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Elderly, Neuro & MSK > Elderly > Flashcards

Elderly Flashcards

1
Q

Define geriatric giants/frailty syndromes

A
  • Falls (instability).
  • Immobility
  • Incontinence
  • Cognitive impairment
  • Iatrogenesis e.g. increased susceptibility to the side effects of medication
  • Inanition (state of malnutrition, physical and mental exhaustion)
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2
Q

Define polypharmacy

A

When a patient takes 4 or more medications regularly.

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3
Q

What is the strongest risk factor for frailty?

A

Age

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4
Q

List the risk factors for frailty

A
  • Age
  • Female
  • Sarcopenia
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5
Q

What is the FRAX score?

A

Fracture risk assessment tool - helps to identify people who may be at risk of developing osteoporosis.

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6
Q

Outline the impact of falls

A
  • Injury
  • Fear of falling
  • Social isolation
  • Deconditioning
  • Discharged to care home —> loss of independence
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7
Q

Outline the components of a comprehensive geriatric assessment

A
  • Recognition of frailty.
  • Holistic medical review (biopsychosocial) including: identification/optimisation of medical illnesses, goal setting, drug review and anticipatory care planning.
  • Individualised care and support plan.
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8
Q

Give examples of when you would assume frailty

A
  • Dementia and/or delirium
  • Living in nursing home or residential care
  • Parkinson’s disease
  • Falls (not always)
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9
Q

Sheltered accommodation vs residential homes vs nursing homes

A
  • Sheltered accommodation: resident lives in their own flat, but there may be communal areas (independent living/warden controlled).
  • Residential homes: staffed by carers.
  • Nursing home: staffed by nurses and carers, residents are more dependent and have higher, complex care needs.
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10
Q

Test for delirium?

A

4 A’s test

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11
Q

What questions would you ask in an elderly social history?

A
  • Do they live alone?
  • Stairs in the house?
  • Use of walking aids?
  • Carers (if so, what for?)
  • Family support?
  • ADLs? - independent?
  • Lifeline (safety necklace button)?
  • Aids/safety equipment in the house (e.g. handrails, wet rooms, stair lifts etc)?
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12
Q

Management of frailty

A
  • Vitamin D
  • Diet/nutrition
  • Exercise
  • Medications
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13
Q

Outline the issues associated with polypharmacy

A
  • Associated with falls
  • Increased risk of drug interactions
  • Increased risk of adverse effects
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14
Q

Describe the common drugs that have adverse effects on the elderly

A
  • Anticholinergics: dry mouth, urinary retention, constipation, confusion (increased risk of delirium), dizziness, blurred vision, falls.
  • Diuretics: postural hypotension, AKI.
  • Antihypertensives: postural hypotension, AKI.
  • Hypnotics: drowsiness, confusion, unsteadiness.
  • NSAIDs: AKI, GI bleeding.
  • Antibiotics.
  • Amitriptyline: anticholinergic effects - blurred vision, dry mouth, and constipation etc.
  • Opioids: constipation, sedation.
  • Beta blockers: bradycardia.
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15
Q

Outline the types of falls

A
  • Simple ‘one off’ fall.
  • Recurrent falls
  • Syncope and pre-syncope.
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16
Q

Outline the limitations to successful falls rehabilitation

A
  • Injury - long rehab process, limits activities.
  • Dementia - confusion, non compliance.
  • Fear of falling.
  • Osteoporosis.
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17
Q

Define syncope

A

Transient LOC due to cerebral hypoperfusion.

18
Q

Define mild cognitive impairment

A

Problems with memory or higher cortical thinking, not severe enough to interfere with everyday life.

19
Q

What is the abbreviated mental test score (AMTS)?

A

10-point assessment to rapidly assess/screen elderly patients for the possibility of dementia and delirium.

< 6 suggests dementia or delirium.

20
Q

Which drugs can precipitate delirium?

A

Opiates, anticholinergics and benzodiazepines.

