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Medicine > Elderly Medicine > Flashcards

Elderly Medicine Flashcards

1
Q

Define frailty

A

Diminished strength, endurance and physiological function that increases an individual’s vulnerability for developing increasing dependency and/or death

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2
Q

Define sarcopenia

A

Age-related loss of muscle mass
Low muscle mass + poor physical performance OR low muscle strength
(if AND then = severe sarcopenia)
(if just low muscle mass = pre-sarcopenia

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3
Q

How could you go about diagnosing sarcopenia?

A

Measure patient’s gait speed

  • If <0.8m/s - have DEXA
  • If >0.8m/s - do grip strength test - if this is then low, do DEXA
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4
Q

What are the treatment options for sarcopenia?

A
  • Exercise intervention
  • Protein supplementation
  • CGA
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5
Q

What does the 4AT test screen for?

A

Delirium

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6
Q

What are the 4 parts of the 4AT?

A

1) Alertness
2) AMT4: Age, DOB, place, current year
3) Attention: months of year backwards
4) Acute change or fluctuating

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7
Q

What does a score of 1-3 in the 4AT suggest?

A

Possible cognitive impairment

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8
Q

What does a score of 4 in the 4AT suggest?

A

Possible delirium +/- cognitive impairment

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9
Q

In the abbreviated mental test, which score suggests possible dementia?

A

A score less than 7

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10
Q

What is a normal score in the MMSE?

A

27 or more/30

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11
Q

How may delirium present?

A

Decrease in alertness and awareness, confusion (perception and orientation change), hallucinations, attentional deficit

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12
Q

What must you examine in a patient with delirium?

A
  • Consciousness
  • Evidence of head injury or meningism
  • Hips
  • Neuro exam (focal deficit)
  • Palpable bladder
  • Focus of infection
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13
Q

How can you conservatively treat a patient with delirium?

A
  • Reduce noise/stimulus
  • Ask family to come in
  • Correct sensory deprivation (glasses and hearing aids)
  • Never physically restrain
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14
Q

What medical treatment is available for patients with delirium? What is the alternative for patients with PD/LBD?

A

Haloperidol

PD/LBD: Use lorazepam as haloperidol is a dopamine receptor antagonist

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15
Q

Define dementia

A

Global impairment of mental function (intellect, memory and personality) without impairment of consciousness. Persistent for at least 6 months. Progressive and interferes with everyday function.

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16
Q

What 3 endocrine conditions can be a differential for dementia?

A

Hypothyroidism
B12 deficiency
Hypercalcaemia

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17
Q

Name 3 conditions that lead to “pseudo-dementia”

A
  • Normal pressure hydrocephalus (consider if new incontinence and gait dyspraxia)
  • Space occupying lesion
  • Depression
18
Q

What does FRAX measure?

A

Assesses 10 year risk of fragility fracture

19
Q

What investigations should be done with a patient found to have a high risk of fragility fractures as measured by FRAX?

A

DEXA scan

20
Q

What BMD T score is needed to diagnose a patient with osteoporosis?

A

-2.5 or lower

21
Q

What treatments should be offered to patients with osteoporosis?

A

Vitamin D and calcium supplementation and bisphosphonates (alendronic acid)

22
Q

In what stroke patients should enoxaparin NOT be given in? What is the alternative for them?

A

Do NOT give enoxaparin to ANY stroke patients - use intermittent pneumatic compression instead to lower DVT risk

23
Q

How should suspected TIAs be treated? What medication should be introduced when the diagnosis is confirmed?

A

Give 300mg aspirin

Start 75mg of clopidogrel once diagnosis is confirmed

24
Q

Why must you be careful prescribing digoxin in elderly people?

A

With increasing age, renal clearance decreases and digoxin is a water-soluble drug which means it might build up.

25
Q

What medication can treat dizziness caused by anti-hypertensives?

A

Prochlorperazine

26
Q

What is the Waterlow risk assessment?

A

A pressure ulcer risk tool

27
Q

List some risk factors for ulcer formation

A

Malnutrition, neuro deficit (e.g. diabetes), continence, skin appearance (e.g. atrophic due to steroids), smoking, peripheral vascular disease + anaemia, meds (cytotoxics + anti-inflammatories), weight, mobility

28
Q

What is a grade 1 ulcer?

A

Skin discolouration w/ non-blanching erythema

29
Q

What is a grade 2 ulcer?

A

Partial thickness skin loss with ulceration that does NOT involve the subcutaneous tissue

30
Q

What is a grade 3 ulcer?

A

Full thickness skin loss with damage and necrosis of subcutaneous tissue

31
Q

What is a grade 4 ulcer?

A

Full thickness skin loss with necrosis extending down to the underlying bone, tendon or muscle

32
Q

What is a Comprehensive geriatric assessment?

A

Gold standard of care for management of frail older adults.
“Multidimensional, inter-disciplinary diagnostic process focused on determining a frail older person’s medical, psychological and functional capability in order to develop a coordinated and integrated plan for treatment and long term follow-up”

33
Q

What are the 6 domains of a CGA?

A
  • Physical symptoms
  • Mental health symptoms
  • Functionality in ADLs
  • Social support
  • Financial support
  • Advance care planning
34
Q

Why might elderly people find speech more difficult to understand?

A

Older people have increased hearing loss at higher rather than lower frequencies, therefore consonant loss is more marked than vowel loss making speech difficult to understand.

35
Q

What must a patient be able to do to have capacity?

A

1) Understand
2) Retain
3) Consider the information
4) Communicate

36
Q

What are the 4 circumstances where an Independent Mental Capacity Advocate would be used?

A

1) Any serious medical treatments
2) A move to a hospital that would be over 28 days
3) A move to a care home that would be over 8 weeks
4) Deprivation of liberty

37
Q

To whom does a Deprivation of Liberty apply to?

A

Only those people within a hospital or care home setting

38
Q

For whom should a DNACPR be considered for?

A

All patients who may be at risk of cardio or respiratory arrest

39
Q

What should you do in a patient or relative disagrees with a DNACPR?

A

You should offer a second opinion

40
Q

What is Barthel index?

A

An outcome measure of functional independence in activities of daily living - based on a 3 point scale.

41
Q

What score from the Barthel index suggests a poor prognosis for discharge home?

A

If the patient scores below 40

Medicine (15 decks)

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