Care Of The Elderly

Question 1

What are the two states of delirium? Define each

Answer 1

Hyperactive: agitation, delusions, hallucinations, wandering, aggression

Hypoactive: lethargy, slowness with everyday tasks, excessive sleeping, inattention

Question 2

What are some of the biggest causes of delirium?

Answer 2

CHIMPS PHONED

Constipation
Hypoxia
Infection
Metabolic disturbance
Pain
Sleeplessness
Prescriptions
Hypothermia/pyrexia
Organ dysfunction (hepatic or renal impairment)
Nutrition
Environmental changes
Drugs (over the counter, illicit, alcohol and smoking)

Question 3

What are some important bits of information to get during a history of a pt with delirium?

Answer 3

• PMH including atherosclerosis, stroke, previous confusion, head injury, recent admissions
• current medications
• social history including ho

Question 4

What is frailty?

Answer 4

Frailty is a syndrome of vulnerability where relatively minor stressors can result in functional and sometimes physiological deterioration

Question 5

What is the Rockwood score and when should caution be used when applying it?

Answer 5

Frailty measurement score based on physical function

Be cautious using this in those with long standing disability

Question 6

People with frailty have poorer outcomes in hospital including higher risk of…

Answer 6

• death
• inpatient falls
• pressure ulcers
• nosocomial infections (acquired while accessing healthcare)
• longer length of stay
• loss of function
• discharge to a care home

Question 7

What is a Comprehensive Geriatric Assessment?

Answer 7

A multidimensional approach to addressing the overall wellbeing of a person including their medical, physical, psychological, functional, and social needs

Question 8

What are some ways to prevent delirium?

Answer 8

• be aware of the risk factors
• minimise bed moves
  -be vigilant for early signs
• involve family in care

Question 9

When suspecting delirium, look out for NEW or WORSE:

Answer 9

• confusion
• drowsiness
• behaviour

Question 10

What is SQiD?

Answer 10

Single Question in Delirium

“ Do you think [patient] has been more confused lately?”

Question 11

What are some risk factors for delirium?

Answer 11

TIME AND SPACE

Toilet
Infection
Medication
Electrolytes

Anxiety/depression
Nutrition/hydration
Disorientation

Sleep
Pain
Alcohol/drugs
Constipation
Environment

Question 12

What scenarios would result in a review medications in patients?

Answer 12

Falls, delirium, dementia, functional decline, immobility

Question 13

What are the 7 steps of medication review?

Answer 13

Step 1: identify aims and objectives of therapy
Step 2: identify essential drug therapy
Step 3: do they take unnecessary drug therapy?
Step 4: are therapeutic objectives being achieved?
Step 5: are there ADR’s or risks of ADR’s?
Step 6: is the drug cost effective?
Step 7: is the person willing and able to take the treatment?

Question 14

What are important things to consider in step 1 of medication review?

Answer 14

• management of current problems
• prevention of future problems

Question 15

What are important things to consider in step 2 of medication review?

Answer 15

• drugs that have essential replacement functions e.g. insulin in T1DM, thyroxine
• drugs that prevent rapid functional decline e.g. PD meds

Question 16

During step 3 of medication reviews, identify and review the need for drugs with…

Answer 16

• temporary indications
• higher than usual maintenance doses
• limited benefit in general or in the specific person

Question 17

In step 4 of medication review, you must identify need for adding/intensifying treatment, in order to…

Answer 17

• achieve symptom control
• achieve biochemical/physiological targets
• to prevent disease progression/exacerbation

Question 18

What are some important things to consider in step 5 of medication review?

Answer 18

• side effects
• drug-disease and drug-drug interactions
• monitoring systems for high risk drugs
• risks of accidental overdose

Question 19

In order to aid adherence review in step 7 of medication review, you must know:

Answer 19

• form of drug
• dosing schedule
• can they adhere to drug regime?

Question 20

What questions need to be asked in order to trailer to persons preferences during step 7 of medication review?

Answer 20

What are persons therapeutic objectives and treatment priorities?

Which medicines have sufficient magnitude of effect to make them worth taking?

Question 21

What are important things to remember in constipation?

Answer 21

• much easier to prevent than treat
• review drugs that cause constipation BEFORE prescribing laxative
• avoid prescribing 2 laxatives from the same class e.g. laculose and macrogol

Question 22

What are the classes of laxatives, give an example of each

Answer 22

• bulk laxatives (spaghula husk and methylcellulose)
• stimulant laxatives (bisacodyl, senna and sodium picosulfate)
• osmotic laxatives (laculose)
• stool softeners (arachis oil and docusate sodium)

Question 23

What are important things to remember if patient has continence issues?

Answer 23

• orientate to bathroom
• rule out retention
• consider UTI if NEW
• review culprit drugs
• avoid catheters