Care Of The Elderly

Question 1

What is postural hypotension?

Answer 1

Fall in blood pressure of at least 20mmHg on standing, can cause someone to feel light-headed and is associated with falls and significant morbidity in the elderly.

Question 2

Name 3 classes of medication that can cause postural hypotension.

Answer 2

Alpha blockers
Antihypertensives
Diuretics

Question 3

How is a lying standing BP done?

Answer 3

Record BP after patient has been lying down for at least 5 mins, then ask patient to stand up and record BP at 1, 3 and 5 mins. Positive result if drop >20mmHg, dropped to <100mmHg systolic even if not 20mmHg, or a drop in diastolic BP of >10mmHg with symptoms.

Question 4

Name 4 cognitive assessment screening tools.

Answer 4

AMT
MMSE
MOCA
GPCOG

Question 5

What is the comprehensive geriatric assessment? (CGA)

Answer 5

Holistic tool used to assess older and frail patients to optimise their management. It has 4 main domains:

• Physical assessment
• Functional, social and environmental
• Psychological
• Medication review

Question 6

What AMT score suggests cognitive impairment?

Answer 6

Score out of 10, <7/8 suggests cognitive impairment.

Question 7

What is the AMT4?

Answer 7

Shorter version of the AMT with only 4 questions.

Score of 3 or less suggests cognitive impairment is likely.

Question 8

What MMSE score suggests cognitive impairment?

Answer 8

20-24 = mild dementia
13-20 = moderate dementia
<12 = severe dementia

Question 9

What is mild cognitive impairment?

Answer 9

Stage between the expected cognitive decline of normal ageing and the more serious decline of dementia. It’s characterised by mild problems with memory, language, thinking or judgement.

Question 10

What screening tool can be used for rapid assessment of delirium?

Answer 10

4AT - takes less than 2 minutes and is a rapid way to assess suspected delirium. Assesses the following domains: alertness, AMT4, attention and acute change or fluctuating course.

Question 11

Name some risk factors for osteoporosis.

Answer 11

Female
Prolonged steroid use
Drug and alcohol excess
Family history (history of parental hip fracture)
Post-menopausal
Smoking
Increased age (50+)
Low BMI

Question 12

At what DEXA score should treatment for osteoporosis commence?

Answer 12

If T score

Question 13

What is the FRAX score?

Answer 13

Predicts 10 year risk of a patient developing a fragility fracture.

Question 14

What is the Waterlow score used for?

Answer 14

To screen patients who are at risk of developing pressure areas. It takes into account a number of factors including BMI, nutritional status, skin type, mobility and continence.

Question 15

What is the STOPP START tool?

Answer 15

Screening tool of older people’s prescriptions and Screening tool to alert to right prescriptions. Used as part of CGA toolkit to review medication in the elderly, stopping any unnecessary medication with adverse effects and starting any indicated medications.

Question 16

What are the most common causes of delirium?

Answer 16

Infection
Electrolyte imbalances
Constipation
Medication-induced or drug withdrawal
Alcohol or drugs
Vitamin deficiencies

Question 17

Name some conditions that mimic Parkinson’s Disease.

Answer 17

Essential tremor
Normal pressure hydrocephalus
Dementia with Lewy bodies
Multiple system atrophy
Progressive supranuclear palsy

Question 18

Which 3 factors are assessed as part of the MUST score?

Answer 18

BMI
Unplanned weight loss in past 3-6 months
Likelihood of weight loss whilst unwell or if there is likely to be no nutritional intake for >5 days.