Frailty and Common Conditions in Older People Flashcards

1
Q

Why is treating older adults different?

A
  • 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.
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2
Q

What are the CV physiological changes associated with ageing?

A
  • Reduced vascular compliance, increased systolic HTN, LVH and aortic sclerosis.
  • Reduced cardiac reserve.
  • Increased risk of arrhythmias.
  • Increased risk of postural HTN.
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3
Q

What are the respiratory physiological changes associated with ageing?

A
  • 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
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4
Q

What are the renal/GU physiological changes associated with ageing?

A
  • 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
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5
Q

What are the GI physiological changes associated with ageing?

A
  • 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
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6
Q

What are the MSK physiological changes associated with ageing?

A
  • Sarcopaenia
  • Bone loss
  • Reduced ligament and tendon strength
  • Increased risk of:
    • Osteoporosis
    • OA
    • Instability
    • Falls
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7
Q

What are the physiological changes to the nervous system associated with ageing?

A
  • Decreased neurons and neurotransmitters
  • Compromised thermoregulation
  • Risk of:
    • Reduced cognitive function
    • Delirium
    • Altered response to infection
    • Sleep disorders
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8
Q

What are the physiological changes to the immune system associated with ageing?

A
  • 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.
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9
Q

What are the other changes of aging? Include:

  • Cognitive decline
  • Functional decline
  • Social changes
  • Financial changes
  • Cultural / generational change
A
  • Cognitive decline
    • Forgetting to take tablets, drink fluids, eat meals, pass urine.
      • Can become dehydrated and malnourished.
  • 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.
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10
Q

Describe the atypical presentation of illness in older people.

A
  • 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
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11
Q

What are the causes of delayed presentation in the elderly?

A
  • Insidious onset
  • Felt to be a ‘normal part of ageing’
  • Reluctance to cause trouble
  • Communication issues
  • Lack of social support
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12
Q

Describe what often happens to frail patients in hospital.

A
  • 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
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13
Q

What are the essential things which must be brought with an elderly person when they are admitted to hospital?

A
  • Medications / list
  • ACP / POA paperwork
  • Personal belongings
    • Clothes / shoes
    • Dentures / glasses / hearing aids
    • Mobility aids
  • Collatera history
  • ‘Red bag’ scheme
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14
Q

What are the key factors in delirium prevention?

A
  • Identify risk factors
  • Orientation
  • Appropriate environment
  • Social / cognitive stimulation
  • Increase mobility
  • Avoid dehydration / constipation
  • Adequate nutrition / hydration
  • Pain management
  • Sensory impairment
  • Reduce sleep disturbance
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15
Q

What are the domains of comprehensive geriatric assessment?

A
  • Function and ability
  • Mental health and cognition
  • Disease severity and comorbidity
  • Support networks and needs
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16
Q

What are the 10 most implicated drugs in adverse drug events?

A
  • NSAIDs
  • Diuretics
  • Warfarin
  • ACE-I / ARB
  • Antidepressants
  • Beta-blockers
  • Digoxin
  • Prednisolone
  • Opiates
  • Clopidogrel
17
Q

What are the components needed for a patient to have capacity to make a decision?

A
  • 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.
18
Q

What is involved in anticipatory care planning?

A
  • ‘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.
19
Q

What are the components of a safe discharge home for an elderly person?

A
  • ‘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.