Care of the Elderly Flashcards
What are the causes of falls in the elderly?
Cardiac e.g. arrhythmias Neurological e.g. seizure, stroke, peripheral neuropathy Vasovagal Intoxication/alcohol/pharmacological Benign paroxysmal positional vertigo Infection Environmental (rare)
What is important to ask in a history for falls?
Palpitations? Dizziness? LOC? Tongue biting? Incontinence? Bang head? Onset? Previous similar episodes? Medications? Alcohol/drug use? Any injuries?
What is important to do when examining a patient after a fall?
Cardiovascular and respiratory examination
Basic GALS examination
Neuro observations if they have a head injury
What investigations should you do in an elderly patient who has fell?
ECG L&S BP Urine dipstick Bloods (U&E, CRP, FBC for WCC, creatinine kinase) X-rays if injured CT/MRI head
What is the management of a fall in the elderly?
Treat the underlying cause if found
Prevention: increasing physical activity and exercise, reviewing medication, changing adverse environmental factors (PT & OT assessment), improving management of any medical conditons
What are the different types of incontinence?
Stress Urge Overflow Functional Bedwetting
What are the risk factors for incontinence?
Multiparity Hysterectomy Obesity Bowel dysfunction Menopause Dietary factors e.g. alcohol and caffeine Drugs e.g. TCAs and diuretics
What are the symptoms of incontinence?
Leakage of urine on sneezing, coughing, exercise, rising from sitting, lifting
Frequency of urine and failure to reach the toilet on time
Nocturia
Dribbling of urine after leaving the toilet
Loss of bladder control
Feeling of incomplete bladder emptying
Dysuria
Bladder spasms
What examinations should you perform for incontinence?
Women: digital examination of the pelvic muscle contraction, pelvic, abdominal and neuro examination
Men: DRE, abdominal and neuro examination
What investigations should you perform in someone presenting with incontinence?
3-day bladder diary
Urine dipstick
Post-void bladder scan
Urodynamics
What is the management of incontinence?
Stress: pelvic floor exercises, ring pessary, intravaginal electrical stimulation, duloxetine, surgery
Urge: limit fluid intake and avoid irritants, toilet regime e.g. every 4 hours, anti-cholinergic drugs e.g. oxybutynin and tolterodine, botox to the bladder neck
Overflow: identify and eliminate obstruction, consider alpha-blocker for prostate enlargement e.g. doxazosin, consider catheterisation
What is the definition of delirium?
Delirium is defined as an acute and fluctuating disturbance in consciousness, attention and global concentration
What are the risk factors for delirium?
Elderly Pre-existing dementia Blind or deaf Very young Post-operative Burn victims Alcohol and benzodiazepine-dependent Serious illness
What are the signs and symptoms of delirium?
Decreased level of consciousness Disorientation Inattention Illusions/hallucinations Altered personality Mood disorders Speech disorders (slurred speech, aphasic error, chaotic pattern) Lacking insight
How is delirium diagnosed?
Collateral history to determine if the changes in mental status are recent and the patients normal level of functioning
Drug and alcohol history
MMSE
Patient should be examined to look for potential sites of infection or any focal neurological signs
