Care of the Elderly

Question 1

How ro define progressive frailty

Answer 1

• slow decline
• dwindling
• sarcopenia
• weight loss
• multiple comorbidites
• functional and cognitive impairment
• increased susceptibility to illness
• reduced capacity to recover
• LTC

Question 2

When should you think about a palliative approach in elderly patient with chronic illness?

Answer 2

1. yes to surprise question
2. New diagnosis of life limiting condition
3. Worsening prognosis of disease
4. downward step in response to treatment
5. Multiple hospital admissions
6. Admission to nursing home
7. Spouse has recently died

Question 3

List some goals of a pall care needs assessment in elderly

Answer 3

• match type and level of care
• where specialist care is required
• facilitate communication between primary and specialist

Question 4

List some examples of palliative care integration into care of the elderly

Answer 4

• Geriatric oncology
• Heart failure clinics
• Pulmonary rehabilitation clinics
• Breathlessness clinics (lung cancer)
• Rehabilitation

Question 5

List core elements of a palliative approach for elderly in the COMMUNITY

Answer 5

• timely access to PC specialists
• Case management across care settings
• home care support 24 hours
• Cultural needs addressed
• need to consider workforce issues
• integration of health and social services

Question 6

Specific geriatric syndromes : dementia

Answer 6

• difficulties in ID terminal phase
• protracted duration of terminal phase
• communication and capacity
• pain and symptom assessment difficult
• behavioural disturbances

Question 7

PEG tubes in dementia : adverse effects

Answer 7

• pain
• bleeding
• restraint usage
• fectal incontinence
• aspiration / pna
• no survival benefit

Question 8

Specific geriatric syndromes : delirium

Answer 8

• risk factors in elderly
  
  • age> 70
  • dementia
  • visual impariment
  • hospitalization for fracture
  • severe medical illness

Question 9

Specific geriatric syndromes: depression

Answer 9

• older age is risk factor
• unmarried
• living alone
• lack of social supports
• negative life events
• lower SES
• medical conditions (CVD, PD, cancer, stroke, COPD, arthritis, dementia)

Question 10

Depression in elderly : considerations and treatment

Answer 10

• can mirror medical illness
• validated Geriatric depression scale
• impacts cognition
• Sertraline, citalopram, escitalopram first line.
• fewer drug drug interactions

Question 11

Effects of aging on skin

Answer 11

• epidermis thins
• unable to retain water, barrier function decreased
• wound healing decreased
• may change absorption of transdermal meds
• increased risk of pressure ulcers

Question 12

List changes in drug metabolism in the elderly

Answer 12

• Reduction in hepatic first pass metabolism
  
  • reduced bioavailability of some drugs
  • increased bioavailability of others (opioids!)
• Less lean body mass, more body fat and total water
  
  • smaller volume of distribution for hydrophilic drugs
  • larger volume of distribution for lipophilic drugs (fentanyl)
• Decreased Renal Function
• Fragile brain