Geriatric medicine, frailty and multimorbidity

Question 1

What is aging

Answer 1

Virtually all physiological functions lose efficiency and no longer have the capacity to maintain homeostasis when faced by external stresses

Question 2

What are some factors that are associated w/ the acceleration of aging?

Answer 2

Smoking

Diabetes

Question 3

In what are the factors that impact aging?

Answer 3

Genetics

Activity levels

Environment

Question 4

Aging theories fall into which 2 broad categories?

Answer 4

Limited replication of cells

Relating to evolution

Question 5

As we age, our organs function less well, with the percentage function of each individual system reducing by the order of what _____?

Answer 5

0.5–1% per organ system per year from the age of 30.

Question 6

What is sarcopenia?

Answer 6

Progressive and generalised muscle disorder w/ a particular reduction in the fast-twitch type 2 muscle fibres

Question 7

Sacropenia increases the risk of what?

Answer 7

Increases the risk of adverse outcomes such as falls and fractures

Question 8

fast-twitch type 2 muscle fibres is needed for kind of power? What actions doe this allow for?

Answer 8

Explosive power

Allows for sprinting, standing from a chair or even coughing

Question 9

What is frailty?

Answer 9

Risk of deterioration when faced w/ a physiological stressor

Question 10

What are the components of Fried’s phenotypic frailty assessment? (5)

Answer 10

Weight loss

Gait speed (6 s or more for 4m)

Energy expenditure (low levels)

Subjective feeling of lethargy (everything feels like an effort)

Muscle strength (grip strength by gender)

Question 11

What are the risk factors for falls?

Answer 11

Cognitive impairment

Medications

Excess alcohol

Change in environment (eg admitted to hospital or moving to new accommodation)

Question 12

What are the 2 categories of falls?

Answer 12

Intrinsic (optimisable + static)

Extrinsic (optimisable + static)

Question 13

List reasons for optimisable intrinsic falls (3)

Answer 13

Concurrent illness

Cardiac syncope

Medications

Question 14

List a reason for static intrinsic falls

Answer 14

Weakness from previous stroke

Question 15

List reasons for optimisable extrinsic falls (2)

Answer 15

Trip hazards

Grab rails

Question 16

List a reason for static extrinsic falls

Answer 16

Stairs into house

Question 17

Syncopal falls usually result injuries to which body part?

Answer 17

The face, normally ppl put their arms out when falling for protection

Question 18

What some primary investigations to check for a fall pt?

Answer 18

Lying - standing BP

ECG

Meds (antihypertensives or diuretics)

Question 19

Describe the principles of immediate management of falls (4)

Answer 19

Treat acute illness (ABCDE approach)

Assess for injuries

Pain control

Prepare for safe surgery if required

Question 20

In the event of a hip fracture immediate pain management induced the use what to minimise the opiate use?

Answer 20

Facia iliac nerve block

Question 21

A pt has a fall what are some things you need to prep them for surgery if they need it?

Answer 21

Optimise their fluid balance

Correct clotting - if on anticoagulants

Question 22

What are the 3 major things to asses for in the history and exam of fall?

Answer 22

Events leading to the fall

Risk factors for falling

Consequences of fall

Question 23

What blood tests would you oder for a pt w/ a fall? (5)

Give rationale for each

Answer 23

FBC (eg anemia, infection/sepsis)

Serum creatinine and electrolytes (AKI, electrolyte imbalance)

Glucose/HbA1c (hypoglycemia)

Bone profile/vitamin D

TFT, micronutrient levels (Bit B12, folic acid, iron studies

Question 24

Why are you doing on ECG on a fall pt?

Answer 24

To check for conduction abnormalities

Question 25

What kind of imaging should be done on a fall pt? (2) Give rationale

Answer 25

Plain x ray (fractures) CT head (large or small vessel cerebrovascular disease, to exclude trauma - eg subdural haemorrhage)