Geriatric ILOs Flashcards
Give 4 causes of immobility (DAME)
Drugs
Age
Medical conditions
Environmental
Give points to be asked in an immobility Hx using SPLATT
Symptoms Previous fall Location Activity Time Trauma?
Give 4 systems to examine when someone is immobile
CVS
Neurological
MSK
Vision
Give 4 causes of falls
Dementia
Frailty
Vision defect
Environment e.g. poor lighting
Give 3 investigations for falls
Systems examinations
AMT4
Medication review
Give 3 consequences of falls
Injury e.g. haemorrhage
Immobility e.g. muscle loss
Depression
Give 3 causes of faecal incontinence
Structural abnormality
Neurology e.g. MS
Overflow
Give 3 risks for faecal incontinence
Female
Age
Nursing home resident
Give 3 management options for faecal incontinence
Dietary advice
Laxatives
Irrigation
Give 3 causes of urinary incontinence
Stress (weak muscles)
Pelvic floor damage
Enlarged prostate
Give 3 risks of urinary incontinence
Age
Pregnancy
Obesity
Give 3 investigations for urinary incontinence
Urinalysis
Cystoscopy
Urodynamic tests
Give 3 treatment options for urinary incontinence
Alpha agonists
Pelvic floor exercise
Surgery
Define delirium
Acute, fluctuating change in mental status. Classed as hypoactive, hyperactive or mixed
Give 4 causes of delirium
- Infection
- Polypharmacy
- Drugs
- Electrolyte imbalance
Give 2 symptoms of hypoactive and hyperactive delirium
Hypo: lethargy, decreased motor activity
Hyper: restlessness, hallucinations
Give 2 non-pharmacological and 2 pharmacological Tx for delirium
- Talk to pt. calmly
- Ensure pt. has hearing aid/glasses
- Haloperidol
- Lorazepam
Define dementia
Deterioration in cognition = behavioural problems and impairment in activities of daily living
Give the functions of each of the 4 domains in the brain
Frontal: executive function/language
Parietal: visuospatial function
Temporal: memory/language
Occipital: visual processing
In dementia, where are neurons usually lost from first?
Temporal lobe, then parietal and frontal
Outline the cause of Alzheimer’s and give one treatment
Accumulation of beta-amyloid peptide = neurofibrillary tangles/amyloid plaque and loss of acetylcholine
Tx: Acetylcholinesterase inhibitor e.g. Donepezil
What is vascular dementia?
Any dementia caused by cerebrovascular disease or impaired blood flow of sudden onset
Give 3 symptoms of Lewy body dementia and how is it diagnosed
- Visual hallucinations
- Parkinsomism
- Dysautonomia
Clinical Dx
Give 2 causes and 2 symptoms of fronto-temporal dementia
Pick’s disease + HIV
Disinhibition + Apathy
Define sarcopenia and give 2 causes
A major component of frailty, the loss of skeletal muscle mass and strength as a result of ageing
- Motor neuron loss
- Disuse e.g. immobility
What is the gold standard test for muscle mass assessment in sarcopenia?
CT/MRI
Give 2 management options for sarcopenia
Increased protein intake
Vitamin D supplement
List the symptoms of depression using SIGECAPS
Sleep disorder Interest deficit Guilt Energy deficit Concentration deficit Appetite disorder Psychomotor agitation Suicidality
What tool is used to diagnose depression in the elderly?
Geriatric depression score: 30 item self-reporting assessment tool
Give 3 risks for depression
- Recent bereavement
- Social isolation
- Stroke
Give 2 drugs for depression and their MOA
Sertraline (generally 1st line SSRI)
Mirtazapine (an SNRL, an appetite stimulant and mild sedative)
Define fragility fractures and give the 2 causative conditions
Fractures that result from mechanical forces that would not normally cause a fracture – due to abnormal bone
Osteopenia + osteoporosis
Give 3 risks of fragility fractures
- Female
- Increasing age
- Chronic alcohol excess
What score determines 10 year risk of fractures?
FRAX or Q-fracture
Give 3 drugs used in osteoporosis
- Calcium supplement
- Vitamin D supplement
- Alendronic acid 70mg once week
What is the MOA of bisphosphonates in osteoporosis?
Inhibit bone resorption by inhibiting key signalling pathways of osteoclasts
Define pressure ulcers and give 2 causes
Localised injury to skin/underlying tissue as a result of pressure
Immobility + sensory impairment
Give 3 symptoms of pressure ulcers
- Non-blanching erythema
- Open wound
- Exudate
Give 3 management options for pressure ulcers
- Pressure reducing aid and re-positioning
- Hygiene, cleansing and dressings
- Analgesia
Define elder abuse and give 2 risks
Failure of carer to provide basic needs and safety of an older person, resulting in harm or high likelihood of harm
Age >75 + dementia
What should be done in cases of elder abuse?
- Social services evaluation
- Report to authorities
Outline the differences between conductive and sensorineural hearing loss
Conductive: external and middle ear by interfering with transmission
Sensorineural: inner ear and auditory nerve
Give 3 causes of hearing loss
- Mechanical obstruction (impacted wax)
- Trauma (e.g. laceration)
- Infection
Outline Weber test
Turning fork in centre of forehead and pt. asked which side is louder:
- Both equal = normal
- Left louder = right sensorineural impairment
- Right louder = left sensorineural impairment
Outline Rinne test
Turning fork on mastoid bone (bone conduction) then next to external ear (air conduction)
- air conduction louder than bone = positive test
- bone conduction louder than air = negative test and indicates conductive hearing loss
Give 2 causes of each acute and chronic vision loss
A: optic neuritis + retinal vascular occlusion
C: Glaucoma + diabetic retinopathy
