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Year 4 - Elderly, Neuro & MSK > Elderly > Flashcards

Elderly Flashcards

1
Q

What is polypharmacy?

A

The action of being prescribed and taking more than 4 medications

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2
Q

What is fragility?

A

A medical syndrome that has multiple causes and contributing factors which frequently leading to a decline in strength, endurance and increased risk of dependability and/or death. This is often associated with the ageing process.

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3
Q

What is delirium

A

Acute confusional state that impacts on the normal functioning on the brain, has a short and acute onset usually caused by something organic that can be treated or looked at.

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4
Q

Neurological causes of delirium (5)

A

Encephalopathy, subdural haematoma, brain injury, stroke, cerebrovasuclar disease

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5
Q

Cardiovascular causes of delirium (3)

A

AF, MI, HF

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6
Q

Respiratory causes of heart failure (4)

A

Pneumonia, COPD, aspiration, pulmonary disease

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7
Q

GI causes of delirium (3)

A

Constipation, bleeding, malnutrition

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8
Q

Urogenital causes of delirium (2)

A

Urinary retention and UTI

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9
Q

Skin and joints causes of delirium (3)

A

Chronic pain, pressure sores, cellulitis

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10
Q

Metabolic/endocrine causes of delirium (3 groups)

A

Hyper/hyponatraemia, hyper/hypoglycaemia, thyroid dysfunction

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11
Q

Medicinal causes of delirium (3)

A

TCA, Anti-cholinergic medication, anti-histamines

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12
Q

Examples of anticholinergics

A

Atropine
Oxybutynin

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13
Q

5 other examples of delirium causes

A
  1. Alcohol intake
  2. Sleeping disturbances
  3. Uncontrolled pain
  4. Hearing impairment
  5. Changes in environment
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14
Q

What are 4 flagship depictions of delirium

A
  1. Acute/short onset
  2. Fluctuating symptoms
  3. Organic cause
  4. Affect in cognition (poor attention)
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15
Q

Onset of delirium vs dementia

A

sudden v gradual

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16
Q

Duration of delirium v s dementia

A

Hours-days, months to years

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17
Q

Symptoms of delirium vs dementia

A

Different depending on type of dementia but mostly hallucination and emotional for delirium that fluctuate between normal and not. Also restless

Dementia is more memory loss that affects adl and interrupts communication, task completing and problem solving.

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18
Q

Reversibility of delirium v dementia

A

Delirium is usually reversible if cause is treated dementia tends not to be and gradually gets worse

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19
Q

Steps of treating delirium? (5)

A
  1. Identify cause and treat with medication etc. infections
  2. Environmental medication e.g., calm environment with clocks and calendars placed to allow focus
  3. Behavioural interventions e.g., regular pattern to day reassurance and comfort
  4. Medication e.g., IM haloperidol if severe, lorazepam for those with Parkinson’s or rivastigmine with caution
  5. Regularly review as it fluctuates and doesnt last long
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20
Q

What is dementia defined as?

A

Broad category to describe brain disease that cause long term impacts on memory and the ability to think. More common in elderly but there are several types

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21
Q

What are the main types of dementia (4+1)

A

Alzheimer’s, vascular, Lewy body, frontotemporal, Parkinson’s dementia

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22
Q

Describe Alzheimer’s

A

Most common - 60-80% of dementias

Main symptom - memory loss that affects ADLs, challenges in problem solving and planning

Symptoms - issues communicating (speaking/
writing), learning new tasks and familiar tasks, confusion with time and place

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23
Q

Describe vascular dementia

A

Second most common - caused by degradation of blood vessels in the brain

Main symptom - speed thinking and concentration

Symptoms - physical problems like waking, mood disturbances (depression and anxiety)

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24
Q

Describe Lewy body dementia

A

Involves abnormal round structures called Lewy bodies growing in nerves invovled with thinking, memory and motor control

Main symptoms - visual hallucinations

Symptoms - alertness and attention deficiency

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25
Q

Describe frontotemporal dementia

A

characterised by the progressive atrophy of the frontal and/or temporal lobes

Main symptoms - behavioural and emotional instability

Symptoms - language difficulties and motor problems

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26
Q

Treatment for Alzheimer’s (2)?

A

Donepazil and memantine (cholinesterase inhibitors and memantine)

Cognitive therpay also

27
Q

Treatment for vascular dementia

A

Controlling risk factors
- control HTN
- control diabetes
- control cholesterol

Antiplatelets and anticoagulant used

28
Q

Treatment for Lewy body dementia

A

Cholinesterase inhibitors (donepazil), antipsychotics for hallucinations but used with caution

Physical activity, healthy diet and cognitive stimulation

29
Q

Treatment for frontotemporal dementia?

A

No specific treatment just antidepressant for mood management or antipsychotics for behaviour.

