Care of the Elderly

Question 1

What is fragility?

Answer 1

a state of increased vulnerability resulting from ageing- associated decline in functional reserve resulting in compromised ability to cope with everyday or acute stressors

Question 2

what are the 4 geriatric giants?

Answer 2

Instability (falls)
Immobility
Intellectual impairment
Incontinence

Question 3

4 components of a geriatric assessment

Answer 3

1. Medical
2. Functional
   3, Psychological
3. Social and environmental

Question 4

RFs for pressure sores?

Answer 4

age, reduced mobility, sensory neuropathy, incontinence, low/high BMI, poor nutrition, skin hygiene, peripheral vascular disease

Question 5

common sites of pressure sores?

Answer 5

ischial tuberosity
greater trochanter
heels

Question 6

risk assessment for pressure sores

Answer 6

Waterlow score

Question 7

prevention of pressure sores

Answer 7

turning in bed/ pressure redistribution matress
minimise sedation
careful positioning
transparent adhesive films for superficial ulcers
hydrocolloid barrier cream for wounds
antibiotics
pain relief

Question 8

causes of falls

Answer 8

Drugs (polypharmacy, alcohol, antihypertensives, opioids)
Age-related changes- gait, balance
Medical- stroke, syncope, MI, PD
Environmental

Question 9

consequences of prolonged falls

Answer 9

pressure sores
rhabdomyolysis
hypothermia
hypostatic pneumonia
anxiety and depression
friction burns

Question 10

mx of falls

Answer 10

cardiac symptoms -> refer for pacing
stop unnecessary drugs
PT
OT
OP prevention

Question 11

RF of stroke

Answer 11

age, afro-Caribbean, hypertension, heart disease, AF, carotid stenosis, smoking, obesity, alcohol, prev TIA

Question 12

risk of stroke in AF

Answer 12

CHADS2VASc
>1- aspirin
>2- anticoagulants- warfarin of NOACs

Question 13

cause and features of total anterior circulation infarct

Answer 13

MCA occluded by embolus/spreading thrombus from ICA
All 3 of:
Higher cortical dysfunction e.g. dysphasia, visuospatial neglect
Homonymous hemianopia
Contralateral weakness and/or sensory deficit involving 2 out of face, arm or leg

Question 14

cause and features of partial anterior circulation infarct

Answer 14

branch of MCA or ACA
2 of:
Higher cortical dysfunction e.g. dysphasia, visuospatial neglect
Homonymous hemianopia
Contralateral weakness and/or sensory deficit involving 2 out of face, arm or leg

Question 15

cause and features of lacunar infarct

Answer 15

occlusion of deep perforating artery

Pre motor, pure sensory or mixed or ataxia

Question 16

cause of features of posterior circulation infarct

Answer 16

brainstem, cerebellum and occipital lobes
any 1 of:
isolated homonymous hemianopia
brainstem signs
loss of consciousness
cranial nerve palsy and contralateral motor/sensory deficit

Question 17

Ix of stroke

Answer 17

CT brain

Question 18

Mx of ischaemic stroke

Answer 18

1st line- thrombolysis e.g. IV alteplase (<4.5 hours)
2nd line- aspirin 300mg for 2 weeks
then clopidogrel 75mg OD
secondary prevention- antihypertensives, statins
PT, SALT, OT

Question 19

Mx of haemorrhagic stroke

Answer 19

control BP- beta blocker

Beriplex of warfarin related

Question 20

what is osteoporosis?

Answer 20

decreased bone mineral density due to imbalance between remodelling and resorption
presents with a fracture

Question 21

RFs of OP?

Answer 21

smoking
early menopause
steroid use
underweight
inactivity
alcohol
age

Question 22

Ix of OP?

Answer 22

DEXA scan
>1 = normal
-1 to -2.5= osteopenia

Question 23

mx of OP?

Answer 23

alendronate 1st line- oral once a week, sat up on an empty stomach for half an hour
Vit D and calcium
strontium ranelate or reloxifene

Question 24

SE of bisphosphonates

Answer 24

oesophagitis, osteonecrosis of the jaw, atypical stress fracture

Question 25

causes of delirium

Answer 25

Pain
Infection/ iNtracranial problems
Constipation
Hydration
Medication- withdrawal or interactions. anticholinergics, opiates, benzos
Environmental- reduced sensory input

Question 26

types of delirium

Answer 26

hyperactive- agitation, inappropriate behaviour, hallucinations
hypoactive- lethargy, reduced conc
others- loss of appetite, orientation impaired

Question 27

Ix of suspected delirium

Answer 27

4AT screening tool for delirium
MMSE or AMT
Bloods- FBC, U&E, LFT, Ca, glucose, CRP
CXR
ECG
Urinalysis

Question 28

Mx of delirium

Answer 28

environment- side room, orientation aids, consistent reassuring staff, quiet, well-lit
Meds- haloperidol 
avoid benzos
stop precipitating drugs
review legal status- lack capacity

Question 29

definition of malnutrition

Answer 29

BMI <18.5 OR
Unintentional weight loss >10% in the last 3-6 months OR
BMI <20 plus unintentional weight loss >5% within the alst 3-6 months

Question 30

causes of malnutrition

Answer 30

inadequate nutritional in take- starvation
increased nutrient requirements- cancer, sepsis, injury
inability to utilise ingested nutrients- malabsorption
increased loss- vomiting and diarrhoea

Question 31

complication of treatment for malnutrition

Answer 31

refeeding syndrome

Question 32

what is osteomalacia?

Answer 32

normal bony growth but decreased mineral content

Question 33

what is rickets?

Answer 33

osteomalacia when still growing

knock-knee, bow leg, hypocalcaemia

Question 34

causes of osteomalacia?

Answer 34

vit D deficiency
renal failure
drug induced e.g. anticonvulsants
liver disease e.g. cirrhosis

Question 35

features of osteomalacia?

Answer 35

bone pain, fractures, muscle tenderness, proximal myopathy

Question 36

Ix of osteomalacia

Answer 36

low 25(OH) vit D
raised alk phos
low calcium and phosphate

Question 37

Tx of osteomalacia

Answer 37

calcium with vit D tablets

Question 38

when to suspect paget’s disease

Answer 38

if bone pain and an isolated raised ALP in an older male

Question 39

what is paget’s disease

Answer 39

disease of increased bone turnover with excessive osteoclastic resorption followed by increase osteoblastic activity

Question 40

features of paget’s disease

Answer 40

bone pain
bowing of tibia
bossing of skull- if untreated

Question 41

tx of paget’s disease

Answer 41

bisphosphonate (oral risedronate or IV zoledronate)

calcitonin