Geriatric Syndrome Flashcards
Frailty, Falls, Dizziness, Delirium, Urinary Incontinence
What is the role of Cinnarizine in vestibular disorders?
What patient population is it used in caution in?
Increases cochlear circulation, but has antihistaminergic & antidopaminergic effects.
Caution: Avoid in PD patients (can worsen symptoms).
What is the 4 types of dizziness?
Dizziness
Vertigo, Pre-syncopal dizziness, Dysequilibrium, Unspecified dizziness
How does trauma contribute to delirium?
Delirium
Head injury, postoperative pain, and inflammation can trigger delirium.
Less impt
What is the usual dose of Haloperidol for general agitation?
Delirium
SC/IM/PO Haloperidol 0.3–1 mg BD, up to 5 mg/day (for non-ICU patients).
Name 2 classes of medication involved in hypoglycemia in FRID
Falls
Insulin, SUs
What does the mnemonic I WATCH DEATH stand for in delirium?
Delirium
It represents the common causes of delirium: Infections, Withdrawal, Acute metabolic disorder, Trauma, CNS pathology, Hypoxia, Deficiencies, Endocrinopathies, Acute vascular, Toxins, Heavy metals.
Which CNS pathologies can cause delirium?
Delirium
Stroke, hemorrhage, tumors, seizure disorders, Parkinson’s disease.
Less impt
What is a major downside of using benzodiazepines (e.g., Lorazepam) for agitation?
Delirium
May prolong delirium in elderly or medically complex patients.
Which first-generation antihistamines are used as vestibular suppressants?
Dizziness
Diphenhydramine, Dimenhydrinate, Meclizine.
Name two drug classes involved in sedation in FRID
Falls
- Opioids
- Anticonvulsants
How do α-blockers like tamsulosin affect urinary continence?
UI
Decrease urethral sphincter tone, leading to stress incontinence.
What is the geriatric syndrome of delirium?
Delirium
An acute neuropsychiatric disorder associated with medical conditions, medications, and/or substance intoxications or sudden withdrawal of psychoactive medications
Which substances can cause withdrawal-related delirium?
Delirium
Alcohol, barbiturates, benzodiazepines (sudden cessation can lead to withdrawal delirium).
Less impt
Which phenothiazines are used for dizziness and vertigo?
Dizziness
Prochlorperazine, Promethazine.
What are common causes of urge incontinence?
UI
Detrusor overactivity, local genitourinary conditions (e.g., tumors, stones, obstruction), and CNS disorders (e.g., stroke, Parkinson’s, dementia, spinal cord injury).
What does the mnemonic DIAPPERS stand for in UI?
Delirium → functional
Infection (acute UTI) → urge
Atrophic vaginitis → stress, urge
Pharmaceuticals
Psychological disorder (esp. depression) → functional
Excessive urine output (e.g. hyperglycemia) → urge
Reduced mobility (functional incontinence) or reversible UI (drug-induced)
Stool impaction (pseudodiarrhea) → overflow
Differential diagnoses
Which cardiovascular medications are considered FRIDs?
Falls
Beta-blockers, diuretics, and antihypertensives due to the risk of hypotension and dizziness.
Which type of incontinence is most associated with Parkinson’s disease?
UI
Urge incontinence, due to detrusor overactivity caused by impaired central nervous system control.
Why are phenothiazines contraindicated in Parkinson’s disease (PD), Parkinson’s disease dementia (PDD), and dementia with Lewy bodies (DLB)?
Dizziness
They have antidopaminergic effects, which can worsen Parkinsonian symptoms.
When should pharmacological management of agitation be used?
Delirium
Only as a last resort due to increased mortality and stroke risk in elderly dementia patients.
How does menopause contribute to stress incontinence?
UI
Decreased estrogen leads to weakened pelvic floor muscles and urethral sphincter dysfunction.
How does hypoxia lead to delirium?
Delirium
Anemia, cardiac failure, pulmonary embolism can decrease oxygen to the brain, leading to confusion.
Less impt
Which infections can cause delirium?
Delirium
Encephalitis, meningitis, urinary tract infections (UTI), pneumonia, intra-abdominal infections.
Less impt
Which antipsychotic is considered safest in terms of QTc prolongation?
Delirium
PO Olanzapine (ODT) 1.25–2.5 mg, up to 10 mg/day.
What is the main side effect of first-generation antihistamines for dizziness?
Dizziness
Strong anticholinergic effects → sedation, dry mouth, confusion (especially in elderly).
What are common causes of functional incontinence?
UI
Severe dementia, neurologic disorders, depression, hostility, or mobility limitations preventing timely bathroom access.
Why should oral estrogens be avoided in UI, and what is the alternative?
UI
Oral estrogens increase urinary incontinence – use topical estrogen for atrophic vaginitis instead.
Name 4 classes of medication involved in OH in FRID
Falls
Α-blockers, central antihypertensives, vasodilators, diuretics
What is Betahistine used for, and when should it be avoided?
Dizziness
- Used for chronic management of Meniere’s disease or persistent vertigo.
- Caution in asthma/COPD.
- C/I in active/history of peptic ulcer disease (PUD).
How do opioids affect bladder function?
UI
Decreased bladder sensation and increased urethral sphincter tone, leading to urinary retention.
What are some serious etiologies of dizziness? (7)
Dizziness
- Benign Paroxysmal positional vertigo
- Orthostatic hypotension
- Meniere Disease
- Vestibular migraine
- psychogenic dizziness
- drug-induced dizziness
- vestibular neuronitis
What is functional incontinence?
UI
Urinary accidents due to inability to reach the toilet because of cognitive, physical, psychological, or environmental barriers.
