Elderly Medicine Flashcards
What percent of elderly adults (over 65) have some decayed/ unsound teeth?
over 50%.
What are two challenges with elderly patients?
more CHRONIC DISEASES (cardiovascular, neurological, respiratory, diabetes, rheumatological) AND more COMPLICATIONS (more potential complications during treatment, more oral effects of diseases, more drugs).
What worsens the oral health issues of frail elderly patients (apart from disease and complications)?
access, income, “nothing can be done’
What is fraility?
Think of Ds: disability, dementia, delirium, depression, denourishment (aka malnutrition), destitution, dependency, drugs, death.
What is a common frailty scale used?
rockwood frailty score
How can patients lose their manual dexterity with age??
- Neurological disease (ex. parkinsons or stroke)
- rheumatological disease (ex. osteoarthritis or rheumatoid arthritis).
How do patients lose their physical capacity with age?
Respiratory disease
- COPD
Heart disease
Heart failure
Kidney failure
Anaemia
Cancer
Examle of how older patients lose their physiology with age?
loss of thirst reflex
Disability considerations in dentistry?
High risk of adverse events eg chest pain, shortness of breath
Manual dexterity
Access to services
Visual deficits
Communication issues
Allow for extra time & don’t rush them
Respect
What sensory disabilities do elederly people get with age?
- Visual (Age related macular degeneration, Cataracts).
- Deafness
- Impaired taste
What is multi-infarct dementia?
- made up of lots of blocked small blood vessels.
What is lewy body dementia linked with?
parkinson’s
What are 4 causes of dementia?
- alzheimers (60%)
- multi-infarct (20%)
- lewy body (15%)
- others (5%)
What is the pathological process of dementia?
Can somewhat tell from disease trajectory and symptoms but can’t fully tell until post-mortem.
What is dementia?
Global loss of brain function (cognition, function, personality)
How is dementia diagnosed?
Mainly CLINICAL (history taking, examination, rests of cognition, investigations).
How is dementia treated?
- Mainly non-pharmacological aka SUPPORTIVE.
- drugs can be used to DELAY, NOT cure (CHOLINISTERASE INHIBITORS).
- symptom control using SEDATIVES, yet these increase mortality
What would you be wary of prescribing to patients with dementia? Why?
Codeine, risk of delirium
What act to consult for a patient with dementia to assess ability to consent?
Adults with Incapacity Act 2000 Sect 47
What document may be needed for a dementia patient who lacks capacity?
Adults with incapacity form from GDP
What are some considerations with dementia patients?
- Neglect
- Comprehension
- Capacity to consent (Adults with Incapacity Act 2000 Sect 47)
Assess capacity for each intervention
Must be able to understand information, retain , balance information and communicate decision back
Maximise communication & comprehension
If lacks capacity needs AWI form from GP - Compliance
- Interaction with carers and relatives
- Be respectful
- Prescribing
Risk of delirium (acute confusion) with analgesics
What is delirium and how is it diagnosed?
ACUTE CONFUSIONAL STATE
- confusion assessment method
- screening tool (4AT)
What are predisposing factors to delirium?
- Frail body (age, multimorbidity, advanced illness, malnutrition)
- Frail mind (age, stroke, dementia, depression)
What are CAUSATIVE factors if delirum?
Often multiple underlying causes: Infections, New drugs/drug interactions, Pain, Dehydration, Unusual environment/ people
Often pre-existing dementia
What is depression/anxiety more common in elderly?
- social circumstances, physical illness, related issues of malnutrition and dehydration
what are dental considerations for depressed/ anxious elderly?
compliance, allow time, oral neglect.
How does malnutrition manifest in the elderly?
- 10% of elderly have protein malnutrition
- up to 50% in frail elderly (chronically ill/ institutionalised bc they do not eat enough).
What is one of the problems with malnutrition?
impaired healing
Why would a patient be malnourished?
Lack of accessibility
Unable to eat food
Impaired appetite
Unwilling to eat food (ex. in dementia).
Gastrointestinal problems
(Poor oral health, Further down GI tract)
Respiratory problems (ex. COPD makes patient breathless and hence less likely to eat)
What percent of elderly in the UK live in poverty?
20%, this is likely to go up massively.
What are the various forms of dependency?
Family carers
External carers
Institutionalisation (Sheltered Housing,
Residential Homes, Nursing Homes)
What is sheltered housing?
Warden 9-5 and alarm system, many will have external carers coming into sheltered housing
What is residential home
has carers
What is a nursing home
nurses and carers
considerations with eledrly patients
Get accurate medication history (carer, patient, GP– try to get TWO SOURCES)
Use BNF/ other resources – look up all medications you are unsure of
Reduced Renal Function in elderly
Consideration of antiplatelets/ anticoagulants
Antiplatelets eg aspirin/ clopidogrel
Anticoagulants inc warfarin/ apixiban/ edoxoban/ dabigatrin
Polypharmacy
Appropriate Vs Inappropriate/Problematic – highlight to GP
Consider potential side-effects in relation to your patients symptoms eg tricyclics
Be alert to interactions eg local anaesthetic risk
Avoid harmful drugs with your prescribing
Avoid NSAIDS in over 80s (GI Side effects in 50%)
Avoid overuse of antibiotics (Clostridium difficle risk)
Use smallest doses possible for moderate strength analgesics eg codeine
What should you avoud prescribing in over 80s?
- NSAIDS because 50% have GI side effects.
- use the smallest amount of moderate strength analgesia as possible (ex. codeine).
