Geriatric Medicine - Frailty Flashcards
What is ageing?
It is a progressive accumulation of damage to a complex system
What are the two effects of ageing?
The impairment of individual organ function
The breakdown of complex interplay between organ systems – dyshomeostasis
What does ageing lead to?
Frailty
What is frailty?
An increased susceptibility to environmental stress
How do frail patients present in clinical practice?
These patients tend to present with ‘decompensated frailty syndromes’, rather than the typical features of an illness
These are system failure presentations
What are four ‘decompensated frailty syndromes’?
Falls
Immobility
Delirium
Functional decline
What is delirium?
An acute confusional state, characterised by a disturbed consciousness and reduced cognitive function
What are the three delirium classifications?
Hypoactive Delirium
Hyperactive Delirium
Mixed Delirium
What is hypoactive delirium?
It is marked by lethargy and reduced motor activity
What is the most common classification of delirium?
Hypoactive delirium
What is hyperactive delirium?
It is marked by agitation and increased motor activity
What is the most recognised classification of delirium?
Hyperactive delirium
What is mixed delirium?
It is marked by fluctuations between hypoactive and hyperactive delirium throughout a day
What are the six risk factors of delirium?
Age > 65 Years
Male Gender
Multiple Co-Morbidities
Dementia
Renal Impairment
Sensory Impairment
What are the seven common causes of delirium?
Infection
Post-Operative Hypoxia
Electrolyte Abnormalities
Dehydration
Constipation
Urinary Retention
Drug Induced
What are the two infections commonly associated with delirium?
UTI
LRTI
What are the five drug classes that can cause delirium?
Benzodiazepines
Diuretics
Anti-cholinergics
Opioids
Steroids
Name two drugs that cause delirium
Zopiclone
Amitriptyline
What are three investigations used to diagnose delirium?
Neurological Examination
4 A’s Test (4AT)
Confusion Screen
Why do we conduct a neurological examination when diagnosing delirium?
To rule out any sinister underlying neurological pathology
What is the purpose of 4AT?
It is an assessment tool used to quantify the current cognitive function, allowing for a comparison with previous score
What 4AT score indicates a diagnosis of delirium?
> 4
When do conduct a 4AT?
In all admitted hospital patients over the age of 65
When do we conduct a confusion screen?
It is conducted in individuals in which there is no obvious source of confusion
What are five investigations included in the confusion screen?
Bloods
Wound Swabs
Urinalysis
Chest X-Ray
CT Head
What are five blood tests included in the confusion screen?
FBC
U&Es
TFTs
Glucose
Blood culture
In what five ways do we conservatively manage delirium?
- The supply of care in an appropriate environment
- The treatment of the underlying causative factor
- The encouragement of oral fluid intake
- The encouragement of a normal sleeping pattern
- To discuss power of attorney agreements
What is described as an appropriate environment to treat delirious patient in?
An environment is quiet, has a regular routine and the presence of clocks to orientate time and place
This environment should remain constant, with the avoidance of ward/room transfers
What are two pharmacological management options of delirium?
Sedatives
Anti-Psychotics
What is the first line sedative used to treat delirium?
Haloperidol
What is the first line anti-psychotic used to treat delirium?
Quetiapine
What two things do we tend to avoid in delirious patients?
Catheters
IV fluids
What are the seven causes of falls?
UTIs
Dementia
Drugs
Arrhythmia
Aortic stenosis
Seizure
TIA
What are six drugs which can cause falls?
Antihypertensives
Beta-blockers
Sedatives
Anti-cholinergic
Opioids
Alcohol
What is the most common drug to cause falls? Why?
Antihypertensives
This is due to the improvement hypertension due to weight loss
What four investigations are used to investigate falls?
Examination
ECG
Bloods
4AT
What is an important part of clinical examination when investigating falls?
Gait
What underlying cause of falls is indicated by an ataxic gait?
Cerebellar damage
What underlying cause of falls is indicated by an arthralgia gait?
Arthritis
What underlying cause of falls is indicated by a hemiplegic gait?
Stroke
What underlying cause of falls is indicated by a small steps, shuffling gait?
Parkinsonism
What underlying cause of falls is indicated by a high stepping gait?
Peripheral neuropathy
In which three circumstances would we conduct a CT head scan to investigate falls?
Head injury
Neurological signs
Anticoagulant use
