Elderly - general principles Flashcards
How much more likely is a person to fall in an institution compared to at home?
3x
What is the most common cause if injury in older people?
Falls
1-2% result in hip fractures
What % of falls result in major injury?
10%
How do bisphosphonates work?
e.g. alendronic acid, causes death of osteoclasts
What is teriparatide?
Form of PTH, promote the function of osteoblasts
What is denosumab?
Blocks RANKL and thus inhibits osteoclast function
What is benign paroxysmal positional vertigo?
- Calcium carbonate crystals dislodge from otolith organs and disrupt flow of endolymph in semicircular canals
- sudden dizziness on moving head in particular direction, nausea and vomiting
- Epley/Selmont maneuver to reposition crystals – head tilted in various ways to promote crystal exiting the canals
What % of hospital patients have dementia?
20%
What are the 4 As of Alzheimers?
Apraxia: difficulty planning and performing motor tasks
Amnesia
Aphasia
Agnosia: inability to interpret sensations e.g. inability to recognise things
Where is especially prone to atrophy in Alzheimers?
Earliest sign is medial temporal lobe atrophy
Medial temporal and parieto-temporal lobes
- Relative sparing of primary sensory/ motor/ visual cortex
- Dilated ventricles
Discuss the pathophysiology of Alzheimers
Clusters of amyloid plaques: causes calcium influx and glutamate excitotoxicity = cell death
Hyperphosphorylated tau eads to neurofibrillary tangles and loss of structural integrity
What is donepezil?
Acetylcholinesterase inhibitor - used to treat Alzheimers as Alzheimers causes loss of cholinergic neurons
Also galantamine and rivastigmine
What treatments are available for vascular dementia?
Clopidogrel, aspirin and warfarin to prevent clotting
Lifetstyle changes e.g. stopping smoking, improving diet and exercising
Acetylcholinesterase inhibitors and NMDA antagonists aren’t used to treat pure vascular dementia
What is dementia with lewy bodies?
Deposits of alpha synuclein (lewy bodies) gather in neurons and cause neuronal death
Falls, syncope, neuroleptic sensitivity (sensitivity to antipsychotics), hallucinations and dellusions
Atrophy in midbrain, temporal lobe, pariteal lobe and cingulate gyrus
Discuss fronto-temporal dementia
Mainly early onset
10% familial
Mutation in tau gene
- dementia of frontal type
- progressive non-fluent aphasia
- semantic dementia
What is an antalgic gait?
Gait to avoid pain
Discuss the sub. nigra
2 areas: pars compacta and pars reticulata
The pars compacta serves mainly as an output to the basal ganglia circuit, supplying the striatum with dopamine.
The pars reticulata, though, serves mainly as an input, conveying signals from the basal ganglia to numerous other brain structure
System changes in the elderly
Neuro: slow and less regular gait, slowed cognition
MSK: sarcopenia, osteopenia, pain
CV: loss of myocytes and reduced heart compliance, calcification
Resp: reduced gas exchange efficiency, impaired mucocilliary escalator
GI: impaired peristalsis, reduced bowel motilitym reduced rectal wall elasticity, weight loss
Genitourinary: renal function declines, kidneys shrink, CK reduces with loss of muscle bulk so can give false negatives, prostate enlargement, ability to concentrate urine decreases
Eyes: increased risk of retinal detachment, presbyopia (deterioration of sight with age due to lens stiffness)
Ears: wax more viscious, presbycusis, balance imapired due to loss of ear hair cells
Skin: thin, less elastic, prone to damage, dry, less subcut fat (reduced ability to stay warm), slower repair
Important to consider when assessing discharge of patient
Pre-admission status, where they came from, can they use stairs, toilet
Patient ability: ADLs, washing, cooking, getting to bed, toilet, stairs, dressing (asked by OT)
Once a patients baseline and current status is ascertained, a problem list is made and SMART goals outlined
Where do patients go following discharge?
Home: if functionally suitable and appropriate support
Inpatient rehab: to allow patient to achieve their potential function, indicated if their pre-admission function was high but they currently require a lot of support
Residential home: respite, medically fit but needs time to recover, allows for thorough assessment of need
Nursing home: temporary if extra support needed in short term, permanent if not safe to return home, lacks rehab potential and care needs cannot be met elsewhere
Palliative fast track: within last 6 weeks, allows for funding to be sought so patient can have a say in where they spend their last days
Input of social services in discharge planning
Social services input is needed to organise packages of care
Referral to integrated complex discharge hub is made - this team aid staff to progress discharges
Notification of assessment is submitted 1st: requests social worker to be allocated
Notification of discharge: informs social services that the patient is medically and therapy fit for discharge that day and social serves input is the only cause of delay
