Elderly Medicine Flashcards
Define frailty
Diminished strength, endurance and physiological function that increases an individual’s vulnerability for developing increasing dependency and/or death
Define sarcopenia
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
How could you go about diagnosing sarcopenia?
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
What are the treatment options for sarcopenia?
- Exercise intervention
- Protein supplementation
- CGA
What does the 4AT test screen for?
Delirium
What are the 4 parts of the 4AT?
1) Alertness
2) AMT4: Age, DOB, place, current year
3) Attention: months of year backwards
4) Acute change or fluctuating
What does a score of 1-3 in the 4AT suggest?
Possible cognitive impairment
What does a score of 4 in the 4AT suggest?
Possible delirium +/- cognitive impairment
In the abbreviated mental test, which score suggests possible dementia?
A score less than 7
What is a normal score in the MMSE?
27 or more/30
How may delirium present?
Decrease in alertness and awareness, confusion (perception and orientation change), hallucinations, attentional deficit
What must you examine in a patient with delirium?
- Consciousness
- Evidence of head injury or meningism
- Hips
- Neuro exam (focal deficit)
- Palpable bladder
- Focus of infection
How can you conservatively treat a patient with delirium?
- Reduce noise/stimulus
- Ask family to come in
- Correct sensory deprivation (glasses and hearing aids)
- Never physically restrain
What medical treatment is available for patients with delirium? What is the alternative for patients with PD/LBD?
Haloperidol
PD/LBD: Use lorazepam as haloperidol is a dopamine receptor antagonist
Define dementia
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.
What 3 endocrine conditions can be a differential for dementia?
Hypothyroidism
B12 deficiency
Hypercalcaemia
Name 3 conditions that lead to “pseudo-dementia”
- Normal pressure hydrocephalus (consider if new incontinence and gait dyspraxia)
- Space occupying lesion
- Depression
What does FRAX measure?
Assesses 10 year risk of fragility fracture
What investigations should be done with a patient found to have a high risk of fragility fractures as measured by FRAX?
DEXA scan
What BMD T score is needed to diagnose a patient with osteoporosis?
-2.5 or lower
What treatments should be offered to patients with osteoporosis?
Vitamin D and calcium supplementation and bisphosphonates (alendronic acid)
In what stroke patients should enoxaparin NOT be given in? What is the alternative for them?
Do NOT give enoxaparin to ANY stroke patients - use intermittent pneumatic compression instead to lower DVT risk
How should suspected TIAs be treated? What medication should be introduced when the diagnosis is confirmed?
Give 300mg aspirin
Start 75mg of clopidogrel once diagnosis is confirmed
Why must you be careful prescribing digoxin in elderly people?
With increasing age, renal clearance decreases and digoxin is a water-soluble drug which means it might build up.
What medication can treat dizziness caused by anti-hypertensives?
Prochlorperazine
What is the Waterlow risk assessment?
A pressure ulcer risk tool
List some risk factors for ulcer formation
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
What is a grade 1 ulcer?
Skin discolouration w/ non-blanching erythema
What is a grade 2 ulcer?
Partial thickness skin loss with ulceration that does NOT involve the subcutaneous tissue
What is a grade 3 ulcer?
Full thickness skin loss with damage and necrosis of subcutaneous tissue
What is a grade 4 ulcer?
Full thickness skin loss with necrosis extending down to the underlying bone, tendon or muscle
What is a Comprehensive geriatric assessment?
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”
What are the 6 domains of a CGA?
- Physical symptoms
- Mental health symptoms
- Functionality in ADLs
- Social support
- Financial support
- Advance care planning
Why might elderly people find speech more difficult to understand?
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.
What must a patient be able to do to have capacity?
1) Understand
2) Retain
3) Consider the information
4) Communicate
What are the 4 circumstances where an Independent Mental Capacity Advocate would be used?
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
To whom does a Deprivation of Liberty apply to?
Only those people within a hospital or care home setting
For whom should a DNACPR be considered for?
All patients who may be at risk of cardio or respiratory arrest
What should you do in a patient or relative disagrees with a DNACPR?
You should offer a second opinion
What is Barthel index?
An outcome measure of functional independence in activities of daily living - based on a 3 point scale.
What score from the Barthel index suggests a poor prognosis for discharge home?
If the patient scores below 40
