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Yr3 Medicine- Geriatrics > General Geriatrics > Flashcards

General Geriatrics Flashcards

1
Q

Explain how biological ageing is different to chronological ageing

A
  • Chronological age is about the number (i.e. ageing is based on how old you are- the number)
  • Whereas biological ageing is ths idea that people are affected differently by ageing due to many factors
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2
Q

State some terms you should avoid using in geriatrics

A
  • Poor historian
  • Acopia
  • Mechanical fall (all falls are mechanical- you need to identify underlying cause)
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3
Q

What do you need to find out when taking the history for an elderly patient?

A
  • Current reason for admission
  • Assessment of cognition (may involve collateral history to see if there is any change)
  • Continence assessment- bowels & bladder
  • PMH and disease severity
  • Current medication list and compliance
  • Drug allergies
  • Social & funcitonal history:
    • Where they live
    • What aids they have
    • How are they supported and by whom
    • Who performs tasks e.g. cleaning & shopping
    • Do they have any adaptations or safety features in home
    • Do they have formalised care package
  • Alcohol intake
  • Smoking history
  • Further systemic enquiry
  • Enquire about wishes and advance decisions regarding care if appropriate
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4
Q

What is the comprehensive geriatric assessment (CGA)?

A

Multidimensional, interdisciplinary diagnostic process to determine the medical, psychological and functional capabilities of a frail older person in order to develop a coordinated and integrated plan for treatment and long term follow up.

*It emphasises quality of life and functional status, prognosis and outcome

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5
Q

State some domains of the comprehensive geriatric assessment (CGA)

*Poor Frail Elderly Men Need More Sugar

A
  • Problem list: current & past
  • Medication review
  • Nutritional status
  • Mental health: cognition, mood, anxiety and fears
  • Functional capacity: basic acitivities of daily living, gait & balance, activity/exercise status, instrumental activities of dialy living
  • Social circumstances: informal support available from family or friends, social network such as visitors or daytime activites, eligibility for offered care resources
  • Environment: home environment, facilities and safety within home, transport faciliites, accessiblity to local resources
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6
Q

What members of MDT does CGA usually involve

A
  • Geriatrician
  • Nurse specialist
  • Occupational therapist
  • Physiotherapist
  • Pharmacist
  • Others e.g. speech & language, dietician etc..
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7
Q

Why do we use CGA in clinical practise/what are the benefits?

A

Improves outcomes for elderly people including:

  • Reduced readmissions
  • Reduced long term care
  • Greater patient satisfaction
  • Lower costs
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8
Q

What is meant by frailty?

A

“A medical syndrome with multiple causes and contributors that is characterised by diminished strength, endurance and reduced physiological function that increases an individuals vulnerability for developing increased dependeny and/or death.”

Age related decline in physical and mental resilience/reserve which makes a pt vulnerable to adverse health outcomes

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9
Q

State two methods which are widely used to screen for frailty

A
  • Fried frailty phenotype
  • The frailty index
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10
Q

Explain how the Fried Frailty Phenotype is used to screen for frailty

A

Assess how many of the 5 elements (see below) a pt has:

  • Unintentional weight loss
  • Self-reported exhaustion
  • Weakness (grip strength)
  • Slow walking speed
  • Low physical activity

Present with none= not frail

Present with one or two= pre-frail

Present with three or more= frail

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11
Q

Describe the 9 stages of the Rockwood Clinical Frailty Scale

A
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12
Q

Who should we be assessing for frailty?

A
  • Patients who present with a frailty syndrome:
    • Falls
    • Delerium & dementia
    • Immobility (including pressure sores)
    • Polypharmacy
    • End of life
    • Incontinence
  • Patients from a nursing home
  • Consider in everyone >85yrs old
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13
Q

Iatrogenic problems are uncommon in the elderly; true or false?

A

False- iatrogenic problems are common in the elderly (a lot of elderly pts have lots of medications [polypharmacy])

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14
Q

What is meant by polypharmacy?

A

6 or more medications that are prescribed at any one time

*NOTE: there is no specific agreed amount as to what constitues polypharmacy: generally say about 4-6+ medications

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15
Q

The choice of drug, dose, the side effect profile and interactions of drugs are considerably different in elderly people; true or false

A

True; we must think carefully about the medications,a dn the doses, given to elderly people are the side effects and interactions can be different in the elderly compared to in the young

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16
Q

Why are medication reviews important?

A
  • Ensure pt is on most effective/suitable drug for them
  • Ensure they aren’t taking uncessary drugs
  • Economy reasons
  • DDIs
17
Q

What should you consider in a medication review/what must be checked?

A
  • Is the medication right for the pt
  • Is the pt taking any time limited medications e.g. clopidogrel or GORD treatment
  • Age life expectancy and risk-benefit
  • Is medication effective
  • Cost
  • Appropriate tests to support decisions
  • Drug interactions
  • Side effects
  • Non-adherence
  • Over counter & supplementary medictions
  • Lifestyle modifications
18
Q

What is the STOPP START tool?

A

Screening tool of older people’s prescriptions

and

screening tool to alert right treament

To be used in pts who are 65yrs or over to highlight and prevent inappropriate prescribing and to reduced DDIS and/or ADRs.

19
Q

Older people often have signs & symptoms which are different to those normally expected; true or false?

A

True; this could include hypothermia rather than a fever and a change in their consciousness e.g. hypervigilentn or withdrawn

20
Q

Is there such diagnosis as a social admission?

A

NO; if this is documented it means you’ve not identifed the problem

21
Q

What is discharge planning and what is the purpose of discharge planning?

A
  • Health and social care professionals, together with service users and their families and/or carers, agree care pathways for the elderly person e.g. be this sending them home with a package of care, sending them to rehabilitiation, sending them to a care home. These care pathways should maximise the quality of life, pts/families wishes and independent living.
  • Main aims are to:
    • Reduce person’s length of stay in hospital
    • Prevent unplanned readmission
    • Improve coordination between community services following discharge
22
Q

Discuss- very briefly- how funding for care homes, care packages etc works…

A

In most cases a referral is made to social services to assess for funding; this funding could:

  • Go straight to care home
  • Be made as direct payments to the individual and they can use this money to buy the personal assistance they require
  • Be used to buy a package of care

The process of applying for funding is known as a section 2. A social worker is the allocated to patient/service user and will be responsible for putting together an appropriate package of care.

23
Q

Once a pt is medically stable for discharge nursing staff will send a section ____ to social services.

What must social worker do once they receive a section ___?

A
  • Section 5
  • Social worker is expected to start taking decisive action towards discharge; social services incur a financial penalty if they are responsible for delayed discharge
24
Q

State some examples of what is involved in the discharge of an elderly pt

A
  • Medication to take home (TTO’s)
  • Transport
  • Equipment delivery or adaptions to home if required
  • Therapy assessment (ongoing referall to community occuational therapy or physiotherapy if required)
  • Starting or restarting package of care
  • Outpatient/users appointment
  • District nurse referral if required
  • Palliative care referral if required
  • Transfer back letter for residential/nursing home
25
Q

Suggest some reasons why a discharge might fail

A
  • Not obtained a suitable care package
  • Patient health complications
  • Communication breakdwon between health care professionals and social services
  • Family decisions
  • Decisions around funding

Yr3 Medicine- Geriatrics (8 decks)

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