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Y4 OPIC > General Geriatrics > Flashcards

General Geriatrics Flashcards

1
Q

Common causes of constipation in the elderly?

A

Dehydration
Diabetes
Low fibre intake
Immobility
IBS
Hypothyroidism
Hypercalcemia
Neurological- Stroke, Parkinson’s
Colorectal cancer
Rectal prolapse

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2
Q

How is constipation diagnosed?

A

ROME IV Criteria

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3
Q

How should hard v soft stool impaction be managed?

A

hard- stool softeners, osmotic laxatives (e.g. lactulose/movicol), enemas

soft- stimulant laxatives e.g. senna

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4
Q

Faecal incontinence in the elderly is always abnormal and usually curable. What is it most commonly caused by?

A

faecal impaction with overflow diarrhoea. This accounts for 50% of faecal incontinence. The second most common cause is neurogenic dysfunction

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5
Q

What increases risk of incontinence?

A

Older female
Obesity
Previous pregnancy
Prolapse
Smoking - chronic cough = strain
Constipation = strain
Neurological dysfunction
Medications

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6
Q

What are the key components of a continence exam?

A

Review of bladder and bowel diary
Urine dipstick and MSU
A post micturition bladder scan
Abdominal examination and PR exam
External genitalia review particularly looking for atrophic vaginitis in females

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7
Q

Non pharmacological interventions for incontinence?

A

Switch to decaff drinks
Improve bowel habit
Regular toileting
Pelvic floor exercises

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8
Q

Common drugs for treating overactive bladder?

A

Mirabegron
Oxybutinin
Tolterodine

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9
Q

The MUST score is used to assess patients at risk of malnutrition. What are its 3 components?

A

current BMI,
history of unintentional weight loss,
likelihood of future weight loss

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10
Q

what does NICE recommend for the management of malnutrition?

A

dietician support if the patient is at high-risk

a food-first approach with clear instructions rather than simply prescribing oral nutritional supplements

if supplements are used they should be taken between meals rather than instead of meals

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11
Q

what are the 4 stages of wound healing?

A

hemostasis,
inflammation,
proliferation,
remodelling

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12
Q

Define ‘feed at risk’

What discussions should be had about this?

A

When a patient can choose to continue eating and drinking despite known risk of aspiration

Discuss signs of aspiration and what to do in case of aspiration with family
Give choking advice

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13
Q

What is the evidence for enteral feeding in dementia?

A

Only to be used in acute illness

No evidence of increased life span and increased risk of aspiration and infection

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14
Q

Define delirium.
How do you assess for it?

A

Acute and fluctuating changes to consciousness, cognition or perception

4AT score

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15
Q

What percentage of elderly patients, admitted to hospital, are affected by acute confusional state (delirium)?

A

up to 30%

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16
Q

What are the risk factors for developing delirium (or acute confusional state) ?

A

age > 65 years
background of dementia
significant injury e.g. hip fracture
frailty or multimorbidity
polypharmacy

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17
Q

How can delirium be categorised?

A

hyperactive (agitated and confused), hypoactive
(withdrawn and drowsy) or mixed.

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18
Q

What are the main causes of delirium?

A

PINCH ME

Pain
Infection: esp UTIs
Nutrition: hypo/hyperglycaemia, consider metabolic issues e..g hypercalcaemia
Constipation : consider constipating medications e.g. codeine and ondansetron
Hydration: dehydration, alcohol withdrawal
Medication
Environment: change of environment

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19
Q

What factors favour delirium over dementia as a diagnosis?

A

impairment of consciousness
fluctuation of symptoms: worse at night, periods of normality
abnormal perception (e.g. hallucinations and delusions)
agitation, fear

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20
Q

Examinations in acute confusion?

A

Check for signs of hypoxia
Fluid balance
Mini mental state examination

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21
Q

How do you carry out a fluid balance assessment?

A

Fluid intake and urine output
Cap refill
Pulses and JVP
BP
Skin turgor
Check mucous membranes

22
Q

Investigations in acute confusion ?

A

Confusion screen bloods
Urine dip (infection)
ECG
CT head

23
Q

What is involved in a ‘confusion screen’ bloods and why?

A

Glucose: hypoglycaemia can commonly cause confusion
Bone Profile (Calcium): hypercalcaemia can cause confusion
B12/folate: macrocytic anaemias, B12/folate deficiency worsen confusion
TFTs: confusion is more commonly seen in hypothyroidism

24
Q

How is delirium managed?

A

Tx underlying cause, modify environment, try haloperidol 0.5 mg
(unless pt has Parkinsonism in which case lorazepam 0.5mg )

25
Q

What non pharmacological interventions can help with delirium?

