Childbirth Prostate surgery Obesity Chronic cough Previous pelvic surgery Post-menopause
How would you manage stress urinary incontinence?
Conservative measures Treat causes e.g. COPD, optimise lifestyle factors e.g. lose weight Fluid management Pelvic floor exercises Bladder training Surgery/Pessaries
What is urge urinary incontinence?
Sudden and strong desire to urinate, causes incontinence
AKA overactive bladder, detrusor instability
What factors can affect urge urinary incontinence?
Alcohol/food Infection Constipation Age Structural problems e.g. stones/cancer Neurological disorders
How would you manage urge urinary incontinence?
Same as stress urinary incontinence
Bladder training, double voiding
Anticholinergics, Beta 3 agonists
Botox/nerve stimulator/surgery
What types of drugs can be used to help incontinence?
Muscarinic receptor antagonists (anticholinergic) e.g. oxybutinin, tolterodine, solifencacin
Beta 3 agonists e.g. mirabegron
What are some side effects of the drugs used to help incontinence?
Muscarinic receptor antagonists (anticholinergic) - falls, cognitive impairment, dry mouth, constipation
Beta 3 agonists - hypertension
What are some features of incontinence caused by severe cognitive impairments?
Causes?
Loss of voluntary control over micturition/defecation
More reflex mediated/higher cortical function
Dementia + neurodegenerative conditions
Trauma/stroke/neurodisability
How would you manage incontinence caused by severe cognitive impairments?
Modify any reversible causes
Toileting regime where possible - may incl bowel management
Supportive mit continence products, good skin + pressure area care
What drugs can cause constipation?
Opioid analgesics Supplements - Fe, Ca, Al Beta blockers Ca channel blockers Anticholinergics Antipsychotics
Why are decarboxylase inhibitors administered with dopamine precursors?
So body doesn’t break down precursors before they reach brain.
What area of the brain is targeted for deep brain stimulation?
Subthalamic nucleus (STN)
What is a key hallmark of Alzheimer’s?
Medial temporal atrophy/hippocampus atrophy
