Conditions Flashcards
Causes of cognitive impairment in eldelry
Dementia
Delirium
Infection
Thyroid disease
B12/folate deficiency
ETOH
Chronic SDH
Normal pressure hydrocephalus
Brain tumour
Medication - anticholinergics
Depression
Anaemia
Hyponatraemia
Work-up of cognitive impairment in elderly
Bloods; FBC/LFT/ESR/Ca/TFT/B12/FOLATE
CTB
CXR
FPG
ECG
MSU
HIV/syphilis if indicated
Lewy body dementia and Parkinson disease dementia features
Gradual progressive decline
Visual hallucinations
Fluctuating arousal and attention
Parkinsonism
REM sleep disorder
Frontotemporal dementia features
Impaired executive and language function
Behavioural/personality changes
Vascular dementia features
Sudden onset or progressive / stepwise cognitive decline
Mx BPSD
Recreation; cooking, gardening
Reminiscence; books, photos of family
Exercise
Music
Animal
Touch therapy
Antipsychotics
- Risperidone
Aspects of health to review when on antipsychotics
Every 3/12
Behaviour
Bowel
Sleep
Weight gain
Pain
QTC prolongation
Agranulocytosis
Vascular dementia mx
Aspirin; consider based on CVA/TIA risk vs bleeding risk
Cholinesterase inhibitors
- Donepezil 5mg 4/52 -> 10mg nocte
Anticholinesterase inhibitors
Prescribe if; dx by specialist and MMSE >=10
Donepezil, galantamine, rivastigmine
ADR; n/v, diarrhoea, drowsiness, bradycardia, vivid dreams
Avoid use with NSAIDs
NDMA receptor antagonist for Alzheimer’s
Memantine 5mg and uptitrate to 20mg daily
Indication; mod-severe Alzheimer’s if intolerant to ACHEI’s and MMSE 10-14
Can’t use if seizures
Can combine with ACHEI
Non-pharm mx dementia
ACAT referral
Appoint EPOA
AHCD
Notify Driver License Authority
Webster Pack
Refer to National Dementia Helpline for advice
Refer to Dementia Australia for support/services
Encourage social activities
Exercise 30min daily
Reduce ETOH
Dental health
Healthy diet
Sleep hygiene
Delirium work up
FBC
U+E
Ca
LFT
BGL
O2
ECG
Urine dipstick
Consider; CTB, CXR, BC, Tn
Mx delirium
Psychotic sx or behavioural disturbance
- Haloperidol 0.5mg stat
- Parkinsons/LBD; quetiapine 25mg PO
Drugs implicated in delirium
Anticholinergic; atropine, amitriptyline, oxybutynin, stemetil
Steroids
NSAIDs
Opioids
Alcohol
Levodopa
Delirium prevention measures
Avoid polypharmacy
Pain relief
Prevent constipation
Safe mobilisation
Adequate hydration
Glasses/hearing aids
Good sleep hygiene
Close involvement of family
Reorientation methods
Acute severe behavioural disturbance in adults mx
1st line; Droperidol 10mg IM
Rescue sedation
- Ketamine 4mg/kg IM
Complications of hospital admission in elderly
Delirium
Infection
Constipation
Pressure Ulcers
Deconditioning
Medication errors
Insomnia
Malnutrition
Indications to discontinue medications in elderly
Life expectancy < 2 years
Harm > benefit
Low utility
Pt not in favour of using
Reasons for medication non-compliance
Lack of understanding
Fear of side effects
Cost
Lack of symptoms
Too many medications
Worry they will become dependent
Mistrust of doctors
Work-up of malnutrition
FBC + film
U+E
Ferritin/folate/INR
Zinc
Vitamin D
Lipid
Selenium
Albumin
Mx malnutrition
1-1.2g/kg protein daily
Variety of foods; meat, vegies, fruits, 2x glasses milk
Resource
Dietician
Meals on Wheels
Community cooking classes
Encourage social engagement
Risk factors of falls
Gait issues
Visual/hearing issues
OA
Postural hypotension
Incontinence
Cognitive impairment
Environmental hazards
Footwear
Medications
Exam for recurrent falls
BMI
Vitals
CVS exam
Neuro
Visual acuity
Hearing
Gait
Timed up and go test; >=12 seconds is at risk of falls
