Geriatrics Flashcards
What is frailty?
Diminished strength, endurance and physiological function that increases an individuals vulnerability for developing increased dependency or death
Frailty phenotype model?
Unintentional weight loss
Weakness evident by poor grip strength
Self-reported exhaustion
Low levels of physical activity
How is degree of frailty assessed?
Rockwood frailty Index
Physiological markers of frailty?
Increased inflammatory markers Elevated insulin and glucose in fasting state Low albumin Raised D-dimer + Alpha Antitrypsin Low Vit D
What is included in the comprehensive geriatric assessment?
Physical health Mental health Functional ability Social circumstances Environment
What is the comprehensive geriatric assessment?
Evidence based approach to identify health problem and establish management plans in older frail patients
4 physical assessment scales?
Barthel Index
Berg Balance test
Nottingham Extended ADL
Timed up and go test
5 mental assessment scales?
Abbreviated mental test Montreal Cognitive Assessment Mini mental state exam Geriatric depression scale Confusion Assessment Method
How do you assess malnutrition in the elderly?
BMI + Malnutrition Universal Screening Tool
BMI, Unexpected weight loss, acutely ill or no food for >5 days
What is re-feeding syndrome?
Metabolic abnormalities that occur when a patient begins eating again after a period of starvation or limited intake
- In particular low levels of phosphorus
Mechanism of re-feeding syndrome?
When eating after starvation, insulin is increased and so is BMR using up all the electrolytes such as phosphates, magnesium and potassium + intracellular movement of electrolytes causes further depletion
Cardiogenic causes of falls?
Arrhythmia
Structural Heart Disease
What is orthostatic hypotension?
When standing for 3 mins SBP drops by 20 or DBP drops by 10. Failure of compensatory mechanisms
Pharmacological management of orthostatic hypotension?
Fludrocortisone or Midodrine
Reflex syncope?
Inappropriate cardiovascular response of vasodilation or bradycardia leading to cerebral hypoperfusion
e.g. Vasovagal, Situational, Carotid sinus syndrome
Causes of postural hypotension?
Diuretics
Alpha/ Beta blocks
Aortic stenosis
Heart Failure
Complications of the long lie?
Loss of independence, Decreased confidence, Internal bleeding, Rhabdomyolysis, Hypothermia, Pneumonia, Pressure Sores
Pressure ulcer?
Injuries to the skin or underlying tissue primarily caused by prolonged pressure on the skin
Mechanism of a pressure ulcer?
Localised external pressure on skin causes occlusion of the arteries and tissue compression
Stage 1 pressure ulcer?
Non-blanching Erythema
Skin is intact and non-blanchable redness is localised to a bony prominence
Stage 2 pressure ulcer?
Loss of dermis appearing as a shallow open ulcer or fluid filled blister
Difference between stage 3 + stage 4 full-thickness?
Loss of SC fat but in stage 4 the bone, tendon or muscles may be exposed and has a greater risk of osteomyelitis
Suspected deep tissue injury?
Deep blood-filled blister with intact skin
Moisture lesion
Redness/ partial thickness involving the dermis/epidermis caused by excessive moisture from urine, faeces or sweat
Risk assessment tools for pressure ulcers?
Waterlow Pressure Ulcer Policy
Braden Pressure Ulcer Risk Assessment
SSKIN?
Surface support Skin Keep Moving Incontinence Nutrition + Hydration
When are systemic abx prescribed in a patient with pressure ulcers?
Sepsis
Cellulitis
Osteomyelitis
Common cause of community-acquired pneumonia?
Strep Pneumonia
Mycoplasma pneumonia
Influenzae A
Common cause of pneumonia in COPD?
Haemophilus Influenzae
Common cause of pneumonia in IVDU?
Staphy Aureus
Mycobacterium Tubercluosis
Common cause of hospital-acquired pneumonia?
Pseduomondas Aeruginosa or MRSA
How do you assess the severity of CAP?
CURB-65 Confusion Urea >7 RR>30 BP <90/60 >65 1 or less - Outpatient treatment 2 - admit 3 - ITU
Complications of pneumonia?
Lung abscess
Empyema
Sepsis
ARDS
Basal ganglia?
