Care of the Elderly Flashcards
Components of geriatric medicine?
slower treatment response, frailty, acute illness, different disease presentation patterns, co-morbidities, end of life, rehab, chronic illness
What is frailty?
increased vulnerability from ageing and decline in reserve and function in many systems so that ADLs and acute stressors are compromised
Risks for pneumonia?
smoking (lung cancer, COPD, peripheral vascular disease), diabetes, myeloma, dementia; all can lead to pneumonia
Most common presenting complaints in COTE?
falls most common (instability), confusion next (intellectual impairment), then off legs (immobility) and incontinence; last = social admission (acopia), chest pain, SOB, urinary symptoms
The 5Ms of geriatric medicine?
o Mind – dementia, delirium, depression
o Mobility – impaired gait and balance, falls
o Medications – polypharmacy, deprescribing/optimal prescribing, adverse effects, medication burden
o Multi-complexity – multi-morbidity, bio-psycho-social situations
o Matters most – individual meaningful health outcomes and preferences
What is acopia?
no acute medical problem, unable to cope with ADLs; usually underlying geriatric M causing
What aspects to consider when treating in COTE?
try to reduce meds on as can compromise them further and reduce organ function; multiple pathologies to balance; less relevant to have secondary prevention when very old; need to see if meds interact
What is deconditioning?
bedbound for 2+ days, confused, poor nutritional state; can’t look after self, fall and can’t walk
What is encompassed in a comprehensive geriatric assessment?
multidimensial, multidisciplinary diagnostic process; use medical, psych and functional capabilities; make co-ordinated integrated plan and long-term follow up; physical health, mental health, functional ability, social circumstances, environment
What is the goal of rehab?
restore patient’s max function; multi-discipline
What legal/ethical issues are there within COTE?
palliative care, discharge destination, dementia (MHA – safeguard; physical, neglect, physiological, financial, discriminatory, institutional, sexual abuse; must report it; don’t confront abuser; don’t ask too many questions)
What are common conditions in COTE?
delirium, dementia, depression, falls, syncope, PD, osteoporosis, incontinence, stroke, TIA, pressure ulcers, MCA
What is the 5 criteria of frailty?
slowness, weight loss, impaired strength, exhaustion, low physical activity
What is the frailty index and score?
number of deficit divided by number of deficits considered
What 2 types of ADLs are there?
basic (self-maintenance) or instrumental (independence in community)
What ADL assessment is used for dementia patients?
Lawton Brody
What ADL assessment is used for chronic disease and rehab patients?
Barthel index and functional independence measure
How is ADL decline prevented?
evaluation, management unit with MDT for therapy and review, home visits
Polypharmacy definition?
More than 5 meds
When is a medication review carried out?
when functional decline or development of syndromes; non-adherence think of depression/dementia
Risks in polypharmacy?
frailty, lack of communication, polypharmacy, change in pharmacokinetics, lack of evidence
What is involved in inappropriate prescribing?
CIs, wrong dose/duration, no affect on pt outcome, adversely affects prognosis
What should be done to safely prescribe?
benefits outweigh risks, cost effective, safe, tailored to individual
Why is resp disease more common in elderly?
More dead alveolar space
When should B2 agonists not be used?
MI
What is used for COPD depression?
paroxetine
What is used to treat CAP?
narrow-spectrum beta lactam and macrolide; for hospitalised use ceftriaxone with azithromycin; abx for 1wk
How is TB managed/treated?
CXR, tuberculin test; more likely to get miliary, meningitis, skeletal/GU if older; most from reactivation
What is obstructive sleep apnoea (OSA)?
repeated apnoea and hypopnoea in sleep which is common in older
RFs for OSA?
diabetes, obesity, renal failure, IHD, hypothyroidism, stroke
Complications from OSA?
drowsiness, fatigue, morning headache, difficulty conc, impaired ADL, cvd mortality
Management and treatment of OSA?
management = weight loss, no alcohol, thyroid replacement, avoid supine sleep; treat = CPAP; use overnight-attended polysomnography
Lung cancer RFs?
smoking, FH, occupational carcinogens, 2nd hand smoke, air pollution, underlying lung disease
Lunger cancer poor prognosis risks?
dementia, poor nutrition, no social support, bad stage, bad performance status, poor differentiation histology
Treatment an management of lung cancer?
surgery, chemo for advanced and radio; lots of cases in >60yrs
Age RFs for heart failure?
elevated left ventricular end diastolic pressure, increased arterial stiffness, impaired response to beta adrenergic stimulation, decline in sinus node function, renal and lung problems
Treatment for HF?
exercise, functional electrical stimulation, ACEi/ARBs, digoxin, bet blockers titrated to HR, cardiac resynchronisation therapy for those with LV fraction <35%, QRS >120 and advanced HF symptoms; most treatments do not reduce mortality but hospitalisations
What is delirium?
Acute disturbance of consciousness, change in cognition, reduced ability to focus, sustain and shift attention; can fluctuate
Causes of delirium?
condition (pneumonia, sepsis, meningitis), intoxication, med use (sedatives, narcotics, anticholinergics, psychotropics [benzodiazepines, anticonvulsants, Parkinson meds]), vascular disorders, metabolic disorders, vitamin deficiency, endocrinopathies, trauma, epilepsy, neoplasia
RFs for delirium?
sensory impairment, severe illness (infection/organ impairment), cognitive impairment, high urea/creatinine ratio, biochem disturbance, functional impairment, depression, alcohol/drug withdrawal; post-op risks = same as above plus old age, living sitch, abnormal preop bloods, surgery type
Delirium S+Ss?
acute, fluctuate, impaired consciousness, poor conc, memory deficit, abnormal sleep cycle, hallucinations, agitated, emotionally labile, neuro signs; hypoactive = apathy and quiet confusion; hyperactive = agitation, delusions, disorientated
Delirium investigations?
ABC, GCS, vitals, cap glucose, examination, bloods, urine, cultures, ECG, CXR, CT
Delirium diagnosis?
clinical; difficult in blind, >80yrs, dementia; DSM is gold standard; confusion assessment = acute onset, fluctuating course, inattention, disorganised thinking, altered consciousness level
Delirium prevention?
avoid risks and treat condition; insufficient evidence for pharma drugs