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Care of the Elderly > CofE > Flashcards

CofE Flashcards

1
Q

What are 5 functional tests done for Dementia?

A 
MMSE
ACE III
AMT
6- CIT
GPCOG
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2
Q

What score on an MMSE indicates dementia?

A

<25/30
Cut-offs are <10 for severe
10-20 moderate
21-24 mild

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3
Q

What are characteristics of an Essential tremor?

A

Better at rest
Intention tremor
Better with alcohol and BBs

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4
Q

Describe the Parkinsonian Gait

A 
Pedestal turning
Broad based
Shuffling
Forward flexed
Reduced arm swing
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5
Q

What are causes of Parkinsonism?

A 
Idiopathic
Drugs- METOCLOPRAMIDE
Trauma
Wilson's
HIV
Parkinsons Plus syndromes
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6
Q

What are the 5 Parkinson’s plus syndromes?

A 
MSA = Multiple System Atrophy
PSP = Progressive Supranuclear Palsy
LBD = Lewy Body Dementia
CBD = Corticobasilar Degeneration
VP = Vascular Parkinsons
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7
Q

What are non motor features of Parkinsons?

A 
Depression
Dementia
Nausea and loss of smell
Diarrhoea and Constipation
Visual Hallucinations
Frequency/Urgency
REM Sleep Disorder
Dribbling
Prosody
Poor Executive Funtioning
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8
Q

Who is on an MDT for Parkinsons?

A 
GP
NEuro
Specialist Nurses
Social Worker
OT
Physio
Carers
SALT
Patient Support Groups
Pharmacist 
Nutritionist
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9
Q

What is the only thing that causes megaloblastic microcytic anaemia?

A

B12/ folate deficiency

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10
Q

What is involved in a comprehensive geriatric assessment?

A 
Physical
Psychiological
Functional
Social
Psychological
Med Review
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11
Q

What is involved in a physical geriatric assessment?

A 
Falls risk
Heart disease 
Dentition
Weight
Nutrition
Continence
Vision and hearing
Pain
Cancer
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12
Q

What is involved in a psychiological geriatric review

A 
Mood disorders
Cognition
Depression
Agitation
Delirium
ISOLATION
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13
Q

What is assessed around functional capacity in a geriatric assessment?

A 
Bathing
Dressing
Toileting
Continence
Feeding
Grooming
Transferring
Shopping and ADLs
Transport
Telephone and contant
Handles
Finances
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14
Q

What is involved in a social and environmental geriatric review?

A 
Home
Family
Advanced care preferences
Help needed?
Social support
Partner health
Groups
Spirituality
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15
Q

Why are old people prone to pressure sores?

A 
Lack of mobility
Loss of sensation
DM
Topical steroids
Malnourishment
Cognitive Impairment
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16
Q

How can pressure sores be prevented?

A 
4 hourly nurse checks
Regular turning
Air matresses
Risk assessment
Barrier creams
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17
Q

What are the 3 systematic determinants of continence?

A
  • Parasympathetic S2-4 Contract the detrusor
  • Sympathetic T12-L2 - Upper sphincter and ureter
  • Somatic NS External sphincter
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18
Q

What are 4 causes of incontinence (DRIP)?

A

Delirium
Retention
Infection/Information/Impacted stool
Polyuria (drugs)

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19
Q

What is the first line treatment for stress incontinence?

A

Duloxetine

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20
Q

What is the first line treatment for urge incontinence?

A

Oxybutynin

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21
Q

Why are antimuscarinics contratindicated in the elderly?

A

Cause confusion and blurred vision

22
Q

What are risk factors for incontinence?

A 
Immobility
Chronic disease
DM
Medications (diuretics)
Parity
Obesity
Smoking
Delirium
COPD (stress)
23
Q

What affects geriatric food intake in hospital?

A 
Environement
Meal times
Food temp/smell
Unfamiliar foods
Pain
Poor apetite
Infection
Burns
Medication
24
Q

What 3 factors contribute to geriatric malnutrition?

A 
Reduced intake
Increased requirements (liver disease, surgery, chemo)
Greater losses (vomiting, diarrhoea, chemo etc)
25
Q

What does MUST stand for?

