Care of the Elderly Flashcards
Causes of falls in elderly people?
Drugs (e.g. sedatives, alcohol)
MSK (e.g. OA of hip)
Syncope (e.g. vasovagal, cardiogenic, arrhythmias)
Stroke/TIA
Postural hypotension (secondary to antiHTs, hypovolaemia, dopaminergic drugs)
Vertigo (e.g. BPV, meniere’s disease)
Neuro: periph neuropathy, Parkinson’s
Hypoglycaemia
Poor environment (e.g. poor lighting, loose rugs)
Visual impairment
Dementia
3 main features of Parkinson’s?
Tremor
Bradykinesia
Rigidity (lead-pipe; cogwheel)
Differentiating features of Parkinsonian tremor?
Slow (pill-rolling) Worse at rest Asymmetrical Reduced on distraction Reduced on movement
Pathophysiology of Parkinson’s?
Loss of dpominergic neurons in substantia nigra
What drug usually combines with L-dopa in Parkinson’s to prevent S/E?
Dopa decarboxylase inhibitor (e.g. carbidopa or benserazide)
Complications of L-dopa therapy for Parkinson’s?
Postural hypotension on starting treatment
Confusion, hallucinations
L-dopa induced dyskinesias
On-off effect: fluctuations in motor performance between normal function (on) and restricted mobility (off).
Shortening duration of action of each dose (i.e. end-dose deterioration where dyskinesias become more prominent at the end of the duration of action)
How to calculate risk of stroke post-TIA?
ABCD2 Risk
Age > 60 (+1); BP >40/90 (+1); Clinical features: unilat. weakness (+2), speech disturbance w/out weakness (+2); Duration of sx: >1hr (+2), 10-59 mins (+1); Diabetes (+1)
Define frailty
Increased vulnerability resulting from ageing associated decline in reserve and function across multiple physiologic systems –> ability to cope with everyday/acute stressors is compromised.
What is acopia?
Medical slang - social admission. Pt’s can’t cope with ADLs. Hugh mortality rate because of missed path, biased against.
Don’t use this term
What are geriatric giants?
The major categories of impairment in elderly people. Include immobility, instability, incontinence & impaired intellect/memory.
Impaired vision and hearing loss - common chronic probs. Hearing problems –> social isolation, depression, and dependence. Vision probs –> falls, meds being taken incorrectly cos written instructions couldn’t be read, finances being mismanaged.
Complications with treatment in older people?
Much more prone to s/e, can –> red. organ func., often multiple pathologies, polypharm.
What is rehabilitation
Process of restoring a patient to maximum function. (Need to know pre-morbid function.)
Can happen in a variety of settings, in and out of hospital.
Involves MDT, including doctors.
Leads to process of discharge planning.
What are the legal/ethical issues surrounding geriatric medicine?
End of life care (fluids, feeding, abx)
MCA (decisions about treatment, discharge)
Dementia/delirium
Immediate management for TIA
ABCDE assessment
Aspirin (300mg daily) stat - with PPI if indicated
Specialist assessment within 1 week if suspected TIA
Long term management of TIA
Lifestyle modification
Clopidogrel 75mg od
Statins, antihypertensives if necessary
Warfarin, NOACs if AF, mitral stenosis, dilated cardiomyopathy, recent big septal MI