Collection of nerve cells located at the base of the cerebrum deep in the brain that smooth out, coordinate and initiate movement
Complications of Parkinson’s?
Autonomic dysfunction Motor involuntary movements On-off phenomenon Freezing of gait Falls Aspiration pneumonia Pain sleep disturbances Pressure ulcers Daytime sleepiness Behaviour change - Gambiling, hypersexuality
Early signs of Parkinson’s?
Mood changes
Ansomia
Acting out dreams during their sleep
Visual/ Auditory hallucinations
Diagnosis of Parkinson’s?
MRI
DAT scan
MOA of levodopa?
Combines with DOPA decarboxylase and cross the BBB. Then is converted to Dopamine to stimulate dopaminergic receptors
MOBI?
Inhibits the enzyme that normally breaks down dopamine
e.g. Selegiline, Rasagiline, Safinamide
Why is cabergoline not recommended as a dopamine agonist for Parkinson’s?
Risk of cardiac Fibrosis
What group of medications are more effective for managing excessive sleepiness, hallucinations and impulse control in Parkinson’s disease?
Dopamine agonists
Pramipexole
Ropinirole
Rotigotine
Symptoms of Parkinson’s?
Tremor Rigidity Akinesia Postural Instability Bradykinesia
Osteoporosis?
When BMD is >2.5SD below the peak mass. Increased risk of fragility fracture due to increase osteoclast activity
Risk factors of osteoporosis?
Female Menopause Corticosteroid use Rheumatoid arthritis IBD Chronic liver disease BMI<18.5
FRAX score?
Risk of fracture over a period of 10 years in a patient with osteoporosis
What specialist test can be used to estimate bone turnover?
Serum C telopeptide
Management of osteoporosis?
Bisphosphonates
Calcium + Vit D
HRT in premenopausal women
Lifestyle changes
SE of bisphosphonates?
Nausea, Gastritis, Oesophageal bleeds, Osteonecrosis of the Jaw, Bone/ Muscle/ Joint Pain, Atypical stress fracture
Types of incontinence?
Stress Urge Mixed Bladder outlet obstruction (Overflow) Fistula Functional incontinence
Stress incontinence?
Weakness of the urinary outlet
Urge incontinence?
Failure of the bladder to store urine due to high bladder pressure
Functional incontinence?
Incontinence due to general impairment e.g. cognitive, functional, affective
Examination of a patient presenting with incontinence?
Mental - cognitive assessment
Cardioresp - Signs of chronic respiratory disease or HF
Abdo - kidneys or bladder enlarge, PR exam
Pelvis - Vaginal atrophy or prolapse, pelvic floor strength, cough
Neuro - Gait, sensation of lower limbs and pelvis
Medication and Urinary incontinence
Alcohol - Polyuria ACEi - Cough + stress incontinence Anticholinergic - Retention + overflow Diuretic - polyuria, frequency, urgency Opiate - Retention, constipation, sedation TCA - Retention + Overflow
Investigation of incontinence?
Urinalysis
Mid stream urine for culture, microscopy + sensititivity
Post-void bladder scan
Bladder diary
Causes of stress incontinence?
Instrumentation during birth or Pelvic floor damage
Vaginal prolapse
Post-prostectomy in men
Management f stress incontinence?
Lifestyle changes
Pelvic floor exercises
Duloxetine - SNRI
Mid-urethral sling insertion (Tension free vaginal tape)
What is polypharmacy?
Being prescribed more than 4 medications
Consequences of polypharmacy?
Increased morbidity + mortality
Increased hospital admission length
Reduced compliance
Increased risk of adverse drug reactions
Types of constipation?
Hard stool in the rectum - faecal impaction which can lead to overflow diarrhoea
Whole distal colon - loaded with soft putty like faeces
High Impaction - Caused by obstructive lesion
The effect of ageing on the bowel?
Decreased motility
Decreased peristaltic speed and strength
Weak connective tissue - Diverticula
Increased sensory threshold - urge to open bowels
Investigations of constipation?
PR exam
Bloods - FBC, U+E, TFT
Abdo X-ray
Other - colonscopy, CT abdomen, Barium enema
Management of constipation?
Rehydration, Mobilisation, High fibre, Med Review Docusate Macrogol/ Lactulose (softening) Senna Enema or Manual evacuation
