Geriatric assessment

Question 1

what theories may be applied to reasons for ageing

Answer 1

DNA damage
free radical theory
telomeres and the hayflick limit
cross link theory

Question 2

what is the hayflick limit

Answer 2

number of times a cell can divide before division ceases

multiple repeats of a motif at the end of a chromosome that form a loop

Question 3

what is the cross link theory of ageing

Answer 3

tendons, skin and blood vessels lose elasticity

Question 4

what is the disposable soma hypothesis

Answer 4

repair and maintenance of a body takes energy and resource

after reproduction there is little evolutionary value in maintaining and repairing the body

Question 5

what is frailty

Answer 5

loss of homeostasis and resilience

increased vulnerability to decompensation ie minor illness can lead to significant deterioration in functioning

Question 6

is multimorbidity the same thing as frailty

Answer 6

no, multimorbidity leads to higher rates of adverse events and poorer QOL but multimorbid pts can be resilient

Question 7

types of elder abuse?

Answer 7

financial, verbal, sexual, physical

Question 8

what is a comprehensive geriatric assessment

Answer 8

problem list
objectives of care
management plan
review

Question 9

components of CGA

Answer 9

medical
psychological
spiritual
social functioning

Question 10

aspects of medical component CGA

Answer 10

problem list
comorbidity
medication review
nutrition status

Question 11

aspects of functioning component CGA

Answer 11

basic/extended ADLs
activity and exercise status
gait and balance

Question 12

aspects of psychological component CGA

Answer 12

mental status and cognitive functioning

mood and depression testing

Question 13

aspects of social component CGA

Answer 13

informal needs
social circle
care resource eligibility
safety at home

Question 14

where should CGA be delivered

Answer 14

MDT assessment in hospital has best evidence based care

Question 15

how may acute illness differ in an elderly patient

Answer 15

atypical or masked presentation
pathophysiology varies
investigations and management need tailored
consider comorbidity
review medication and justify the need for further medication

Question 16

may may an MI present more atypically in those who are more elderly

Answer 16

SOB
delirium
dizziness
collapse

Question 17

how may sepsis pathophysiology and presentation differ in the elderly

Answer 17

BP may drop earlier, esp if on vasodilating antiHTN
tachy may be absent 
low/normal temp
needs targeted abx for c diff risk 
CRP/WCC may be normal or rise minimally