Care of Older People Flashcards
Confused 84 yr old presents in A&E, what investigations?
Collateral history - sudden onset, varying consciousness, impaired attention --> delirium Examination - focal neuro signs CXR - pneumonia MSU - UTI MMSE/confusion assessment method
Describe frailty in older people
Increased vulnerability from ageing associated decline in reserve and function across multiple physiological systems and comorbidities leading to inability to cope with everyday tasks
Common geriatric issues?
Instability, immobility, intellectually impaired, incontinence
Issues with functional decline?
Bedbound for days/weeks
Confused
Poor nutritional state
Falls
How should an older person be assessed comprehensively?
A multidimensional, multidisciplinary diagnostic process.
Determine persons medical, psychological, social and functional capability
Co-ordinated, integrated plan for treatment and long term follow up
Risk factors for falls in older people?
AF and orthostatic hypotension.
Co-morbidities - neuro disease, cognitive decline, visual deficit, weakness, infection, polypharmacy
What is important to examine in a patient who has fallen?
Cardio - Murmur, AF, cardiac failure, orthostatic hypotension
Neuro - gait, cognition, vision, vestibular
MSK
What investigations for patient who has fallen?
ECG - arrhythmia
Lying and standing BP - drop in 20mmHg (systolic) and 10mmHg (diastolic) –> orthostatic hypotension
FBC (anaemia, infection)
U&E - dehydration, drug clearance
Management of falls?
MDT, meds review (stop unnecessary meds)
Lifestyle - hydration, graded standing
Orthstatic HTN - fludrocortisone
Physio and OT
Consequence of falls?
Loss of confidence, fear of falling, serious injury
Why do patients get pressure ulcers?
skin ischaemia from sustained pressure over bony prominence from prolomged hospitalisation
Risk factors of pressure ulcers?
immobility, decreased sensiation, vascular disease, poor nutrition
How can pressure ulcers be prevented?
Specialist tissue viability nurses identify risk pt
Risk assessment - Norton scale/waterlow pressure sore risk assessments
Change positions
Keep skin clean/dry
Rx for pressure ulcers?
adequate nutrition, non-irritant moist wound dressing (hydrocolloid), analgesia
Antibiotics
Debridement of grade 3/4
86 yr old lady confused and treated for UTI, further questions?
Premorbid personality? Past medical hx? Meds? social circumstances? Any previous similar episodes
Causes of delirium?
Drug use - new dose Electrolyte abnormalities Lack of drug (withdrawal) Infection (pneumonia, UTI) Reduced sesory input Intracranial probem - post ictal, stroke, meningitis Urinary retention/faecal impaction Myocardial - MI/arrhythmia
Managing delirium?
Treat cause, manage environment
Clocks/calendars, sleep hygiene, avoid room/ward changes, minimise provocation
Describe the Clincal geriatric team
MDT Chair
Geriatrician
OT/Physio
Social worker
Complications of long lie following fall?
Pressure ulcers, dehydration, rhabdomyolysis
Ix of pressure ulcers?
CRP, ESR WCC Swabs Blood cultures Xray for bone involvement
What is osteoporosis and what are the RF?
Decreased bone mineral density due to imbalance between remodelling and resorption
RF: smoking, early menopause, alcohol, underweight, inactivity, age
Common fractures in osteoporosis?
Spinal, hip, neck of femur
Dx of osteoporosis?
DEXA scan
Risk assessment of 10 year fragility fracture?
FRAX score
Rx for osteoporosis
Bisphosphonates eg risodronate, vitamin D and calcium supplements
84 yr old bleeding from gums?
Vitamin C deficiency
How is nutrition assessed?
MUST screening tool
What is refeeding syndrome and what are the biochemical features?
Metabolic disturbances as a result of reinstitution of nutrition to patients who are starved/severely malnourished
Biochemically: hypophosphatemia, hypokalaemia, thiamine deficiency, abnormal glucose metabolism
Complications of refeeding syndrome
Cardiac arrhythmias, coma, convulsions, cardiac failure
Rx of refeeding syndrome?
Monitor blood biochem, commence refeeding with electrolyte replacement according to guidelines
85 year old man with 2/12 Hx diarrhoea. Wife noticed decline in cognition. Palpable liver edge. Urine dip shows nitrites, protein and leucocytes. On admission, he is very confused.
Give 2 causes for his confusion
What test would you do to assess his mental state?
Wife unable to cope at home.
How would you assess the situation before discharge?
confusion: infection and metabolic abnormalities
Mental state: MMSE
Assess situation: CGA, MDT, carers, physio, OT
