Elderly Care Flashcards
Define frailty
A group of older people who are at highest risk of adverse outcomes such as falls, disability, admission to hospital, or the need for long term care
Why should we focus on frailty
A gradual multi system loss of physiological reserves and of homeostatic robustness- resulting in lower resilience and increased vulnerability
Often present to health services after a minor change, but with serious (often non specific) symptoms, such as falls, inability to mobilise to provide self care and/or confusion
What are the formal frailty assessments
British Geriatric society recommends:
- GAIT speed- taking more than 5 seconds to cover 4m
- Timed up and go test- taking more than 10 seconds to get up a chair, walk 3m, turn and sit back down
- PRISMA 7 Questionnaire- prompts further assessment
If someone is suggested to have frailty due to assessment by geriatrician, what should be done
A Comprehensive Geriatric Assessment (CGA)
- Holistic interdisciplinary assessment of a patient with comprehensive care and support plan (CSP)
- Time consuming (>1hr) and requires full multi-disciplinary team
- Not done in acute setting
In patient assessment
- Clinical frailty scale or frail assessment
Describe the STOPP/START Tool v2 and what it is validated to do?
Screening Tool of Older Persons’ potentially inappropriate prescriptions (STOP)
Screening Tool to Alert doctors to Right (indicated) Treatment (START)
Validated to:
Significantly reduce adverse drug reactions
Improve medication appropriateness
Reduce length of hospital stay in those hospitalised with acute illness
Integrated into some Trust formularies and CCG’s
Describe what the PINCER intervention is
A pharmacist led IT intervention to reduce prescribing errors in primary care
System to identify patents at risk from common and important prescribing errors (some which may be elderly)
- Patients who have a diagnosis of heart failure who are prescribed an NSAID (contraindicated)
Pharmacy technicians support this as it is IT databased focused
Identifies at risk patients for medication reviews
NICE supported
COST EFFECTIVE
What is medication/polypharmacy review
STOPP/START toolkit as a start
PINCER intervention in primary care
Anticholinergic burden
Consider national and regional guidance
Optimise pain relief- considered in stop and start, but often mismanaged
- Paracetamol regularly may help, buprenorphine patch if compliance is an issue
Holistic approach
Involve carers and family
Consider degree of frailty when making recommendations- frailty score
- wouldn’t want to give someone all these drugs that give her more side effects
What are the reasons for falls from medicines
Sedation Impaired postural stability (balance) Hypotension- low BP Drug induced parkinsonism (parkinson like symptoms) Visual impairment Hypoglycaemia Vestibular damage (tinnitus, deafness) Hypothermia (low body temp) Confusion Dehydration
What are the conditions and drugs that cause sedation
Conditions: Depression Sleep apnoea Electrolyte imbalance Hypothyroidism Chronic pain Vitamin and mineral deficiency
Benzodiazepines Antipsychotics Dopamine agonists Phenobarbital Anti-cholinergic's Muscle relaxants Opiate analgesics Z-drugs: zopiclone etc Carbamazepine Sedating anti-histamine Sedating anti-depressants
What are the conditions and drugs that cause impaired postural stability
Conditions Labyrinthitis parkinsons disease Meziere's Multiple Sclerosis Diabetes Stroke
Drugs Benzodiazepines Anti-psychotics Z-drugs Opiate analgesics Muscle relaxants Sedating anti-depressants Phenytoin Sedating anti-histamines
What are the conditions and drugs that cause hypotension
Infection Parkinson's disease Dehydration Heart failure Hypothyroidism Valvular disease
Alpha blockers Diuretics Beta blockers Anti-hypertensives MAOIs SNRIs Anti-psychotics Anti-anginas Sedating anti-depressants
What are the conditions and drugs that cause parkinsonism
Brain injury Lewy body disease Encephalitis/meningitis Stroke Brain tumour Liver disease
Atypical antipsychotics- at high doses Metoclopramide Methyldopa Cinnarizine Typical 1st generation anti-psychotics Tetrabenzine
What are the conditions and drugs that cause visual impairment
Diabetes Glaucoma Brain injury Cataracts Stroke Parkinson's disease
Benzodiazepines Amiodarone Ethambutol Sedating anti-histamines Anti-psychotics Topiamate Sedating anti-depressants Alpha blockers
What are the conditions and drugs that cause hypoglycaemia
Diabetes Malnutrition Alcohol Renal failure Exercise Hormone deficiencies
Insulin Quinine Sulphonylureas Metaglinides ACE inhibitors Beta blockers
What are the conditions and drugs that cause vestibular damage
Infection Ear blockage Stroke Multiple sclerosis Noise induced hearing loss Paget's disease
Loop diuretics Salicylates Quinine VINCA ALALOIDS (CHEMO) Platinum based chemo Amino glycoside antibiotics
What are the conditions and drugs that cause hypothermia
Hypothyroidism Alcohol Addison's disease Metabolic disorders Heart failure Malnutrition
Beta blockers Benzodiazepines Anti-psychotics Sedating anti-histamines Z-drugs Sedative anti-depressants
