Ageing deck 1

Question 1

What common problem can cause confusion in the elderly?

Answer 1

Dehydration

Question 2

What is the definition of delirium?

Answer 2

Acute confusional state

Question 3

What are the four most common signs/symptoms of delirium?

Answer 3

Disturbance in attention
Change in cognition
Develops over a short period
Tends to fluctuate

Question 4

What are some pathophysiology theories that try to explain the causes of delirium? (3)

Answer 4

Variable derangement of multiple neurotransmitters (particularly ACh)
Direct toxic insults to the brain
Aberrant stress response

Question 5

What are the most common causes of delirium?

Answer 5

Hip fracture
UTI
Polypharmacy

Question 6

Is delirium associated with dementia?

Answer 6

YES

Higher risk of getting dementia if you have a history of delirium

Question 7

What is the onset of delirium?

Answer 7

Sudden (hours/days)

Question 8

Is delirium reversible?

Answer 8

Oui

Question 9

How long does delirium last?

Answer 9

No more than a few months

Question 10

What does the 4AT measure?

Answer 10

Alertness
AMT4 (age, DoB, place, current year)
Attention (months of yr backwards)
Acute change/fluctuating course

Question 11

What does CAM measure?

Answer 11

Acute and fluctuating course
+
Inattention

with either

Disorganised thinking
and/or
altered level of consciousness

Question 12

What are the 2 delirium subtypes?

Answer 12

Hyperactive

Hypoactive

Question 13

What are the signs/symptoms in a patient with HYPERactive delirium?

Answer 13

Agitated
Aggressive
Wandering

Question 14

What are the signs/symptoms of a patient with HYPOactive delirium?

Answer 14

Withdrawn
Apathetic
Sleepy
Coma

Question 15

Does delirium have a singular cause?

Answer 15

Non!

Often multiple causes

Question 16

What are some key investigations to do in a patient presenting with delirium?

Answer 16

Find cause!

• Bloods
• Review meds
• Check hydration
• Stop nephrotoxic drugs
• BP/perfusion

Question 17

What are some environmental/supportive factors to consider for a patient with delirium?

Answer 17

• Calm environment
• Sleep chart
• Family brings things from home
• Glasses and hearing aids (if necessary)
  etc

Question 18

When should you sedate a patient with delirium?

Answer 18

Only if they are a danger to themselves or staff

Question 19

What are some pharmacological measures that can be used in patients with delirium?

Answer 19

Haloperidol
Quetiapine (Parkinson’s/Lewy body dementia)
Benzodiazepines

Question 20

When can you use benzodiazepines in a patient with delirium?

Answer 20

If alcohol/benzodiazepine withdrawal or seizure
Lorazepam
Can worsen delirium

Question 21

What is sarcopenia?

Answer 21

Age related loss of muscle mass and function

Question 22

What is the classification system for sarcopenia?

Answer 22

Must have 1 plus 2 or 3

1. Low muscle mass
2. Low muscle strength
3. Low physical performance

Question 23

At what age does muscle mass begin to decline?

Answer 23

Age 30

Question 24

What is sarcopenic obesity?

Answer 24

Low muscle mass + increased fat levels

Question 25

What is main way to prevent sarcopenia?

Answer 25

EXERCISE

Question 26

What is cachexia?

Answer 26

Weakness and wasting of the body due to severe chronic illnesses

Question 27

What is the recommended amount of exercise for an elderly person?

Answer 27

Same as for an adult

150 mins per week

Question 28

What are 2 drugs you could consider giving to a patient with sarcopenia?

Answer 28

ACEi

Creatine

Question 29

Why would you consider giving an ACEi to a person with sarcopenia?

Answer 29

Reduces inflammation and improves mitochondrial function

Question 30

Why would you consider supplementing creatine in a person with sarcopenia?

Answer 30

Dietary compound that is involved in delivering energy to muscles