Elderly Care Flashcards

Question

What is the general management of dementia?

Answer 1

Modify reversible aggravating factors Assess for and treat depression appropriately Social considerations Practical considerations - deprivation of liberty? Risk management

Answer 2

Acetylcholinesterase inhibitors Memantine Aspirin and Statins

Answer 3

Long-term conditions or chronic diseases are conditions for which there is currently no cure which are managed with drugs and other treatment

Answer 4

Reduce morbidity Improve quality of life Increase longevity

Answer 5

Increase ability to work Reduce costs Reduce demands on health services Reduce demands on social services

Answer 6

Multidimensional holistic assessment of an older person considers health and wellbeing and leads to the formulation of a plan to address issues which are of concern to the older person and their family and carers when relevant

Answer 7

``` Medical Psychological Social Functional Environmental ```

Answer 8

STOPP: screening tool of older persons prescriptions START: screening tool to alert doctors to right treatment

Answer 9

``` Measure performance in activities of daily living - 10 variables Faecal incontinence Urinary incontinence Grooming Toilet use Transfers Walking Dressing Climbing stairs Bathing ```

Answer 10

Time taken to stand up from a chair, walk 3 meters, turn around, walk back and sit down again Assess person's mobility Score 10 seconds or less - normal 11-20 - normal for frail elderly and disabled Greater than 20 seconds - need assistance outside and further intervention required Greater than 30 seconds - falls prone

Answer 11

``` Doctor Nurse Physiotherapist Occupational therapist Dietician Social worker Community matron District nurse Specialist nurse ```

Answer 12

Complex admissions to hospital Planning for transfer of care for rehabilitation/re-enablement Continuing Care assessment An older person having multiple falls A frail patient prior to surgery A person receiving intermediate care or other community based rehabilitation

Answer 13

Problem List | Plan of action for each problem

Answer 14

Multiple body systems gradually lose their built-in reserve poor functional reserve

Answer 15

Poor physiological reserve Risk of adverse outcome after apparently minor event eg infection/new medication Dramatic change in their physical and mental well being Poor outcome after operation Frailty is not an inevitable part of ageing, it is a long-term condition Frailty is not static, it can be improved with intervention or worsened

Answer 16

PRISMA 7 questionnaire; more than 3 Walking speed; taking more than 5 sec to walk 4 m Timed up and go test; 3 meter in 10 sec Grip strength; hand held dynamometer when patient can't walk Out-patient surgical setting; Edmonton frail scale;cognition/nutrition

Answer 17

``` Age Multi-morbidity Disability Polypharmacy Smoking Alcohol excess Poor diet (obesity / low protein) Inactivity Immune-endocrine axis Vitamin D deficiency Psychological factors Social factors ```

Answer 18

``` Falls Immobility Delirium Incontinence Susceptibility to medication side-effects ```

Answer 19

4 or more medications

Answer 20

``` Unintentional weight loss Reduced muscle strength Reduced gait speed Self-reported exhaustion Low energy expenditure ≥3 features suggests Frailty ```

Answer 21

``` Symptoms: sensory loss Signs: tremor Diseases / diagnoses: dementia Deficits combine to increase “frailty index” Accumulate with age ```

Answer 22

WAre you more than 85 years old? Male? Do you have any health problems that limit your activities? Do you need someone to help you on a regular basis? Do you have any health problems that require you to stay at home? In case of need, can you count on someone close to you? Do you regularly use a stick, walker or wheelchair to get about? >3 suggests frailty

Answer 23

``` Stand up from a standard chair (with arms) Walk 3m Turn around Walk back to the chair Sit down >10 seconds suggests possible frailty ```

Answer 24

Routine OPD appt: med, surgical,memory Primary care review for older people Social service assessment for care and support Review by community care team/home carers in community Ambulance crew called out Planning for any intervention New medication/operation

Answer 25

Comprehensive geriatric assessment Consider and address reversible conditions Consider specialist input (geriatrician, old-age psychiatrist) Consider other MDT input (community matron) Medication reviews Personalised care planning Influenza and pneumococcal vaccinations Primary prevention: weight management programmes, smoking cessation, detection and brief advice for excessive alcohol consumption, hypertension Secondary prevention programmes – chronic disease clinics Secondary prevention of osteoporosis after fragility fracture using bisphosphonates Targeted assessment and support for people older people: community matron and/or specialist nursing services Named GP for patients >75 years old

