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Geriatrics Flashcards

1
Q

Intervention with highest benefit to reduce risk falls

A

Exercise (in a patient at home not RACF)

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2
Q

CAM

A

Confusion assessment method- Delirium screen

Must have both Acute Onset and inattention plus one of disorganised thinking or altered consciousness

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3
Q

Multi-factorial interventions to prevent progression of dementia

A

Diet
Exercise
Cognitive training
Vascular risk reduction

FINGER STUDY

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4
Q

Most common type of urinary incontinence in elderly

A

Urge incontinence

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5
Q

Definition of frailty

A

Three or more of;
- Unintentional weight loss
- Self reported exhaustion
- Decreased grip strength
- Slow walking pace
- Low physical activity

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6
Q

Clinical frailty score

A
  1. Very fit - regular exercise, motivated, robust, no medical problems
  2. Well - occasional exercise, no medical problems
  3. Managing Well - Seasonal exercise, medical problems well controlled
  4. Vulnerable.- Symptoms limit ADLs but not yet reliant on others
  5. Mildly Frail - require assistance with higher order ADLs - transport, bills, shopping, cooking
  6. Moderately frail - require stand-by assist for all ADLs
  7. Severely frail - completely dependent on others
  8. Very severely frail - EOL care and likely to die of even a mild illness
  9. Terminal ill - < 6 months to live but are otherwise not evidently frail
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7
Q

Only intervention proven to reduce frailty

A

Exercise

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8
Q

Test of the benefits of exercise in elderly

A

6 minute walk test

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9
Q

Affects on sleep in elderly

A

NOT DECREASED need for sleep
- Increased nocturnal awaking or arousal
- Decreased Non-REM sleep (preserved REM sleep)
- Fragmented sleep-wake cycle

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10
Q

Definition of dementia

A

Chronic > 6 months, impairing personal or occupational activities with 2 or more impairment in

  • Memory
  • Executive function
  • Attention
  • Language
  • Social cognition and judgement
  • Psychomotor speed
  • Visioperceptual or vsiospatial abilities

MUST have neuroimaging to make diagnosis
MMSE < 24

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11
Q

Side effects of Donepezil

A

Cholinergic side-effects
- Diarrhoea and GI upset is most common!
- Urinary frequancy
- Asymptomatic bradycardia
- Vivid dreams
- Headache
- Long QT
- Lowers seizure threshold

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12
Q

CADASIL

A

Cerebral Autosomal Dominant Arteriopathy with Subcortical infarcts and Leukoencephalopathy
Recurrent strokes/TIA in young patents 40 - 50 without risk factors, due to smooth muscle atrophy in blood vessels
Causes Vascular dementia
Notch 3 gene on Chromosome 19
Muscle biopsy will show arterioles with dense bodies
No treatment

Complicated by migraines, urinary incontinence, pseudobulbar palsy

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13
Q

Anti-psychotics for use in dementia/delirium

A

Respiridone in dementia
Haloperidol in delirium (does not sedate patients)

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14
Q

Drugs contributing to falls

A

Anti-depressants - SSRI (highest)
Anti psychotics
Benzos
Sedatives
Some Anti-HTN’s (highest shortly after commencement)
NSAIDs
Diuretics
Beta blockers and digoxin

Perindopril and indapamide protective!

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15
Q

Drugs contributing to falls

A

Anti-depressants - SSRI (highest)
Neuroleptics
Benzos
Sedatives
Some Anti-HTN’s (highest shortly after commencement)
NSAIDs
Diuretics
Beta blockers ad digoxin

Perindopril and indapamide protective!

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16
Q

Which medication is protective against falls?

A

Perindopril and indapamide

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17
Q

Medications associated with weight loss in elderly

A

Digoxin
Theophylline
Antipsychotics
SSRIs (Citalopram, Fluoxetine, Paroxetine) -> Amitryptaline causes weight gain!
Frusemide
Metformin

18
Q

Cardiovascular changes in elderly

A
  • Decrease in maximum heart rate
  • Increase in end diastolic and end systolic volume
  • Increase in stroke volume
  • Reliance on Frank Starling mechanism
19
Q

Weight re-distribution in elderly

A

Decrease in Subcut and appendicular fat
Increase in Visceral and Truncal fat

20
Q

Changes in muscle fibres with ageing

A

Decreased Type 2 muscle fibres for gross, sustained movements
Preserved Type 1 muscle fibres for fine and precise movements

i.e. can knit but can’t run!

21
Q

Changes in respiration with ageing

A

Increased Residual capacity and functional residual capacity
Decreased FEV1 > FVC
Decreased DLCO
Reduced respiratory drive to hypoxia and hypercapnia
Stable total lung capacity

22
Q

Cause of Nocturia in elderly

A

Increased ANP in response to fluid retention

23
Q

Visual impairment

24
Q

Visual impairment

25
Visual impairment
26
Visual impairment
27
Strongest risk factor for fall
Prior falls
28
Strongest risk factor for delirium
Restraint Use Malnutrition with BMI < 20 INCREASE BY FOUR-FOLD
29
HELP Model of delirium management
Orientation Vision and Hearing aids Early mobilisation Non-drug approaches to sleep and anxiety Fluid Replacement Noise reduction
30
Drugs with reduced incidence of dementia
Perindopril and Indapamide
31
Barthol Score
For ADLs - Feeding - Bathing - Dressing - Grooming - Toileting - Bowels - Bladder - Mobility on flat surface - Stairs - Transfer bed to chair The need for supervision renders the patient not independent
32
Worst Parkinsons Meds for side effect of psychotic symptoms
In order; Anticholinergics (Amantadine, Selegiline) Dopamine agonists (Pramipexole, Ritigotine) Dopamine replacement (L.Dopa)
33
NH patient Vs community dweller risk of falling each year
Around 50% Vs. 30% (but increases to 50% > 80 years even in community dwellers)
34
Time to up and Go test
> 13.5 seconds indicates increased risk of falls
35
Visual aid interventions that improve falls risks
Cataracts Singles lens help with outside falls only
36
Interventions to reduce falls in NH patients
Vitamin D supplementation for deplete patients (otherwise nothing)
37
Types of Fronto-temporal dementia
Behavioural - disinhibited, apathetic Progressive Non-fluent Aphasia - slowed speech and problems understanding speech Semantic - Problems recognising people or items, trouble finding the right word for objects
38
Types of Fronto-temporal dementia
Behavioural - disinhibited, apathetic Progressive Non-fluent Aphasia - slowed speech and problems understanding speech Semantic - Problems recognising people or items, trouble finding the right work for objects
39
Genes associated with Alzheimers
APOe4 - Late onset alzheimers and cardiovascular disease Presenilin 1 Presenilin 2 Amyloid precursor proteins Protective: APOe2
40
Types of Fronto-temporal dementia
Behavioural - disinhibited, apathetic Progressive Non-fluent Aphasia - slowed speech and problems understanding speech Semantic - Problems recognising people or items, trouble finding the right work for objects
41
Protein deposition and types of dementia
Alzheimers - Extracellular Beta Amyloid and intracellular Tau proteins forming Neurofibillary tangles Lewy body dementia - intracellular Alpha-synuclein Vascular dementia/Picks disease - Intracellular Tau proteins FTD - Intracellular Tau and TDP-43 PSP - Intracellular Tau CBD - Intracellular Tau MSA - Alpha-synuclein Mixed (LATE neuropathology) - Tau, Beta amyloid, alpha-synuclein, TDP-43

RACP (17 decks)

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