A

Malnutrition Universal Screening Tool

26
Q

Descrive refeeding syndrome

A

Starvation/Chronic malnutrition causes:
1. decreased glucose, increased glucagon and cortisol
2. This causes gluconeogenesis, glycogenesis and protiin catabolism
3. This causes vitamin depletion and salt and water intolerance
4. When refed, insulin is secreted
5. This causes increased protein and glycogen synthesis, increased glucose uptake, increased thiamine USE, and increased potassium, magnesium and phosphate USE
6. The result is HYPOKALAEMIA, HYPOMAGNESIA, HYPOPHOSPHATEAMIA, THIAMINE DEFICIENCY, SODIUM + WATER Retention
= oedema

27
Q

What bloods do you need to do in refeeding syndrome?

A

Calcium
Phosphate
Mg
K

28
Q

What is needed to prevent refeeding syndrome?

A

Thiamine
Vit B
Multivitamin

29
Q

Why are thiazide like diuretics contraindicated in the elderly?

A

Gout

30
Q

What is the metabolic imbalance caused by loop diuretics?

A

Metabolic alkalosis as H and K are excreted

31
Q

What are risk factors for falls?

A 
Infection
Cognitive impairment
Visual impairment
Slow relflexes
Frailty
AF
Isolation
Parkinsons
TIA/stroke
ANTICHOLINERGICS
Benzos
ANTIHYPERTENSIVES
32
Q

What is osteoporosis?

A

Loss of bone mass and structural deterioration of bone tissue

33
Q

What scan is used to assess osteoporosis?

A

DEXA

34
Q

What score is used to assess osteoporosis risk?

A

FRAX

35
Q

What is included in the FRAX score?

A 
Age/ Sex/ BMI
Previous fracture or parent fracture
Current smoker and alcohol use
RA
GLucocorticoids
2dry osteoporosis due to: T1DM, Hypergonadism, Perimenopausal, Malnourished, Chronic liver disease
36
Q

How is osteoporosis treated?

A

Bisphosphonates: ALENDRONATE
Calcium and vit D supplements
Raloxifine (similar to HRT but lower cancer risk)
Denosumab -monoclonal AB to RANKL

37
Q

What are the conditions necessary to take bisphosphonates in?

A

1 hour before food
Once weekly
With lots of water
Sit upright 1/2 an hour after and no food for an hour

38
Q

What are the side effects of bisphosphonates?

A

GI irritation
Ulcers
Bone/joint pain

39
Q

What indicates a NOF fracture?

A

External rotation

Abducted shortened leg

40
Q

When should you aim to operate on a NOF fracture?

A

Same day or next day to avoid wasting

41
Q

What are teh 5 principes of the Mental Capacity Act?

A

Presume Capacity
Individuals should be supported to make their own decisions
Individuals allowed to make unwise decisions
Best Interests
Least Restrictive Option should be taken

42
Q

What are the 4 components of capacity?

A
  1. Understand Options
  2. Retain information
  3. Weigh up options
  4. Communicate a decision
43
Q

When should DoLs be used?

A

Only when it is the least restrictive method to keep a person safe

44
Q

How long are DoLs for?

A

12 months max but renewable

45
Q

Who is permission for DoLs needed from?

A

Local Authority

46
Q

What does DoLs enforce?

A

Kept locked in care home/ward and not free to go out without close supervision and always supervised.

47
Q

What are the 6 criteria that must be considered in DoLs?

A
  1. Age <18
  2. Mental Health Assessment for mental illness
  3. Mental Capacity Assessment
  4. Best Interest Assessment- look at advanced directive, family/friends/progfessional opinion and values and beleifs
  5. Eligibility- confirm not already under the MHA
  6. “No refusals” assessment- check not going against an advanced directive they or their lasting power of attorney made.
48
Q

What does DoLs need to be to be valid?

A

In writing

Include the purpose

49
Q

What 2 kinds of Lasting power of attorney are there?

A

Property and financial

Health and welfare

50
Q

What are the risks of PEG feeding?

A 
Perforation
Peritonitis
Infection
Abscess
Poor wound healing
Aspiration
51
Q

Who appoints deputies to make LPA decisions?

A

Court of Protection

52
Q

What is the role of an IMCA?

A

Make decisions on behalf of people who lack capacity if there is no one but paid staff willing or able to do so, and no one to consult to as about best interests and advanced directive

Care of the Elderly (1 decks)

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