A

Reassurance
Consistency
Orientation – clock, pictures, talking, stimulate, family
Avoid transfer between wards / less moves
Minimise sensory deprivation/overload – ear wax, hearing aids
Safe wandering
Sleep hygiene – scheduled med rounds, overnight interventions

26
Q

What are the complications associated with delirium?

A

increased mortality, prolonged hospital admission, higher complication rates, institutionalisation and increased risk of developing dementia

27
Q

What is the GPCOG test?

A

a test designed as a GP screening tool for dementia

28
Q

Give some risk factors for multi-morbidity

A

increasing age
Female sex
Low socioeconomic status
Tobacco and alcohol usage
Lack of physical activity
Poor nutrition and obesity

29
Q

What is the most common comorbid condition?

A

Hypertension

30
Q

Define fraility.

How should it be assessed?

A

Frailty is defined as a state of impaired homeostasis leading to increased vulnerability to minor stressor events.

through the evaluation of gait speed, self-reported health status, or the PRISMA-7 questionnaire

31
Q

What topics are covered in the PRISMA-7 questionnaire?

A

age,
sex,
health problems,
help at home,
mobility,
social support

32
Q

Give some physical manifestations of frailty

A

Sarcopenia- loss of skeletal muscle, fat mass may be preserved
Unintentional weight loss- disease, ill fitting dentures, inability to make or eat meals
Fatigue

33
Q

What is the clinical frailty scale? How is it helpful?

A

Set of 9 phenotypes ranging from very fit to terminally ill which can be used to summarise the older patient’s overall level of fitness or frailty and predict outcomes of survival/prognosticate

34
Q

What is a CGA?

A

comprehensive geriatric assessment —> Multidimensional, interdisciplinary diagnostic processes to determine the medical, psychological and functional capabilities of frail older people to develop a coordinated & integrated plan for treatment and long-term follow up

35
Q

What are the domains of a CGA? (7)

A

Problem list – current and past
Medication review
Nutritional status
Mental health – cognition, mood and anxiety, fears
Functional capacity - basic activities of daily living , gait and balance, exercise status
Social circumstances
Environment - home environment, facilities and safety within the home, accessibility to local resources

36
Q

What are some tools that can be used to see how well a patient is coping with their ADLs?

A
  • Barthel Index
  • Nottingham Extended activities of daily living
37
Q

What are the “geriatric giants”?

A

Immobility
Instability/falls
Incontinence
Impaired memory (dementia, delirium)
Iatrogenesis

38
Q

What is the Waterlow score?

A

Used to identify patients at risk of pressure sores

39
Q

what factors increase the risk of pressure ulcers?

A

malnourishment,
incontinence,
lack of mobility,
pain

40
Q

Outline grades 1-4 of pressure sores

A
41
Q

Outline the management of pressure ulcers

A

hydrocolloid dressings and hydrogel to provide a moist wound environment to encourage healing

wound swabs taken routinely

consider referral to the tissue viability nurse

surgical debridement for selected wounds

42
Q

Which tool is used to assess the risk of stroke in the short term post TIA?

A

The ABCD2 score

The ABCD2 score is calculated by summing up the points for five different factors including age, blood pressure, clinical features, duration of symptoms and the presence of diabetes. ABCD2>=4 indicates a higher risk.

43
Q

Give some indications that a patient is reaching the end of life

A

Bed bound.
Semi-comatose.
Only able to take sips of fluid.
Unable to take medicine orally

44
Q

4 medications used in palliative care?

A

opioid e.g. morphine
anti-emetic
anti-secretory - glycopyrronium
sedation - benzodiazepine

45
Q

Outline the concept of polypharmacy and how to approach prescribing in the elderly

A

Polypharmacy is the concurrent use of multiple medications. Polypharmacy in advancing age frequently results in drug therapy problems related to interactions, drug toxicity, falls with injury, delirium, and nonadherence. It is associated with increased hospitalizations and higher costs of care.

Reduce dose- often start at 50% of the adult dose
Review regularly (can use STOPP START)
Give clear instructions

46
Q

What can Trimethoprim do to the kidneys in the elderly population?

A

False AKI

Transient rise in creatinine levels by reducing the creatinine excretion of the kidneys. This does NOT reflect the actual GFR and therefore this phenomenon is not reflective of an Acute kidney injury but rather the calculated eGFR

47
Q

A patient is struggling after constantly worrying about their spouse with dementia. What is this often called?

How should it be managed?

A

Carer strain
Refer to social services

48
Q

What are the symptoms of carer strain?

A

Frustration,
Self neglect,
Isolation from other relationships

49
Q

What percent of carers in England have suffered from carer strain?

A

75%

50
Q

Give an example of a sequence task that an occupational therapist may assess

A

Washing and dressing oneself

51
Q

What does the term safeguarding describe?

A

Measures to protect the health, well-being and human rights of individuals which allow people to live free from abuse, harm and neglect

Y4 OPIC (7 decks)

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