Care of the elderly Flashcards
What increases the susceptibility of acquiring C. difficile?
- Antibiotic related: Fluoroquinolones (ciprofloxacin), cephalosporins (cefotaxime), penicillin and clindamycin
- In contact with another person who has C. diff
- PPIs
How is C. diff spread?
In bacterial spores within faeces
prevented by handwashing, room sterilisation, limited antibiotic use
What are the symptoms of a C. diff infection?
Watery diarrhoea
Fever
Nausea
Abdominal pain
How is c. diff diagnosed?
Blood culture: C diff toxin positive
Stool culture: c diff toxin positive
What is the management of C. diff?
- Stop offending antibiotics.
- infection control
- oral metronidazole
- if severe - vancomycin
What are some of the complications of c. diff
dehydration pseudomembranous colitis toxic megacolon perforation of the colon sepsis
How can c. diff be prevented?
- prevent cross infection
2. reducing antibiotic misuse
How likely is an elderly person going to fall within one year of having a fall?
66%
What are the risk factors for falling?
- Age >80
- Low weight
- Dependent on others for ADLs
- Previous fall (in the last 12 months)
- Fear of falling
- Balance problems
- Gait and motility problems ie parkisons
- Pain
- Drugs ie polypharmacy, antihypertensives
- Cardiovascular conditions
- Cognitive impairment
- Urinary incontinence (rushing to the toilet)
- Stroke
- Diabetes
What increases the risk of injury from falling?
- Weak bones (osteoporosis, osteomalacia, paget’s diseaese, bone mets)
- predisposition to falls
- poor self protection (lack of subcutaneous fat, loss of consciousness, neuropathy)
What questions should be asked when a patient presents with a fall?
- Is it an isolated event? is there a pattern to the falls?
- What causes the fall?
- What was the patient doing at the time?
- Was there a loss of consciousness?
- Was there any warning signs before the fall?
- What was there post-fall state like?
- Collateral history
- When was their last eyesight and optician review?
- Ask about past medical history
- Polypharmacy and drugs?
What examinations should be done in a person who has fallen?
Vital signs (postural hypotension) Cardiac examination Neurological examination Systemic examination Mini-mental state examination Blood glucose Visual impairment assessment 'Timed up and go test' 'Turn 180 degree test'
What is the management of a fall?
Treat any injuries Treat underlying causes Medication review Physiotherapy review OT review Optician review
How can falls be prevented?
- Group and home based exercise programmes
- Home safety interventions
- T’ai chi
- Risk assessment of environmental factors
- Treating underlying medical condition
- Alcohol reduction
- Vitamin D for ‘weak bones’
What is osteoporosis?
A progressive systemic skeletal disease characterised by reduced bone mass and micro-architectural deterioration of bone tissue
What is an osteoporotic fracture?
Fractures resulting from mechanical forces that wouldn’t ordinarily result in fracture
What does a T score of below -2.5 SD from normal indicate?
Osteoporosis
What is the epidemiology of osteoporosis?
Women are more likely to get it than men
Age related disease (bone mass declines with age, and is accelerated when women hit menopause)
What are the risk factors for fragility fractures?
REDUCED BMD Increasing age Female sex Low body mass (<19kg/m2) Parental history of a hip fracture Parental history of fragility fracture Corcticosteroid therapy Cushing’s syndrome Alcohol (>3 units a day) Smoking If increased risk of falling due to medical conditions
What are some of the secondary causes of osteoporosis (medical conditions)
Rheumatoid arthritis and other inflammatory arthropathies.
Prolonged immobilisation or a very sedentary lifestyle.
Primary hypogonadism (men and women).
Primary hyperparathyroidism.
Hyperthyroidism.
Post-transplantation.
Chronic kidney disease.
Gastrointestinal disease such as Crohn’s disease, ulcerative colitis and coeliac disease.
Untreated premature menopause (<45 years) or prolonged secondary amenorrhoea.
Type 1 diabetes mellitus.
Chronic liver disease
Chronic obstructive pulmonary disease
What is the presentation of osteoporosis?
Asymptomatic until patient has a fall resulting in a fragility fracture
Fractures are commonly at the spine, hi[ and wrist
What are the investigations for osteoporosis?
Xray
DEXA scan
Bloods (FBC, ESR, CRP, U&E, LFTS, TFTS, hormones, serum immunoglobulins and urinary bence Jones’ proteins)
What is the management of osteoporosis?
- Lifestyle advice
- Adequate calcium and vitamin D intake
- Bisphosphonates
- Denosumab
- Treatment of fractures
What is incontinence and what are the different types?
- An involuntary leakage of urine
1. Functional
2. Stress
3. Urge
4. Mixed
5. Overflow
6. True incontinence
What are the characteristics of functional incontinence?
- patient is unable to reach the toilet in time
- usually have poor mobility
- can be unfamiliar to surroundings
What are the characteristics of stress incontinence?
- Involuntary leakage during effort or exertion, coughing or sneezing.
- Due to an incompetent sphincter
- Can be associated with a genitourinary prolapse
What are the characteristics of urge incontinence?
- Involuntary urinary leakage accompanied by, or immediately preceded by urgency of micturition
- Detrusor instability or hyperreflexia = involuntary detrusor contraction
- Can be idiopathic or secondary to neuro problems
What are the characteristics of mixed incontinence?
Involuntary leakage or urine associated with urgency and exertion, effort, coughing or sneezing
What is the characteristics of overflow incontinence?
-Chronic bladder outflow obstruction. Often seen in prostatic disease in older men. Can lead to obstructive nephropathy
What is true incontinence?
Fistulous track between vagina and ureter or bladder or urethra causing continuous leakage or urine
