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Geriatrics > Frailty/ Falls/ Delirium/ Incontinence > Flashcards

Frailty/ Falls/ Delirium/ Incontinence Flashcards

1
Q

What is frailty?

A

A susceptibility state that leads to a person being more likely to lose function in the face of a given environmental challenge

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2
Q

Why are people living longer?

A
  • Increased resources available
  • Better economic conditions
  • Improved screening programmes with earlier diagnosis and treatment
  • Better outcomes following major events
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3
Q

What functions are reduced in aging?

A
  • Reduced baroreflex sensitivity in the elderly
  • Reduced peripheral vasoconstriction
  • Reduced metabolic heat production
  • Reduced sweat gland output
  • Reduced skin blood flow
  • Smaller increase in cardiac output
  • Less redistribution of blood flow from renal and splanchnic circulations
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4
Q

What are the results of frailty syndromes?

A
  • Falls
  • Delirium
  • Immobility
  • Incontinence
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5
Q

What are the extrinsic factors involved in incontinence?

A
  • Physical state and co-morbidities
  • Reduced mobility
  • Confusion
  • Drinking too much or at the wrong time
  • Medications
  • Home circumstances
  • Social circumstances
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6
Q

What are the functions of the bladder?

A

Urine storage
- Involves detrusor muscle relaxation with filling (>10cm pressure) to normal volume 400-600ml combined with sphincter contraction

Voluntary Voiding
- Involves voluntary relaxation of external sphincter and involuntary relaxation of internal sphincter and contraction of bladder

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7
Q

What causes stress incontinence?

A

Bladder outlet too weak

Weak pelvic floor muscles

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8
Q

What are the symptoms of stress incontinence?

A

Urine leak on movement, coughing, laughing, squatting

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9
Q

When is stress incontinence common?

A

Common in women with children, especially after menopause

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10
Q

What are the treatment options for stress incontinence?

A

Treatments include physiotherapy, oestrogen cream and duloxetine
– Surgical option – TVT/colposuspension 90% cure at 10 years

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11
Q

What causes urinary retention with overflow incontinence?

A

Bladder outlet too strong

Older men with BPH

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12
Q

What are the characteristic features of urinary retention with overflow incontinence?

A

Poor urine flow, double voiding, hesitancy, post micturition dribbling

Blockage to urethra

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13
Q

What causes urge incontinence?

A

Bladder muscle too strong

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14
Q

What are the features of urge incontinence?

A

Detrusor contracts at low volumes
Sudden urge to pass urine immediately
Can be caused by bladder stones or stroke

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15
Q

What is the treatment of urge incontinence?

A

Treat with anti-muscarinics (relax detrusor)
e.g. oxybutinin, tolterodine, solifenacin
– Bladder re-training sometimes helpful

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16
Q

What groups of drugs are used to relax detrusor muscle?

A

Antimuscarinics (relax detrusor)
– oxybutinin, tolterodine, solifenacin, trospium
• Beta-3 adrenoceptor agonists (relax detrusor)
– mirabegron
• Alpha-blockers (relax sphincter, bladder neck)
– tamsulosin, terazosin, indoramin
• Anti-androgen drugs (shrink prostate)
– finasteride, dutasteride

17
Q

What casues a neuropathic bladder?

A

Under active bladder muscle
Leave a catheter in too long
No awareness of bladder filling resulting in overflow incontinence

18
Q

What is the only effective treatment of a neuropathic bladder?

A

Catheterisation

19
Q

When is a referal for incontinence needed at onset?

A
  • Referral necessary at onset
    • Vesico-vaginal fistula
    • Palpable bladder after micturition or confirmed large residual volume of urine after micturition
    • Disease of the CNS
    • Certain gynaecological conditions (e.g. fibroids, procidentia, rectocele)
    • Severe benign prostatic hypertrophy or prostatic carcinoma
    • Patients who have had previous surgery for continence problems
    • Others in whom a diagnosis has not been made
    • Faecal incontinence
      – Referral after failure of initial management:
      • Constipation or diarrhoea with normal sphincter
      – Referral necessary at onset:
      • Suspected sphincter damage
      • Neurological disease
20
Q

What is delirium?

A

Disturbed consciousness: hypoactive/ hyperactive/ mixed
Change in cognition: memory/ perceptual/ language/ illusions/ hallucinations
Acute onset and fluctuate

21
Q

How common is Delirium?

A

20-30% of all in patients

22
Q

What factors may precipitate delirium?

A 
Infection (but not always a UTI!) 
• Dehydration 
• Biochemical disturbance 
• Pain 
• Drugs 
• Constipation/Urinary retention 
• Hypoxia 
• Alcohol/drug withdrawal 
• Sleep disturbance 
• Brain injury
• Stroke/tumour/bleed etc 
• Changes in environment/emotional distress 
• Sometimes no idea and often multiple triggers
23
Q

What is the 4AT score?

A
  1. Alertness
  2. AMT
  3. Attention
  4. Acute change or fluctuating course
24
Q

When is drug treatment of deliruim indicated?

A

Only if danger to themselves or others or distress which cannot be settled in any other way

THIS SHOULD BE A CONSULTANT DECISION

25
Q

How can delirium be prevented?

A

Orientation and ensuring patients have their glasses and hearing aids
Promoting sleep hygiene
Early mobilisation
Pain control
Prevention, early identification and treatment of postoperative complications
Maintaining optimal hydration and nutrition

26
Q

What is the association between delirium and falls?

A

4.5x more likely to fall if have delirium

Delirium prevention interventions reduce falls also

27
Q

What drugs may cause falls in the elderly?

A 
Antihypertensive
Beta blocker
Sedatives
Anticholinergics
Opioids
Alcohol
28
Q

What aspects to a fall have to be asked about in a fall history?

A

Collapse with no memory: syncope or congestion
Clear history of trip: eyes, nerves
Palpitations preceding fall and no trip: think cardiac
On turning: postural instability: peripheral neuropathy
Any near misses: unsteady on standing
Syncope on exertion: aortic stenosis

29
Q

How should a fallen patient be assessed?

A

ABCDE approach • Check glucose • Top to toe survey

30
Q

When should a CT head be requested?

A

Low GCS <13 • Still confused after 2 hours (or not back to baseline cognitive state) • Focal neurology • Signs of skull fracture • Basal skull fracture – CSF leak, bruising around eyes, • Seizure • Vomiting • Anti-coagualtion

Geriatrics (1 decks)

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