Answer 26

Individualised strength and balance training

Answer 27

Personal goals Medical management goals Escalation and emergency plans Advance care plans – for some

Answer 28

Dose: toxic reaction, collateral reaction, hypersusceptibility reaction Time-course: first dose, early, intermediate, late, withdrawal, delayed Susceptibility: Genetic, Age, Sex, pregnancy, hepatic /renal impairment, other drugs (interactions), diet

Answer 29

Gradual loss of function of cells and organs, with the eventual outcome of death

Answer 30

``` Receptor responses – decreased beta adrenoceptor sensitivity Altered coagulation factor synthesis CNS becomes more sensitive to psychotropics/hypnotics Baroreceptor response less sensitive Renal clearance reduced Thirst response blunted Thermoregulation blunted Altered immune response Slower gastric emptying Reduced plasma albumin Increased ratio of adipose to lean tissue Altered liver metabolism ```

Answer 31

Simplify: once-daily dosing, try to prescribe medicines to be taken at same time of day, try to use medications with dual indications (beta blockers), Consider daily dose reminder system (Dosette box) Educate: Explain reasons for medication and how to take it, Warn of predictable side effects, Enlist support of family and carers in monitoring Monitor: Check tablet boxes and use of medications, Monitor requests for prescriptions, Serum monitoring if needed

Answer 32

All patients aged >75 years should have an annual review of their repeat medication Those taking 4 or more medicines should be reviewed every 6 months May be completed by any suitably qualified health professional

Answer 33

Waterlow score | BMI, nutritional status, skin type, mobility, continence

Answer 34

``` Immobility Instability Incontinence Intellectual Impairment Iatrogenic ```

Answer 35

Cardiac: Arrhythmias, Aortic stenosis Orthostatic hypotension: drugs, autonomic dysfunction, hypovolaemia, hypoadrenalism Neuro: vasovagal, seizure, hypoglycaemia

Answer 36

ABCDE if acutely unwell Cardiovascular (BP, postural drop, dehydration, murmurs) Neurological (GCS / AVPU score, focal neurology) MSK (evidence of trauma / injuries resulting from fall)

Answer 37

``` FBC, U&Es, bone profile, glucose ECG Lying / standing BP Urinalysis Consider: CT head (Head injury with new confusion, on warfarin, new neurology), Xrays, CK, 24 hour tape +/- ECHO, Tilt-table testing ```

Answer 38

Acute onset Fluctuating course Inattention Disorganised thinking or loss of consciousness

Answer 39

Used to identify potential frailty/need for further clinical review if score of 3 or more Are you more than 85 years? Male? In general do you have any health problems that require you to limit your activities? Do you need someone to help you on a regular basis? In general do you have any health problems that require you to stay at home? In case of need can you count on someone close to you? Do you regularly use a stick, walker or wheelchair to get about?

Answer 40

STOPP-START criteria Screening Tool of Older People’s potentially inappropriate Prescriptions Screening Tool to Alert doctors to Right (appropriate, indicated) Treatments

Answer 41

Loss of patient compliance Prescription errors Increased Adverse Drug Reactions and Interactions Inappropriate prescribing

Answer 42

There is no evidence based indication, the indication has expired orthe dose is unnecessarily high One or more medicines fail to achieve the therapeutic objectives they are intended to achieve One, or the combination of several drugs cause unacceptable adverse drug reactions (ADRs), or put the patient at an unacceptably high risk of such ADRs Patient is not willing or able to take one or more medicines as intended

Answer 43

HTN | Heart failure

Answer 44

Identify objectives of drug therapy Identify essential drug therapy Does the patient take unnecessary drug therapy Are therapeutic objectives being achieved? Does the patient have ADR or is at risk of ADR? Is drug therapy cost effective? Is the patient willing and able to take the drug therapy as intended?

Answer 45

``` Amitriptylline Atropine Chlorpheniramine Chlorpromazine Clomipramine Clozapine Diphenhydramine (in some antihistamines, some Nytol andother sleep remedies) Imipramine Nortriptyline Oxybutinin Paroxetine Procyclidine Promethazine Tolterodine ```

Answer 46

Patients over 65 or have had previous fragility fracture should be offered bone protection Patients under 65 offer dexa. Score between 0 and -1.5, repeat scan in 1-3 years. Score less than -1.5 offer bone protection