Geriatric Medicine - Frailty

Question 1

What is ageing?

Answer 1

It is a progressive accumulation of damage to a complex system

Question 2

What are the two effects of ageing?

Answer 2

The impairment of individual organ function

The breakdown of complex interplay between organ systems – dyshomeostasis

Question 3

What does ageing lead to?

Answer 3

Frailty

Question 4

What is frailty?

Answer 4

An increased susceptibility to environmental stress

Question 5

How do frail patients present in clinical practice?

Answer 5

These patients tend to present with ‘decompensated frailty syndromes’, rather than the typical features of an illness

These are system failure presentations

Question 6

What are four ‘decompensated frailty syndromes’?

Answer 6

Falls

Immobility

Delirium

Functional decline

Question 7

What is delirium?

Answer 7

An acute confusional state, characterised by a disturbed consciousness and reduced cognitive function

Question 8

What are the three delirium classifications?

Answer 8

Hypoactive Delirium

Hyperactive Delirium

Mixed Delirium

Question 9

What is hypoactive delirium?

Answer 9

It is marked by lethargy and reduced motor activity

Question 10

What is the most common classification of delirium?

Answer 10

Hypoactive delirium

Question 11

What is hyperactive delirium?

Answer 11

It is marked by agitation and increased motor activity

Question 12

What is the most recognised classification of delirium?

Answer 12

Hyperactive delirium

Question 13

What is mixed delirium?

Answer 13

It is marked by fluctuations between hypoactive and hyperactive delirium throughout a day

Question 14

What are the six risk factors of delirium?

Answer 14

Age > 65 Years

Male Gender

Multiple Co-Morbidities

Dementia

Renal Impairment

Sensory Impairment

Question 15

What are the seven common causes of delirium?

Answer 15

Infection

Post-Operative Hypoxia

Electrolyte Abnormalities

Dehydration

Constipation

Urinary Retention

Drug Induced

Question 16

What are the two infections commonly associated with delirium?

Answer 16

UTI

LRTI

Question 17

What are the five drug classes that can cause delirium?

Answer 17

Benzodiazepines

Diuretics

Anti-cholinergics

Opioids

Steroids

Question 18

Name two drugs that cause delirium

Answer 18

Zopiclone

Amitriptyline

Question 19

What are three investigations used to diagnose delirium?

Answer 19

Neurological Examination

4 A’s Test (4AT)

Confusion Screen

Question 20

Why do we conduct a neurological examination when diagnosing delirium?

Answer 20

To rule out any sinister underlying neurological pathology

Question 21

What is the purpose of 4AT?

Answer 21

It is an assessment tool used to quantify the current cognitive function, allowing for a comparison with previous score

Question 22

What 4AT score indicates a diagnosis of delirium?

Answer 22

> 4

Question 23

When do conduct a 4AT?

Answer 23

In all admitted hospital patients over the age of 65

Question 24

When do we conduct a confusion screen?

Answer 24

It is conducted in individuals in which there is no obvious source of confusion

Question 25

What are five investigations included in the confusion screen?

Answer 25

Bloods

Wound Swabs

Urinalysis

Chest X-Ray

CT Head

Question 26

What are five blood tests included in the confusion screen?

Answer 26

FBC

U&Es

TFTs

Glucose

Blood culture

Question 27

In what five ways do we conservatively manage delirium?

Answer 27

• 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

Question 28

What is described as an appropriate environment to treat delirious patient in?

Answer 28

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

Question 29

What are two pharmacological management options of delirium?

Answer 29

Sedatives

Anti-Psychotics

Question 30

What is the first line sedative used to treat delirium?

Answer 30

Haloperidol

Question 31

What is the first line anti-psychotic used to treat delirium?

Answer 31

Quetiapine

Question 32

What two things do we tend to avoid in delirious patients?

Answer 32

Catheters

IV fluids

Question 33

What are the seven causes of falls?

Answer 33

UTIs

Dementia

Drugs

Arrhythmia

Aortic stenosis

Seizure

TIA

Question 34

What are six drugs which can cause falls?

Answer 34

Antihypertensives

Beta-blockers

Sedatives

Anti-cholinergic

Opioids

Alcohol

Question 35

What is the most common drug to cause falls? Why?

Answer 35

Antihypertensives

This is due to the improvement hypertension due to weight loss

Question 36

What four investigations are used to investigate falls?

Answer 36

Examination

ECG

Bloods

4AT

Question 37

What is an important part of clinical examination when investigating falls?

Answer 37

Gait

Question 38

What underlying cause of falls is indicated by an ataxic gait?

Answer 38

Cerebellar damage

Question 39

What underlying cause of falls is indicated by an arthralgia gait?

Answer 39

Arthritis

Question 40

What underlying cause of falls is indicated by a hemiplegic gait?

Answer 40

Stroke

Question 41

What underlying cause of falls is indicated by a small steps, shuffling gait?

Answer 41

Parkinsonism

Question 42

What underlying cause of falls is indicated by a high stepping gait?

Answer 42

Peripheral neuropathy

Question 43

In which three circumstances would we conduct a CT head scan to investigate falls?

Answer 43

Head injury

Neurological signs

Anticoagulant use