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IBSc PHEM Applied Science > Elderly People And Frailty > Flashcards

Elderly People And Frailty Flashcards

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1
Q

What percentage of trauma patients are over 65

A

52%

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2
Q

Most common mechanism of trauma in older people

A

Fail from <2m eg from standing

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3
Q

How does TBI present differently in older people

A

Often have higher GCS than younger people

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4
Q

Why may older pts recieve less specialist trauma care

A

Poor prehospital and ED identification of injuries as major trauma

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5
Q

Challenges for airway in older people

A

Damaged or missing teeth
Thin fragile lips
Inability to open mouth widely
TMJ disease
Arthritis
Oropharyngeal cancers
Shirt stiff neck
Thyroid masses

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6
Q

Why should there be high suspicion for cervical spine injuries in elderly pts

A

Pre existing degenerative spinal disease
May be alert and have normal neurology
X ray interpretation may be challenging due to degen disease

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7
Q

First line imaging modality for neck in elderly

A

CT

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8
Q

Complications of prolonged immobilisation in elderly

A

Pressure ulcers
Pneumonia
Respiratory failure
Dysphagia
Delirium
Raised ICP
Lying flat can worsen resp conditions

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9
Q

Imaging considerations for elderly trauma

A

Assessment imaging and image reporting within 2 hours
Movement restrictions clearly documented
Specialist esce,action for challenging interpretation of imaging

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10
Q

Breathing challenges in older people

A

Decr lung elastic recoil
Decr small airway calibre
Decr expiratory flow
Incr dynamic airway collapse
Decr chest wall compliance
Decr respiratory muscle strength
Decr gas exchange
Decr mucociliary clearance
Enlarged alveolar ducts and alveoli
Decr elastic fibres, incr cross linked collagen
Decr surfactant
Less effective cough
Incr WOB
Atrophy of resp muscles
Decr alveoli number
Diminished chemoreceptor response

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11
Q

What factors should trigger a trauma call and immediate consultant/reg review in a pt over 65 with an obvious injury or MOI

A

Sig injury to 2+ body regions
Suspected pelvic injury
Suspected head or spinal injury
Suspected chest injury
SBP <110
HR >90
GCS <15 even if baseline
Lactate >2 or BE <-2
On anticoagulants or has bleeding disorder
Severe pain
Acute SOB
Haemorrhage

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12
Q

Circulation challenges in older pt

A

Stiffened aorta and peripheral arteries
Incr peripheral vascular resistance
Incr LV thickness
Decr cardiac output
Conduction abnormalities
Less able to incr HR
Arrhythmias may cause a fall

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13
Q

Maximum heart rate at 20 and 60

A

20 194
60 162

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14
Q

Blunted tachycardia

A

Older trauma pt may lack compensatory tachycardia with hypervolaemia

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15
Q

Causes of blunted tachycardia in elderly

A

Catecholamine insensitivity
Athersclerosis
Myocyte fibrosis
Conduction abnormalities
Beta blockers
Calcium channel bLockers

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16
Q

Why are elderly more susceptible to subdural subarachnoid and intra ventricular haemorrhage

A

Fragile vessels
Shearing stresses
Anticoagulants
Expanded subarachnoid spaces

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17
Q

How does raised ICP presentation differ in elderly pts

A

Signs less likely to manifest due to brain atrophy
More blood can pool in haematoma or haemorrhage before signs

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18
Q

Why is it more difficult to identify intercranial injury in elderly

A

May not have hard neuro signs
Medication and comorbidities complicate
Less likely to manifest signs of raised ICP due to brain atrophy

19
Q

Environment/exposure considerations in elderly

A

Temp management
Pressure area care
Early imaging
Holistic approach
Lying flat can exacerbate resp condition
Environment without visual cues can bring on delirium

20
Q

What can prevent injuries being identified in elderly

A

Distracting injuries
Cognitive impairment, delirium, and communication issues can prevent reporting injury
Less likely to be seen by senior doctors
Less likely to get major trauma team, trauma CT or trigger major trauma pathways
Longer injury time to spdiscovery

21
Q

Considerations for analgesia and anaesthetics in elderly

A

May need smaller doses
Less cardiac output may mean drugs take longer to be circulated and have effect
Pain can trigger delirium

22
Q

Why do elderly people have ‘lower’ physiological boundaries for triage

A

Less ability to compensate means vital sign derangement may be blunted or absent
○ SBP <110 and
○ HR <90
○ GCS <15 even if baseline
○ Lactate >2 or BE <-2

23
Q

What can make assessment of pupils difficult in elderly

A

Blindness
Glass eyes

24
Q

Why are whole body scans usually better for elderly than selective scans

A

Less likely to miss injuries
Radiation exposure less likely to be important in elderly

25
Q

Considerations for contrast/non contrast scans

A

May have kidney issues
Contrast still indicated if bleed suspected

26
Q

What investigation should also be done if an elderly pt meets head CT criteria

A

Neck CT

27
Q

What condition can increase the change of trauma from minor mechanism

A

Osteoporosis

28
Q

Renal differences in elderly pt

A

Decr GFR
Decr drug clearance time
Diminished acid base balance control
Inefficient concentrating and diluting
Poor RAAS response

29
Q

Neurological changes in elderly

A

Decr brain size
Decr functioning neurones

30
Q

GI changes in elderly

A

Decr gut motility
Decr bowel absorbtion
Poor nutritional status
Decr body mass

31
Q

MSK differences in elderly

A

Decr bone mass and density
Stiffened ligaments and joints
Joint degeneration and cartilage thinning
Loss of muscle bulk and apsarcopenia
Disc degeneration

32
Q

Signs of occult haemorrhaged

A

HR >90
SBO <110
Lactate >2.5

33
Q

What medications may hide a normal shock response

A

Beta blockers
Anticoagulants
Steroids

34
Q

What comorbidities increase mortality

A

Renal impairment
Hepatic impairment
Chronic steroid use
Previous malignancy

35
Q

Why is there a higher risk of SDH in elderly

A

Brain atrophy widens subdural compartment, stretching bridging cortical veins making them more susceptible to shearing injury

36
Q

Increased intracranial bleeding risk factors in elderly

A

Fragility of vessels
Hypertension
Amyloid angioplasty
Haematological conditions
Alcohol
Anticoagulant use

37
Q

Spinal changes in elderly

A

Osteoporosis
Incr spinal rigidity
Spinal injury often multi level
Spinal canal stenosis
Spinal conditions may incr rigidity of mid/lower c spine, and incr mobility of superior c spine

38
Q

Most common sites of spinal injury in elderly

A

C1 on c2
Thoracolumbar junction T12-L2

39
Q

What condition is a major risk factor for vertebral compression fractures

A

Osteoporosis
Common in post menopausal women

40
Q

Why is there increased mortality for blunt thoracic trauma in elderly

A

Finished physiological reserve
Resp compromise
Incr susceptibility to infections

41
Q

Which pelvic fractures are more common in the elderly

A

Lateral compression more common than anterior posterior compression fractures
Opposite to normal pattern in younger people

42
Q

Fracture types more common in elderly

A

Pathological fractures
Peri prosthetic fractures

43
Q

What features specific to elderly care should be assessed in all elderly trauma

A

Cognition
Anticoagulation status
Frailty
Treatment escalation plan

IBSc PHEM Applied Science (21 decks)

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