Care of the elderly Flashcards
Outline the role of professionals involved in the MDT care of elderly people
Physio-mobility OT- activities of daily living and functioning SALT Old person liaison psychiatry dietician pharmacist
Difference between mental health act and mental capacity act
MHA is only about compulsory treatment of mental disorder, for the benefit of the patient but also,
at times, for the protection of others.
MCA is about empowering people to make decisions for themselves, as much as possible and,
where they can’t, determining what is in their best interests. It applies to almost all kinds of decision,
with very few exceptions, one of which is the treatment covered by the MHA.
Where a patient is detained under the MHA for treatment of the mental disorder, the MCA will
continue to apply for all other kinds of decisions. The patient may still have capacity to make decisions
about medical treatment for physical health, for example, and if they do have that capacity they are
perfectly entitled to refuse medical treatment for a gangrenous leg, for example, despite being
detained for compulsory treatment of their mental health.
Presentation of dementia
Cognitive impairment (memory loss, language, attention, thinking, orientation, problem solving)
Psychiatric or behavioural distrubances
Difficulties with activities of daily living
Presentation of Alzheimers disease
progressive and global cognitive impairment memory loss word finding difficulty apraxia difficulty planning disorientation apathy altered eating habits incontinence insidious onset No disturbance in consciousness
Pathophysiology of alzheimers
degeneration of cerebral cortex with cortical atrophy
Accumulation of beta amyloid plaques and neurofibrillary tangles
Pharmacological management of alzheimers
Acetylcholinesterase inhibitors eg donepezil, rivastigamine, galantamine (cholinergic side effects)
Memantine is second line
Presentation of vascular treatment
sudden onset and stepwise treatment
Evidence of vascular pathology
Tx contol vascular risk factors, lifestyle changes
Investigations of suspected dementia
Abbreviated mental test/ MMSE/ 6 CIT CT/MRI- vascular damage? FBC, ESR, U+E- rule out infection B12, folate Investigate substance misuse Hx of head trauma
Presentation of delirium
DELERIUM
Disordered thinking Euphoric/ fearful/ depressed/ Language impaired Illusion/ delusions/ hallucinations/ Reversal of sleep wake cycle Inattention Unaware/ disorientated Memory deficits
Causes of delirium
acute/ systemic infections intracranial infections drugs- opiates, sedatives, levodopa, anticonvulsants alcohol withdrawal Metabolic distrubances Hypoxia Stroke/ MI head injury epilepsy nutritional deficiencies post surgery
Investigations of delirium
FBC- anaemia/ infection U+Es- metabolic disturbances Urinanalysis chest x ray ECG ABG Dug levels- digoxin, lithium, alcohol Blood glucose Neurological imagine
Septic screen
Blood culture CXR skin and throat swabs urine microscopy and cultures lumber puncture
stress incontinence vs functional incontinence vs urge incontinence vs overflow incontinence
Functional
-unable to get to to toilet in time due to poor mobility/ unfamiliar surroundings
Stress
- leakage due to incompetent sphincter
- when coughing/ laughing/ on exertion
- 50% of post menopausal women
- pelvic floor weakness- eg uterine prolapse, urethrocele
Urge= overactive bladder
- urge to urinate quickly followed by uncontrollable emptying of bladder
- detrusor muscle instability or hyperreflexia
overflow
- chronic bladdeer outflow obstruction
- most likely cause in men- prostate enlargement
Management of overflow incontinence
Lifestyle: avoid caffeine, alcohol, void twice in a row to aid emptying, bladder training
alpha-blockers: tamulosin (decreases smooth muscle tone)
5 alpha reductase inhibitors eg finastende
Surgery- TURP- transurethral resection of prostate
Management of Urge incontinence
Bladder training
Pelvic floor exercises
Antimuscarinic=anticholinergic- tolderidine and oxybutinin]
topic oestrogen if post menopausal urgency
Botox
mirabegron- B3 adrenergic antagonist
Management of stress incontinence
Pelvic floor exercises first line
Ring pessary for uterine prolapse
surgery
List some causes of falls
Osteo/rheumatoid arthritis CNS disease decreased vision cognitive impairment and confusion depression postural hypotension peripheral neuropathy medication- antihypertensives, sedatives pain parkinsons and gait disorders muscle weakness UTI pneumonia anaemia hypothyroidism alcohol environmental causes
What factors increase the risk of injury from falls in elderly population
weak bones: osteoporosis, osteomalacia, padgets, metastases dementia lack of protective subcutaneous fat neurological decline- poor reflexes motor and sensory problems slow and stiff joints
List some drugs that might induce a fall
betablockers (bradycardia) diabetic medication (hypoglycaemia) anytihypertensives (hypotension) Benzodiazepines (sedation) antibiotics anticoagulants- risk of bleed polypharmacy
List some investigations to do after a fall
Bedside
- Obs- BP, HR, RR, sats, temp
- lying standing BP
- urine dipstick
- ECG
- cognitive screening
- blood glucose
Bloods
- FBC
- U+E
- Liver function tests
- thyroid function
- troponin- MI
Imaging
- CXR
- CT head (esp if hit head)
- echo
Triad of parkinsonism
- Tremor- at rest, pill rolling
- rigidity- cogwheel
- bradykinesisia- slow to initiate movement
Gait: reduced arm swing and shuffling steps, freezing at obstacles
Expressionless face
Causes of parkinsonism
idiopathic, PD, drugs (dopamine blockers eg typical psychotics, neuroepileptics, metoclopamide), trauma, magnese, copper toxicity
Risk associated with sudden withdrawal of anti-parkinsons medication
neuroleptic malignant syndrome
-fever, muscle rigidity, altered mental state, autonomic dysfunction
Presentation of parkinsons disease
insidious onset and slow progression
Parkinsonism
+/-
loss of smell, constipation, visual hallucinations, frequency/ urgency, dribbling of saliva, depression, dementia, poor executive function, dragging of foot, fixed facial expression
Pathophysiology of parkinsons
degeneration of dopaminergic neurones in substantia nigra–> less dopamine
treatment of Parkinsons
-Levodopa
(be aware of sudden withdrawal-> neuroepileptic syndrom)
- Dopamine agonist eg ropinirole
-MAO-B agonist
exact definition of delirium
An acute, reversible and transient state of fluctuating impairment of cognition, perception and consciousness
6 cognitive assessment tools
addenbrookes montreal 6-CIT CP-COG MMSE AMT
5 A’s of alzheimers
Apraxia Aphasia Apathy Amnesia Agnosia
Define syncope
temporary loss of consciousness due to hypoperfusion of the brain
Fast onset, short duration, spontaneous recovery
ECG signs of hyperkalaemia
tall tented T waves
absent P waves
domains of geriatric assessment and members of MDT
Medical Assessment – Problem list (diagnosis and treatment), co-morbid conditions & disease severity, Medication review- doctor / consultant
Functional Assessment – ADL, gait, balance- occupational therapist, physiotherapist
Psychological Assessment – cognition, mood- nurse, psychiatrist
Social assessment – care resources, finances- social worker
Environmental assessment – home safety
