Care of the Elderly Flashcards
If a patient falls when getting out of bed, what does that indicate?
Postural hypotension
If a patient falls and there is tongue biting and incontinence what does that indicate?
A seizure
If the patient is either pale or flushed after the fall what does that indicate?
Vasovagal attack
If the patient is confused after the fall what could that indicate?
Head injury
If the patient had weakness or speech difficult after the event what does that indicate?
Stroke/TIA
What medications may cause or help to identify the cause of a fall?
B-blockers - bradycardia Diabetic medications - hypo HTN drugs - hypotension Benzodiazepines - sedation Antibiotics - current infection
What bedside investigations would you perform after a fall and why?
Observations (BP/HR/RR/Sats/Temp) - sepsis / bradycardia
Lying and standing blood pressure - orthostatic hypotension
Urine dipstick - infection / rhabdomyolysis (blood in urine)
ECG - bradycardia / arrhythmias / heart block
Cognitive screening - cognitive impairment
Blood glucose - hypoglycaemia secondary to poor intake
What bloods would you perform after a fall and why?
Full Blood Count - anaemia / Infection
Urea and Electrolytes - dehydration / Electrolyte abnormalities, rhabdomyolysis
Liver function tests - chronic alcohol use
Bone profile - calcium abnormalities in malignancy or over supplementation
What imaging would you do after a fall and why?
Chest X-ray - pneumonia
CT head - chronic or acute subdural / Stroke
Echo - valvular heart disease e.g aortic stenosis
What are the differential diagnoses of the cause of a fall?
General - mechanical (always give a reason e.g. secondary to poor footwear/visual difficulties/polypharmacy
Cardiovascular - arrhythmias / orthostatic hypotension / bradycardia / valvular heart disease
Neurological - stroke / peripheral neuropathy
Genitourinary - incontinence / urinary tract infection
Endocrine - hypoglycaemia
Musculoskeletal - arthritis / disuse atrophy
ENT - benign paroxysmal positional vertigo / ear wax
What are the two main types of delirium?
Hyperactive and hypoactive
What are the symptoms of hyperactive delirium?
Agitation Delusions Hallucination Wandering Aggression
What are the symptoms of hypoactive delirium?
Lethargy
Slowness with everyday tasks
Excessive sleeping
Inattention
What bloods would you do in delirium?
FBC U&E LFTs INR TFTs B12 + folate/haematinics Glucose
How do you treat delirium?
TREAT CAUSE
Supportive management
Environmental adaptation
Avoid medications
What are the causes of a fractured neck of femur (NOF)?
Osteoporosis / osteopenia
Trauma – often falls in the elderly
Pathological fractures – primary bone tumours or metastatic deposits leading to fracture
What would you find on examination of a fractured NOF?
Classically the affected leg is shortened, ABducted and externally rotated
Exacerbation of pain on palpation of the greater trochanter
Pain is exacerbated by rotation of the hip
How long after admission should fractured NOF be treated?
Surgery needs to take place within 36 hours of admission.
How are fractured NOFs classified?
Fractures are classified as extracapsular or intracapsular.
This is an important distinction because the management and risk of complications differ.
The main blood supply of the femoral head traverses under the capsule and along the femoral neck. As a result, the possibility of developing avascular necrosis of the femoral head is much more likely in intracapsular fractures (even more so in those involving displacement).
What classification system is used to classify fractured intracapsular NOF?
Garden classification
Group I & II refer to undisplaced intracapsular fractures
Group III & IV refer to displaced intracapsular fractures
What are the complications of fractured NOF surgery?
Infection
Bleeding
Increased risk of thromboembolic events – deep vein thrombosis / pulmonary embolism
Avascular necrosis of the femoral head
What dementia is this?
Usually begin after the age of 60 (though there are “early-onset” cases, most of which involve genetics).
Can affect all areas of the brain: many functions and abilities can be impacted upon and eventually lost.
Most common presenting symptom is memory loss, with evidence of varying changes in planning, reasoning, speech and orientation.
Alzheimers
What dementia is this?
Single infarct vascular disease: classically cognitive impairment (acutely or subacutely) following the event.
Functional deficits are often seen before memory impairment.
Mood disturbances and mood disorders are common in vascular dementia
Psychosis, delusions, hallucinations and paranoia can often be seen, especially in later stages.
Patients should be screened for depression and for signs of psychomotor retardation (often a more common feature than positive signs of depression).
Emotional lability can be prominent.
Vascular dementia
What dementia is this?
Often involves visual hallucination and Parkinson-like symptoms.
If physical symptoms precede cognitive decline by more than a year, the diagnosis is often Parkinsons, with superimposed cognitive decline.
Fluctuation in cognitive ability is common.
At presentation, problems multitasking and performing complex cognitive actions are more likely to be issues than memory.
Sleep disorders are a common manifestation.
Lewy-body dementia
What type of dementia is this?
Tend to present with one of three clinical pictures (or an overlap): changes in personality and behaviour (which may be labelled psychiatric), or as progressive language difficulty and aphasia.
Behavioural presentation
Altered emotional responsiveness, apathy, disinhibition, impulsivity. Progressive decline noted in interpersonal skills. Changes in food preference, more childlike amusements. Obsessions and rituals may also be noted.
Semantic presentation
Progressive decline in the understanding of word meanings. Speech may still be fluent, but there is difficulty in name-retrieval and use of less precise terms. Are unable to determine the meanings of common words when asked. This tends to develop into the inability to recognise objects, or familiar faces (prosopagnosia).
Non-fluent presentation
Progressive breakdown in the output of language. Speech takes effort and is not fluent. Generally display speech apraxia (poor articulation) or disorders of speech sound. There also tends to be impaired comprehension of sentences and an impact on literacy skills.
Fronto-temporal dementia
