Care of the Elderly

Question 1

components of geriatric medicine

Answer 1

frailty 
acute illness
complex comorbidity 
chronic illness 
rehabilitation
end of life 
different patterns of disease presentation
slower response to treatment

Question 2

what is frailty

Answer 2

state of increased vulnerability resulting from ageing associated with decline in reserve and function across multiple systems and reducing ability to cope with acute stressors

Question 3

common presentations to geriatric medicine

Answer 3

falls
confusion
incontinence 
chest, pain, SOB, urinary symptoms 
social admission (unable to cope with ADL)

Question 4

5 Ms of geriatric medicine

Answer 4

Mind: dementia, delirium, depression

Mobility: impaired gait and balance, falls

Medications: polypharmacy, adverse effects, medication burden

Multicomplexity

Matters most: Individual meaningful health outcomes and preferences

Question 5

comprehensive geriatric assessment

Answer 5

medical assessment
functional assessment
psychological assessment
social and environmental assessment

Question 6

components of medical assessment + professionals involved

Answer 6

Problem list
Co-morbid conditions and disease severity
Medication review
Nutritional status

Doctor, nurse, pharmacist, dietician, SaLT

Question 7

components of functional assessment + professionals involved

Answer 7

Activities of daily living
Activity/exercise status
Gait and balance

OT, PT SaLT

Question 8

components of psychological assessment + professionals involved

Answer 8

Cognitive status testing
Mood/depression testing

Doctor, nurse, OT, psychologist

Question 9

components of social and environmental assessment + professionals involved

Answer 9

Informal support needs and assets
Eligibility/need for carers
Home safety

OT SW

Question 10

what is rehabilitation

Answer 10

Process of restoring a patient to maximum function. (Need to know pre-morbid function.)

Question 11

legal and ethical issues in geriatrics

Answer 11

Care at the end of life (fluids, feeding, antibiotics)
Discharge destination
Dementia/delirium
Mental capacity act

Question 12

what is abuse and what are the subtypes

Answer 12

Abuse: a single or repeated act, or lack of appropriate action, that occurs in a relationship where there is an expectation of trust, which causes harm or distress.

Physical, neglect, psychological, financial, discriminatory, institutional, sexual.

Question 13

causes of acute kidney injury

Answer 13

pre-renal: cardiogenic, hypovolaemia (diuresis, diarrhoea, dehydration)
BUN:Cr > 20:1

renal: glomerulonephritis, renal tubular acidosis (ischaemic, toxic), intersitial nephritis (NSAIDs, penicillin)
BUN:Cr <10:1

post-renal: obstruction, benign prostate hyperplasia
BUN:Cr>15:1 then BUN:Cr <10:1

Question 14

risk factors for incontinence

Answer 14

parity
cognitive impairment/neurological disease
obstruction e.g. large prostate or faecal impaction

Question 15

causes of falls in older patients

Answer 15

overall weakness and frailty 
balance problems
acute illness
cognitive problems 
visual impairment 
medications
environmental hazards

Question 16

types of incontinence

Answer 16

functional incontinence: can not reach toilet in time

stress incontinence/ overactive bladder

overflow incontinence

Question 17

risk factors for pressure ulcers

Answer 17

immobility 
cardiovascular disease
malignancy 
UTI
hip fracture/surgery 
chronic disease: COPD, AD
diabetes
deep vein thrombosis

Question 18

risk assessments for pressure ulcers

Answer 18

norton, braden and waterlow scales

Question 19

health status factors that also influence pressure ulcers

Answer 19

Comorbidities.
Nutrition.
Pain.
Continence.
Neurological (sensory impairment, level of consciousness, cognitive status).
Blood supply.
Mobility.
Signs of local or systemic infection.
Medication.

Question 20

management of ulcers

Answer 20

repositioning

treating concurrent conditions which may delay healing

wound management dressings

pressure relieving surfaces

pain relief (not NSAIDs)

infection control

Question 21

prevention of pressure ulcers

Answer 21

eliminate sources of extra moisture

repositioning and pressure redistribution equipment

Question 22

grading of osteoporosis

Answer 22

normal: hip bone mineral density is T>-1
osteopaenia: between -1 and -2.5
osteoporosis: less than -2.5

severe osteoporosis (-2.5 + fracture)

Question 23

risk factors for osteoporosis

Answer 23

Steroids
Hyperthyroidism, hypocalcaemia
Alcohol
Thin
Testosterone deficiency
Early menopause
Renal or liver failure
Erosive/IBD
Diet

Question 24

risk factors for fragility fractures

Answer 24

increased age 
female sex
parental or past hx of (hip)/fragility fracture
falls 
high alcohol
corticosteroids

Question 25

most common locations for a fragility fracture

Answer 25

spine (vertebrae)
hip (proximal femur)
wrist (distal radius)

Question 26

investigation for osteoporosis and assessment for fragility fracture

Answer 26

DEXA

FRAX

Question 27

management of osteoporosis

Answer 27

lifestyle: stop smoking, reduce alcohol, regular weight bearing exercise

vitamin D + calcium

bisphosphonates: alendronate, zoledronic acid

monoclonal antibody: denosumab

Question 28

delirium causing drugs

Answer 28

Benzodiazepines 
Analgesics: morphine
Anticholinergics 
Anticonvulsants 
Anti-parkinsonism
Steroids

Question 29

method for assessing delirium

Answer 29

o Confusion Assessment Method

1. Acute onset + fluctuating course AND
2. Inattention (e.g. 20-1 test) AND EITHER
3. Disorganised thinking/speech OR
4. Changed levels of consciousness (usually lethargy