Frailty and Common Conditions in Older People Flashcards
Why is treating older adults different?
- Age-associated changes are most pronounced after 85.
- Altered response to illness.
- Very variable.
- Impacted by genetics and lifestyle factors.
- Presentation and response to treatment are altered.
What are the CV physiological changes associated with ageing?
- Reduced vascular compliance, increased systolic HTN, LVH and aortic sclerosis.
- Reduced cardiac reserve.
- Increased risk of arrhythmias.
- Increased risk of postural HTN.
What are the respiratory physiological changes associated with ageing?
- Reduced lung compliance
- Stiffer, therefore reduced exercise tolerance
- Reduced immune function
- More prone to infection
- Reduced cough reflex
- Reduced response to hypoxia / hypercapnia
- Results in reduced respiratory reserve
- Increased risk of infection and bronchospasm
What are the renal/GU physiological changes associated with ageing?
- Reduced renal mass and blood flow - reduced GFR.
- Reduced bladder capacity
- Increased nocturia
- Prostatic enlargement
- Increased risk of:
- AKI (↓ renal clearance)
- Adverse drug reactions volume overload
- Bladder dysfunction
- UTI
- Nocturia
What are the GI physiological changes associated with ageing?
- Reduced gastric motility
- Atrophy of mucosa
- Malabsorption - B12, Vitamin D, folic acid, calcium
- Reduced liver function
- Decreased drug metabolism
- Dental problems
- Increased risk of nutritional problems
What are the MSK physiological changes associated with ageing?
- Sarcopaenia
- Bone loss
- Reduced ligament and tendon strength
- Increased risk of:
- Osteoporosis
- OA
- Instability
- Falls
What are the physiological changes to the nervous system associated with ageing?
- Decreased neurons and neurotransmitters
- Compromised thermoregulation
- Risk of:
- Reduced cognitive function
- Delirium
- Altered response to infection
- Sleep disorders
What are the physiological changes to the immune system associated with ageing?
- Immune dysfunction which leads to increased susceptibility to infection, reduced efficacy of vaccination.
- It is of high importance that older people are vaccinated due to their higher risk of infection.
What are the other changes of aging? Include:
- Cognitive decline
- Functional decline
- Social changes
- Financial changes
- Cultural / generational change
- Cognitive decline
- Forgetting to take tablets, drink fluids, eat meals, pass urine.
- Can become dehydrated and malnourished.
- Forgetting to take tablets, drink fluids, eat meals, pass urine.
- Functional decline
- Unable to exercise, relieve pressure, open pill packets.
- Social changes
- Loss of spouses / nearby relatives.
- Financial changes
- Impact on heating, hot water, food, access to other activities and services.
- Cultural / generational change
- ‘Stigma’ attached to illness, psychological illness, some infections.
Describe the atypical presentation of illness in older people.
- Increased risk in:
- >85s
- Multiple comorbidity
- Polypharmacy
- Cognitive impairment
- Functional impairment
- Results in:
- Late presentation
- Increased morbidity and mortality
- Incresed unscheduled admissions
- Examples:
- Frailty syndromes
- Low mood vs. cognitive impairment
- Infection without fever or raised inflammatory markers
- ‘Silent’ MI
- Pulmonary oedema without SOB
- Paradoxical presentation of thyroid disease
What are the causes of delayed presentation in the elderly?
- Insidious onset
- Felt to be a ‘normal part of ageing’
- Reluctance to cause trouble
- Communication issues
- Lack of social support
Describe what often happens to frail patients in hospital.
- Admissions are often unplanned.
- More susceptible to:
- HAI
- Delirium
- Poor nutrition / dehydration
- Pressure ulcers
- More likely to have adverse outcomes:
- Longer stays
- Readmissions
- Mortality
- Transfer to residential care
What are the essential things which must be brought with an elderly person when they are admitted to hospital?
- Medications / list
- ACP / POA paperwork
- Personal belongings
- Clothes / shoes
- Dentures / glasses / hearing aids
- Mobility aids
- Collatera history
- ‘Red bag’ scheme
What are the key factors in delirium prevention?
- Identify risk factors
- Orientation
- Appropriate environment
- Social / cognitive stimulation
- Increase mobility
- Avoid dehydration / constipation
- Adequate nutrition / hydration
- Pain management
- Sensory impairment
- Reduce sleep disturbance
What are the domains of comprehensive geriatric assessment?
- Function and ability
- Mental health and cognition
- Disease severity and comorbidity
- Support networks and needs
What are the 10 most implicated drugs in adverse drug events?
- NSAIDs
- Diuretics
- Warfarin
- ACE-I / ARB
- Antidepressants
- Beta-blockers
- Digoxin
- Prednisolone
- Opiates
- Clopidogrel
What are the components needed for a patient to have capacity to make a decision?
- Understand information about decision
- Remember the information
- Process the information to make a decision
- Communicate their decision
- Situation specific
- Can fluctuate and change
- Some patients have more lucid periods - many are okay in the morning but by the evening are very confused.
What is involved in anticipatory care planning?
- ‘Thinking ahead’ for care.
- Working with person to plan treatment goals.
- Ensure the right thing is done at the right time by the right people.
- Manage change.
- Prevent illness.
- Promote quality of life.
- Consider DNA CPR.
What are the components of a safe discharge home for an elderly person?
- ‘Well enough to be at home’.
- Medications
- Including aids (dosette box, prompts etc.).
- Physical environment.
- Social support
- Includes friends, family, local services, third sector.
- Carer support
- Formal carers, informal carers.
- Support for carers.
- Smart technology.
