COTE Flashcards
What are the challenges with caring for older people?
Frailty
Complex comorbidity
Different pattern of disease presentation
Slower response to treatment
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 every day or acute stressors is compromised.
What are the 4 most common presentations in COTE?
1) falls
2) confusion
3) incontinence
4) social admission
What is acopia?
Inability to cope
What are intrinsic RF for falls?
- vision
- walking ability
- maintaining balance
- muscle strength
- physical activity endurance
What are extrinsic RF for falls?
Environment - lighting - slippery floors - rugs - walking stick - footwear -
How do you treat falls?
Physio
- strength + balance training
OT
- environment: baths, toilet, dressing rails
Medical
- polypharmacy issues
- stop antihypertensives
- give fludrocortisone to increase circulatory volume = increase BP
- give calcium + vitamin D to increase muscle strength
Why is creatinine clearance more reliable than eGFR?
Creatinine clearance takes into account weight.
Describe features of delirium
- acute onset
- fluctuating course
- impaired attention
- decreased consciousness
- usually reversible
- often accompanies physical illness
- hospital acquired
Causes of delirium?
Drug use (introduction, dosage adjustments)
Electrolyte + physiological abnormalities
Lack of drug (withdrawal)
Infection
Reduced sensory input (blind, deaf, changing environment)
Intracranial problems (stroke, post-ictal meningitis)
Urinary retention + faecal impaction
Myocardial (MI, arythmia, heart failure)
RF for delirium
significant injuries terminal illness older age lack of stimulation cognitive impairment frailty poor nutrition hx of alcohol excess sensory or functional impairment
Clinical Sx of delirium
- acute behavioural change
- altered social behaviour
- altered level of consciousness
- falling + loss of appetite
List 4 methods of cognitive screening?
1) 6 CIT
2) MMSE
3) MOCA
4) Addenbrookes
What are some reorientation strategies for delirium?
- easily visible and accurate clocks + calendars
- continuity of care from nursing staff
- discourage napping
- encourage bright light exposure in daytime
- encourage family + friends to visit
Medical Tx for delirium?
- treat underlying cause
- low dose haloperidol + lorazepam
RF for pressure ulcers?
- age>70yrs
- bedridden
- paralysis
- paralysis obesity
- urinary/bowel incontinence
- poor nutrition
- diabetes
- peripheral arterial disease
what is the scoring system for pressure ulcers?
WATERLOW scoring system
prevention of pressure ulcers?
1) barrier creams
2) pressure redistribution + friction reduction
- special foam mattress
- heel support
- cushions
3) repositioning
4) regular skin assessment
what are causes of malnutrition?
1) decreased nutrient intake
- vomiting
- nausea
- dysphagia
- mood
- hospital
- NBM
2) increased nutrient requirements
- major surgery
- wound healing
- pressure sores
3) inability to utilise
e. g. malabsorption or IBD
Consequences of malnutrition?
1) immune system (decreased ability to fight infection)
2) muscle wasting (causes falls, decreased mobility)
3) impaired wound healing
4) micronutrient deficiencies
What screening tool is used in malnutrition?
Malnutrition Universal Screening Tool (MUST) - takes into account BMI, weight loss score + acute disease effect score
How to treat malnutrition?
1) food
- snacks, nourishing drinks, food fortification
2) oral nutritional supplements
3) enteral/parental nutrition
What is refeeding syndrome?
Group of clinical signs and symptoms that can occur in a malnourished patient when reintroducing nutrition. There is a shift in use of energy stores from fat metabolism to carbohydrate metabolism.
It initiates insulin increase + cellular uptake of potassium phosphate and magnesium. Can result in death.
Mx of refeeding syndrome?
- IV Pabrinex of thiamine or VitB prior to feeding
- Slow reintroduction of nutrition
- Daily monitoring
