Care of the Eldery Flashcards
What is frailty
state of increased vulnerability resulting from ageing associated decline in reserve and function across multiple physiologic systems such that the ability to cope with everyday or acute stressors is compromised
ageing-> functional decline -> increased vulnerability -> less ability to cope
What are the geriatric giants
- instability
- immobility
- incontinence
- intellectual impairment
What comprises a geriatric assessment
- medical
- functional
- physiological
- social and environmental
Who is involved in a medical assessment and what does it contain?
Dr, Nurse, Pharm
Problems list, co-morbs, med review, nutritional status
Who is involved in a functional assessment and what does it contain?
OT, PT, SaLT
AODL, exercise, gait and balance
Who is involved in a psychological assessment and what does it contain?
Dr, nurse, psychologist
cog status, mood/depression testing
Who is involved in a social and environmental assessment and what does it contain?
OT, SW
home safety, support needs, careers
What is rehab
process of restoring pt to max function
What is abuse
single or repeated act or lack of appropriate action that occurs in relationship, wherer theres an expectation of trust which causes harm or distress
What is dementia?
Progressive global decline in cog function without impairment of consciousness
what are the symtoms of dementia?
1st
- memory loss: short term
- emotional disturbance
- behavioural changes (delusions, aggression, loss of normal scoial behaviour)
2nd
- self neglect
- personality changes
- motor/sensory abnorm
- seizures
3rd
- parkinsonisms
- wasting
- incontinence
- mute
How do you diagnose dementia?
- decrease in memory and learning (MMSE)
- decrease in one of: lanuage, motor, recog, function
- gradual onset and continuous decline
- interefers with social or work functioning
- not caused by: organic or delerium
What are the types of dementia?
Alzheimer’s: general brain atrophy, particularly frontal and temporal
Vascular: multiple small infarcts, stepwise progression
Lewy Body: in brainstem and neocortex, fluctuating sypmtoms, halls, sleep disturbance
Fronto-temporal: FT atrophy without Alzheimer’s Hx, massive disinhibition
What invesitgations would you do in ?dementia and why?
- TFT
- U&E: renal failure
- LFT: cirrhosis, carcinoma
- Glucose: db
- CT: tumour, SD haematoma
Non medical management of dementia?
- mental capacity
- advanced care planning
- DVLA
- music/art therapy
- support groups
Medical management of Dementia
Alzheimers and LW: AchE-donepezil, rivastigmine
Just Alzheimers: +memantine
Anti P- risperidone
Cause of fall and test to confirm
- Arrythmia: ECG, cardio examination
- postural hypotension: Lying/standing BP
- UTI: Urine dipstick
- other infection: ESR/CRP
- Stroke/haemorrhage: CT/MRI, neuro exam
- BPPV: Epleys
- alcohol: LFT
- rhabdomyolysis: CK
- dehydration: U&Es
Other: environmental
causes of faecal incontinence
- child birth
- surgical trauma
- anal sphincter degen
- GI: diarrhoea, constipation, crohns, fistula
- Neuro: stroke, tumour, dementia, MS
- Congential; spina bifida, Hirschprungs
Management of faecal incontinence
diet
habits; toilet after meal, perianal exercises
meds: loperamide hydrochloride (anti-diarrhoeal)
surgery: sphincter repair
Why does postural hypotension occur?
normally avoided by baroreceptors, cartoid sinus (CN IX) and aortic arch (CNX) but when BP falls then they cant stretch -> orthostatic hypotension
Causes of postural hypotnesion
hypovolaemia
disease: db, Parkinsons, heart disease
meds: BB, sildenafil, TCA, MAO-I
Symptoms of postural hypotension
- lightheaded
- weakness
- blurred vision
- syncope
- hearing changes
Diagnosis and management of postural hypotension
Dx: BP after 5 mins lying down and 3 mins of standing
>20 down in systolic or >10 down in diastolic = PHTN
mx: stand slowly, lift arms above head for a few mins before standing up, sleep with head raised, fludocortisone
