Geriatric Assessment

Question 1

describe the use of a problem list in geriatric assessment?

Answer 1

comprehensive list of all problems (including non-medical) rather than differential diagnoses as most likely several things at play
allows agreement of objectives of care and then an individual management plan

Question 2

what are the 4 components of geriatric assessment?

Answer 2

medical
functioning (ADLs, activity/balance etc)
psychological
social/environmental (needs, social circle, safety etc)

Question 3

what are ADLs?

Answer 3

activities of daily living

Question 4

frailty syndromes?

Answer 4

off legs (poor mobility)
falls
confusion
continence issues
polypharmacy

Question 5

what is NNT?

Answer 5

number needed to treat

e.g - NNT: 33 = for every 33 people treated with comprehensive geriatric assessment, 1 person avoids needing a care home

Question 6

what is polypharmacy?

Answer 6

patient taking several medications

counts as a problem on problem list

Question 7

common cause of rapid weight loss in confused patients?

Answer 7

dehydration
confused patients have inability to access water or thirst reflex
dehydration therefore usually at the top of problem list

Question 8

how may acute illness present differently in elederly?

Answer 8

pathophysiology may differ
immune response may differ (disease/drugs/nutrition)
co-morbidities
medication always needs to be reviewed

Question 9

how can an MI differ in elderly?

Answer 9

no chest pain in 1/3
collapse
dizziness
delirium
breathless

Question 10

MI investigations in elderly?

Answer 10

ECG
blood tests
angiogram may not be possible depending on comorbidities

Question 11

MI management in elderly?

Answer 11

anti-platelets may not be appropriate (haemorrhagic stroke/upper GI bleed risk)
beta blockers/ace inhibitors etc may reduce blood pressure too much causing falls
side effects of statins must be managed

Question 12

how does sepsis pathophysiology differ in elderly?

Answer 12

BP can drop early (esp if taking vasodilating BP meds - ACE)
temp low, not high
no tachycardic response
can have delirium (blood not getting to the brain)
CRP/WCC might not rise (or not much)
difficult fluid balance (due to heart failure)
need targeted antibiotics (higher risk of C.Diff)

Question 13

vasodilating antihypertensives?

Answer 13

ACE inhibitors
CCBs
nitrates
ARBs
GTN
doxasosin

Question 14

4 Cs?

Answer 14

ciprofloxacin
clindamycin
co-amoxiclav
cephlasporins

Question 15

how may constipation present in elderly?

Answer 15

compression of bladder leading to overflow and urinary retention/incontinence
can cause confusion