21
Q

List the differentials of dementia

A
  • Ageing
  • Mild cognitive impairment
  • Delirium
  • Depression
  • Amnesic syndrome
  • SOL
  • Alcohol abuse
  • Thyroid problems
  • NPH
  • Folate or B12 deficiency
22
Q

Outline the investigations for suspected dementia

A
  • MSE and cognitive assessment.
  • Bloods: FBC, U&Es, LFTs, TFTs, CRP, glucose, B12, folate, bone profile.
  • MSU.
  • CXR.
  • ECG.
  • CT head.
23
Q

Describe the features of delirium

A
  • Disturbance in attention.
  • Disturbance in consciousness.
  • Change in cognition.
  • Disorganised thinking.
  • Altered perception.
  • Altered social behaviour.
  • Occurs over a short period of time (<24 hrs) - acute onset.
  • Reversible and fluctuating.
  • Disturbance is caused by the direct physiological consequences of a general medical condition, substance intoxication, or substance withdrawal.
24
Q

Describe the physiology of ageing

A
  • Increased body fat percentage and decreased total body water.
  • Decreased bone and muscle mass.
  • Reduced immune system function.
  • Decreased elastin, increased collagen and increased calcium deposits in heart and blood vessels, stiffen cardiac muscle, decreasing contractility and CO, and reducing ventricular relaxing and filling.
  • Hypertension due to vessel wall stiffness.
  • Calcification of heart valves.
  • Reduced elastic recoil, reduced chest wall compliance and decreased strength of respiratory muscles —> increased residual volume and decreased vital capacity.
  • Reduced cilia function —> chest infections.
  • Reduced renal blood flow, decreasing eGFR.
  • Decreased peristalsis causing constipation.
  • Decreased oestrogen and testosterone —> osteoporosis.
  • Increased insulin resistance.
  • Neuronal loss.
25
Q

Important examinations in the elderly

A
  • Cognitive assessment
  • Nutritional assessment
  • Hydration assessment
  • Sensory assessment
  • Neurological assessment
  • MSK and gait assessment
  • Pressure sores inspection
  • L/S BP
26
Q

What system is used to assess a patients risk of pressure sores?

A

Waterlow score

27
Q

What are the predisposing factors for delirium?

A
  • Age > 65 years
  • Background of dementia
  • Significant injury e.g. hip fracture
  • Frailty or multimorbidity
  • Polypharmacy
  • Previous delirium
28
Q

Name 3 precipitating factors for delirium

A
  • Infection
  • Change of environment
  • Constipation
29
Q

Outline the management for delirium

A
  • Treat underlying cause
  • Modification of environment
  • Haloperidol
30
Q

Describe the pathophysiology of shingles

A

Primary varicella zoster virus lays dormant in dorsal root ganglia, then it reactivates following immunosuppression.

31
Q

Describe the clinical features of shingles

A
  • Prodromal phase: paraesthesia and pain (throbbing, burning, stabbing) in the affected dermatome.
  • Unilateral, erythematous, vesicular rash in a dermatomal distribution.
  • Systemic features: headache, fever, malaise, fatigue.
32
Q

Which dermatomes are most commonly affected with shingles?

A

Lumbar or thoracic

33
Q

Which cranial nerve is affected in Herpes zoster ophthalmicus?

A

Trigeminal nerve

34
Q

Define Hutchinson’s sign

A
  • The presence of vesicular lesions on the side or tip of the nose that represents the dermatome of the nasociliary nerve (branch of the Ophthalmic division of the trigeminal nerve).
  • This sign correlates highly with subsequent eye involvement.
35
Q

Which condition describes reactivation of herpes zoster in the geniculate ganglion of the facial nerve?

A

Ramsay hunt syndrome

36
Q

Management of shingles?

A
  • Oral anti-viral therapy (e.g. aciclovir), within 72 hours of rash onset.
  • Analgesia.
37
Q

What is the most common complication of shingles?

A

Post-herpetic neuralgia - pain that is persistent, or appears more than, 90 days after the rash onset.

38
Q

Outline the causes of delirium

A
  • Infection.
  • Withdrawal (alcohol, drugs).
  • Acute metabolic.
  • Trauma.
  • Constipation.
  • Hypoxia/hypercapnia.
  • Deficiencies.
  • Endocrine (thyroid, glucose, cortisol).
  • Acute vascular.
  • Toxins (metals).
  • Dehydration.
  • Pain.
  • Environment.
  • Polypharmacy.
39
Q

Diagnostic tools for delirium

A
  • AMT
  • 4 ATs
  • CAM criteria
40
Q

Predisposing factors for pressure ulcers

A
  • Malnutrition
  • Incontinence: both urinary and faecal
  • Immobility
  • Pain (which can lead to decreased mobility)
41
Q

Dementia with fluctuating cognition and hallucinations

A

Lewy body dementia

Elderly, Neuro & MSK (5 decks)

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