Geriatrics Flashcards
What are the 5 Geriatric Giants? (all begin with I)
- Immobility
- Instability
- Intellectual Impairment
- Incontinence
- Inability to manage ADLs
Name some reversible causes of incontinence (5+) mneumonic:
DIAPPERS
- Delirium
- Infection
- Atrophic Vaginitis
- Pharmaceutical
- Psychological
- Excess Fluids
- Restricted Mobility
- Stool (constipation)
Suggest 4 aspects of care that should be considered in a Comprehensive Geriatric Assessment (CGA)?
- medical: e.g. co-morbid, med review, nutrition..
- mental health: cognition, mood, anxiety/fears
- functional capacity: ADLs, gait/balance, PS
- social circumstances: informal carers, social network
- environment: home safety, facilities, technology
What does OPAL stand for? What is their job?
- older person’s assessment and liason team
- evaluate CGA in acute medical inpatients
What should you ask about in a falls history? (6+)
- do they know why they’re in hospital
- any pain? bump to head?
- loss of consciousness?
- did you trip? medications?
- how did you feel before fall? Dizziness? palpitations? light headedness?
- time on floor?
- history of falls
- mobility, home environment
Donepazil is a medication used to treat what? What effect can it have on HR?
Alzeihmers/Dementia
-slows HR by ~3bpm so can worsen bradycardia
What is a side effect of amlodipine for which some pts are on small doses of furosemide unecessarily?
swollen feet
Why is LUTZ e.g. from vaginal prolapse in an elderly person a RF for falls?
- urge/stress incontinence
- rushing to toilet esp. with poor mobility
- incontinence could lead to slipping on urine
What is onychogryphosis?
-hypertrophy of the nail bed (v. long toenails)
What describe a brain age-related change that increases the risk of falls:
-brain atrophy, loss of neurones, reduced synaptic transmission so slower processing speed and loss of proprioceptive sensitivity and impaired vestibular system
What describe a MSK age-related change that increases the risk of falls:
- sarcopenia (loss of skeletal muscle mass) >in legs than arms
- lumbar lordosis, thoracic kyphosis, cervical lordosis postural changes
- reduced stride length and gait speed and a wide based gait
What is presbycussis?
Age related bilateral sensory hearing loss
Name 5 age-related changes in the eyes that increases the risk of falls:
- deterioration in static acuity
- loss of dynamic visual acuity
- pupil becomes rigid and less elastic
- lens becomes opaque
- slow reaction to changes in lighting
- reduced sensitivity to colour contrast
- long-sightedness
- co-morbidities: cataracts, ARMD. glaucoma, retinopathy, stroke
Name 4 CVS pathologies/co-morbidities that increase the risk of falls:
- orthostatic hypotension
- post-prandial hypotension
- carotid sinus syncope
- neurocardiogenic syncope
- arrhythmias
- valvular heart disease
Name 4 balance/gait co-morbidities that increase risk of falls:
- Stroke
- Parkinsonism
- Arthritis
- Neuropathy
- Vestibular disease
- Neuromuscular Disorders
Name 2 alpha blockers, why are they problematic in elderly and falls?
- doxazocin
- tamsulosin
- postural hypotension
Investigations for a pt whose had a fall:
- culture urine
- ECG - make sure named and dated
- postural lying/standing BP
- X-ray e.g. baseline CXR
- routine bloods
- U&Es
- LFTs
Name 3 secondary complications following a fall:
- chest infections/HAIs
- pressure sores
- dehydration
- muscle atrophy
- burns
- hypothermia
Suggest 5 things that will come under a multifactorial risk assessment after a pt has had a fall:
- cognitive impairment, sensory impairment screen
- syncope risk
- visual assessment
- footwear assessment
- co-morbidity management
- medication review
- balance/mobility problems
- home hazards (OT)
- falls history
- continence problems
Dementia definition:
A loss of ___ ___ severe enough to ____ with normal ___, lasting >___, not present since birth and not associated with ___/____ of ____
- loss of mental ability
- interfere with normal ADLs
- lasting >6months
- not associated with Loss/Alteration of conciousness
Mild cognitive impairment causes cognitive changes that are serious enough to be noticed by the individuals experiencing them/to other people but the changes are __ ___ ___ to ___ with __
-not severe enough to interfere with daily life/independent function
NB: these pts have insight
Mocha test is used for testing for
-dementia
Lewy body dementia has a rapid decline, what problems are seen?
NB: if cognitive impairment started before parkinsons = lewy body
-if parkinsons >1yr then cognition falls = parkinson’s dementia
- visuospatial problems
- behavioural issues
- hallucinations/delusions
A very rapid declining dementia with myoclonic jerks is likely to be the rare type of dementia related to ___
CJD
In terms of the Mini mental state exam (MMSE) /30 what are the numbers ascribed to Alzheimer’s, used to guide medical rx:
- mild
- moderate
- moderately severe
- severe
MMSE score:
- mild 21-26
- moderate 10-20
- moderately severe 10-14
- severe <10
What should all patients >65 and all pts with confusion have in hospital?
AMTS test
And what should all patients >75yrs be asked? 2qs?
- Have they been more forgetful in the past 12months
- and the extent to which it has significantly affected their daily life
Name 3 reversible causes of confusion (that can be seen on blood tests)
- thyroid problems (e.g thyroid storm, myxoedema coma)
- folate deficiency, test for vit B12 too as if you treat a b12 deficient pt with folate before b12 will worsen neuro problems
- hypercalcemia e.g. cancer pts, myeloma pts, dehydrated..
Triad of gait ataxia, incontinence and confusion suggests what?
Normal pressure hydrocephalus
Delirium screening is done using what test?
4AT
What does the 4AT screening tool for delirium stand for?
- alertness
- AMT4
- Attention
- Acute change or fluctuating course
What are the AMT4 questions?
- Age
- DOB
- place
- Current year
How do you assess alertness in the AMT4? What would be abnormal
- ask pt to state their name and address
- if asleep, attempt to wake with touch on shoulder
- abnormal if drowsy/agitated
How do you assess attention in the AMT4?
- ask pt to tell you the months of year backwards
- 1 prompt allowed