What are the risks of using benzodiazepines for vestibular suppression?
Dizziness
Short-term: Increased sedation & fall risk.
Long-term: Cognitive impairment & depression.
Which vitamin deficiencies are linked to delirium?
Delirium
Vitamin B12, folic acid, and thiamine deficiencies.
Less impt
What is the geriatric syndrome of falls?
Falls
An unexpected event in which a person comes to rest on the ground, floor or lower surface
Prevention techniques of delirium (11)
Delirium
- Sensory functions optimisations
- Hydration/nutrition
- Bowel movement/urination
- Early mobility
- Pain control
- Medication review
- Social interaction with loved ones
- Reorientation with clock/ calendar/ proper lighting
- Conducive environment
- Promote good sleep
- Address infection/ hypoxia
Impt!
What is overflow incontinence?
UI
Leakage of small amounts of urine due to bladder overdistension or urinary retention affecting bladder/sphincter function.
What are common causes of stress incontinence?
UI
Weak pelvic floor muscles (e.g., from childbirth, pregnancy, menopause), bladder outlet or urethral sphincter weakness, and post-urologic surgery.
How do benzodiazepines contribute to urinary incontinence?
UI
Impaired micturition due to muscle relaxant effects.
When is Haloperidol contraindicated?
Delirium
Prolonged QTc, Parkinsonism (including Dementia with Lewy Bodies [DLB] and Parkinson’s Disease Dementia [PDD]).
What is the geriatric syndrome of frailty?
Frailty
Low physiologic reserves and is highly vulnerable to internal and external stressors
How does OH contribute to falls?
Falls
Lower blood perfusion to brain (dizziness), legs (strength), and eyes (visual acuity)
Fall risk ↑ when dehydrated
When is World Elder Abuse Day?
Elder Abuse
15 June
Which endocrine disorders can cause delirium?
Delirium
Thyroid dysfunction, hypoglycemia, parathyroid imbalances, adrenal disorders.
Less impt
What is the FRAIL Scale?
Frailty
- Fatigue [Have you felt fatigue most of the time over the past month?]
- Resistance [Do you have difficulty climbing 1 flight of stairs?]
- Ambulation [Do you have difficulty walking one block/ 80m?]
- Illness [> 5 conditions: Hypertension, DM, cancer, chronic lung disease, asthma, heart attack, CHF, angina, stroke, arthritis, kidney disease]
- Loss of weight [Have you lost more than 5% of your weight in the past year?]
What is a Parkinson’s disease (PD)-friendly antipsychotic for agitation?
Delirium
PO Quetiapine 6.25–12.5 mg BD, up to 100 mg/day.
What is a geriatric syndrome?
Geriatric syndrome
Includes conditions that are:
* Prevalent in the elderly patients
* Impairments in multiple organ system
* Negative impact on functional, quality of life and mortality
Which medication is used for agitation in alcohol or benzodiazepine withdrawal?
Delirium
PO/IV/SC Lorazepam 0.5–1 mg.
How do anticholinergic drugs increase fall risk?
Falls
They cause blurred vision, confusion, dizziness, and urinary retention, impairing mobility and balance.
Which drugs can cause nocturia due to edema?
UI
Gabapentin, pregabalin, calcium channel blockers, thiazolidinediones, NSAIDs.
What are common causes of overflow incontinence?
UI
Anatomic obstruction (e.g., prostate enlargement, stricture, cystocele), acontractile bladder (e.g., diabetes, spinal cord injury), neurogenic causes (e.g., multiple sclerosis), and medications.
Why should opioids be used cautiously in older adults?
Falls
Opioids (e.g., morphine, oxycodone) cause drowsiness, dizziness, and impaired coordination, leading to a higher fall risk.
When should vestibular suppressants be used?
Dizziness
Only if dizziness persists for more than 30 minutes.
The medications often take > 30 min for onset of action, thus if the dizziness persists for < 30 min, not effective.
What are the 4 mechanisms of FRIDs
Fall risk increasing drugs
Falls
- Sedation
- OH
- Anticholinergics
- Hypoglycemia
What is stress incontinence?
UI
Involuntary loss of small amounts of urine due to increased intraabdominal pressure (e.g., coughing, laughing, exercise).
Which drug is used for nausea and vomiting associated with dizziness?
Dizziness
Metoclopramide (alternative: Ondansetron).
Name 6 classes of medication involved in anticholinergic effects of FRID
Falls
Antidepressants
Antipsychotics
Benzodiazepines
Z-hypnotics
1st Gen Antihistamines
Muscle relaxants
How can deprescribing help reduce fall risk in older adults?
Falls
Stopping or reducing the dose of FRIDs can improve balance, cognition, and overall mobility, reducing the likelihood of falls.
Management of delirium
Delirium
See formularies
What is Elder Abuse
Elder Abuse
any action or inaction that puts the safety or well-being of an elderly persion at risk.
What acute metabolic disorders can lead to delirium?
Delirium
Electrolyte imbalance, hepatic failure, renal failure.
Less impt
Which drug classes decrease bladder contractility due to anticholinergic effects?
UI
Antimuscarinics, spasmolytics, anti-Parkinson’s agents, TCAs, and 1st/2nd gen antipsychotics.
Why should caution be used when prescribing antipsychotics in elderly patients with dementia?
Delirium
Increases mortality and stroke risk, but does not improve quality of life (QoL).
What is urge incontinence?
UI
Sudden leakage of urine (often large volumes) due to an inability to delay voiding after sensing bladder fullness.
Which antidepressant class increases urethral sphincter tone?
UI
SNRIs (e.g., duloxetine, reboxetine).