SALT can be used as well

30
Q

When is Parkinson’s disease dementia diagnosed

A

Overlapping features of Lewy body dementia but had Parkinson’s for a year minimum prior to onset

31
Q

How is PDD managed

32
Q

What is main management for DLB

A

Rivastigmine but levodopa can be used if severe motor issues

33
Q

Causes of falls (6)

A
  1. Degradation of the vestibular system = dizziness and imbalance
  2. Eyesight problems = trips
  3. Muscle weakness and atrophy = not strong enough to support self
  4. Proprioception issues = coordination problem
  5. Decay of postural reflex
  6. Loss of autonomic reflexes
34
Q

Other factors of falls (5)

A
  • frailty
  • comborbidities
  • degenerative conditions (Parkinson’s, dementia arthritis)
  • pre syncope/syncope
  • seizures
35
Q

Risk factors of osteoporosis (10)

A
  1. Older age
  2. Post-menopausal women
  3. Low BMI
  4. Chronic conditions
  5. Certain medications
  6. Long-term corticosteroids
  7. Low vitamin d and calcium
  8. Alcohol and smoking
  9. Personal and family history
  10. Reduced mobility and/or activity
36
Q

Investigation for osteoporosis

A

DEXA-scan bone mineral density check.

37
Q

what scores are used in investigating osteoporosis

A

T-score and z-score

38
Q

What is the threshold for diagnosis of osteoporosis

A

T-score of less than -1

39
Q

what is t-score

A

Your score compared to an average healthy young adult

40
Q

What is a z-score

A

Your score compared to someone of your same sex, age and ethnicity

41
Q

which is used for diagnosing osteoporosis

42
Q

What is osteoporosis

A

Severe degeneration in bone density

43
Q

What is osteopenia

A

Less severe osteoporosis

44
Q

What is syncope

A

Vasovagal episode

45
Q

How does syncope occur

A

Problem with the autonomic nervous system

  1. Vagus nerve triggered
  2. Parasympathetic nervous system triggered
  3. Blood vessels relax
  4. Blood pressure drops
  5. Hypoperfusion to brain
  6. Pre-syncope occurs
  7. Syncope/fainting
46
Q

What tool is used to calculate 10-year osteoporotic fracture

A

FRAX tool or QFRACTURE tool

47
Q

When are you able to have a DEXA-scan

A
  1. Long term corticosteroid use
  2. Previous fragility fracture
  3. Women over 65
  4. Men over 75
  5. Over 50 with RF
48
Q

What is the first line tx for osteoporosis

A

Treatment of underlying cause and bisphosphonates

49
Q

What is the MOA of bisphosphonates

A

Inhibition of osteoclastic activity

50
Q

Where does osteoporosis fractures commonly occur

A

Wrist, spine and hip (3)

51
Q

What is fragility fracture defined as

A

Fracture from standing height or less

52
Q

When is bisphosphonate offered?

A

Tscore of -2.5 or less

53
Q

Examples of bisphosphonates

A

Alendronate and risedronate

54
Q

When can you not prescribe bisphosphonates?

A
  1. Hypocalcamia or hypovitaminosis D
  2. People with CKD
    Alendronate not if eGFR less than 35 Risedronate not if eGFR less than 30.
  3. Achalasia
  4. Pregnant or breastfeeding women
55
Q

What are the side effects of bisphosphonates

A

Reflux
Osteonecrosis of the jaw
Osteonecrosis of the external auditory canal
Atypical stress fractures

56
Q

6 steps of complex discharge planning

A
  1. Individual information gathering (patient, carer, family, social services, anyone involved)
    - assess and establish where we are sending them residential care one, nursing home, sheltered housing
  2. Therapy asses (mental capacity, independence and strength)
  3. Compare to baseline
  4. Problem formulate
  5. Treat plans
  6. Goal set
57
Q

What should goal setting be in complex discharge planning (5)

A

Specific, measurable, achievable,realistic and timely

58
Q

What are the 5 syndromes of frailty

A
  1. Delirium and dementia
  2. Medicinal causes
  3. Incontinence
  4. Falls
  5. Immbolility
59
Q

3 types of incontinence causes

A

Stress, urge, retention

60
Q

Physical causes of immobility

A
  1. Deconditioning
  2. Pressure damage
  3. Decompensation for health conditions
  4. VTE
  5. Infections
  6. Neurological conditions
61
Q

Psychological causes of immobility

A
  1. Low mood
  2. Isolating selves
  3. Reliance on others
  4. Institutional
62
Q

What 3 models are used to assess frailty

A

Gp uses eFI (electronic frailty index)
Cumulative deficit model (rockwood)
Phenotype model (fried)

63
Q

When should calcium be taken in osteoporosis?

A

When dietary intake is inadequate

Year 4 - Elderly, Neuro & MSK (3 decks)

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