E6. Physiology and care of the older patient

Question 1

how does the heart change in older patients?

Answer 1

Blood vessels lose elasticity, accumulation of fatty deposits-
heart has to work harder

Question 2

How do the bones/ muscles and joints change in older patients?

Answer 2

Bones shrink in size and density.

Question 3

How does the digestive system change in older patients?

Answer 3

Swallowing and digestive reflexes slow down

Question 4

How do the kidneys change in older patients?

Answer 4

Less efficient at removing waste as kidneys shrink with age.
May develop urinary incontinence as muscles less effective

Question 5

How does the brain/ nervous system change for the older patient?

Answer 5

Number of brain cells decreases, reflexes slow down and co-ordination becomes harder

Question 6

consequences of multiple co-morbidities in older patients?

Answer 6

Polypharmacy
Drug- drug interactions
Drug disease interactions

Question 7

challenges with communication in older patients?

Answer 7

Sight loss
Hearing impairment
Memory
Language- generational differences (always changing)

Question 8

Challenges with accessibility in older patients?

Answer 8

Collecting prescriptions
Opening containers

Question 9

challenges with caring responsibilities in older patients?

Answer 9

Managing multiple people’s medications

Question 10

what is dementia?

Answer 10

Deterioration in cognitive function

Question 11

risk factors of dementia?

Answer 11

-increasing age
-family history; 1st degree relative

Question 12

cognitive reserve as a risk factor for dementia?

Answer 12

People with a smaller cognitive reserve are higher risk of getting dementia

Question 13

ethnicity risk factor of dementia?

Answer 13

Black African, Black Caribbean, South Asian ethnicities

Question 14

Lifestyle risk factors of dementia?

Answer 14

Smoking
Excessive alcohol
Lack of physical activity and poor diet

Question 15

co-morbidities risk factor of dementia?

Answer 15

Hypertension, atherosclerosis, hypercholesteremia, obesity, type 2 diabetes (Depression)

Question 16

traumatic brain injury risk factor of dementia?

Answer 16

-Can trigger the protein accumulation process
-Repeated trauma (even from early adulthood) – risk increases with number

Question 17

Common early symptoms of dementia?

Answer 17

-Memory loss
-Confusion which may make it hard to carry out daily tasks
-Difficulty concentrating
-Mood changes
-Struggling to follow conversations

Question 18

Describe Alzheimers disease

Answer 18

-Word finding difficulty
-Repetitive questioning
-Forgetting names, places
and faces
-Confused/ scared in
unfamiliar environments

Question 19

Describe vascular dementia

Answer 19

-Movement difficulties/
changes
-Difficulty with planning and
reasoning
-Mood changes –
depression and very
emotional

Question 20

Describe lewy body dementia

Answer 20

-Fluctuating levels of
confusion
-Repeated falls
fainting
-Slowing of physical
movements
-Sleep disturbances

Question 21

later stage symptoms of dementia?

Answer 21

-Significant memory impairment
-Unable to recognise family members or familiar environments

Question 22

communication difficulties of dementia?

Answer 22

-Unable to adequately express feelings, significant word finding
difficulties,
-Nonverbal communication only

Question 23

Mobility symptom with dementia?

Answer 23

Inability to safely and independently
mobilise

Question 24

Behavioural difficulty symptoms with dementia?

Answer 24

-Increased agitation, anxiety, wandering
-Depressive characteristics
-Aggression

Question 25

urination symptom of dementia?

Answer 25

Incontinence

Question 26

Other common diseases with older patients?

Answer 26

-type 2 diabetes -hypertension -heart failure -Osteoporosis -Osteoarthritis -Hearing impairment -Visual impairment -Mental Health

Question 27

what are the four principles of medicines optimisation?

Answer 27

principle 1: aim to understand the patients experience principle 2: evidence based choice of medicines principle 3: ensure medicines use is as safe as possible principle 4: make medicines optimisation part of routine practice

Question 28

considerations for deprescribing and prescribing for the older person?

Answer 28

-pharmacokinetics -adverse drug reactions -STOPP/START - optimising of prescribing, reducing polypharmacy, reducing falls -medication adherence -frailty scores -other considerations

Question 30

what is a frailty score?

Answer 30

-Rockwood Clinical Frailty Scale (CFS) - a tool used to estimate an individual’s degree of frailty on a scale of 1 (very fit) to 9 (terminally ill). -Patients who score a 5 or higher are considered frail.

Question 30

How does the patient take their medicines and access medical care?

Answer 30

-Is patient still independent with their medicines -Do they use any aids to help them to remember to take their medicines -If the patient is not responsible – liaise with the appropriate carer/ family representative

Question 31

Who is involved in their care, and how do they help? Remember, carers need support too.

Answer 31

-Family member -Friend -Paid Carer

Question 32

Does the patient have capacity to make clinical decisions

Answer 32

-Initially patients will still be able to make these decisions with the help of loved ones -May eventually lose this ability – need to be clear who is legal guardian / power of attorney

Question 33

communication considerations when (de)prescribing an older patient?

Answer 33

-Unable to hear when discussing health issues with HCP which can result in poor information gathering or poor understanding of advice/ counselling -Unable to read any written instructions, complete repeat prescriptions correctly

Question 34

mood considerations when (de)prescribing an older patient?

Answer 34

-Unable to participate in usual daily activities –read the newspaper, watch the TV, engage with friends and family members easier -Patients might feel isolated

Question 35

falls risk considerations when (de)prescribing an older patient?

Answer 35

-Visual impairment – more likely to trip -Hearing impairment – ears have a role to play in balance -Higher risk of fracture and poor outcomes if high frailty risk if fall