Geriatrics Flashcards
Features of Parkinsons + Cognitive impairment
Lewy-body dementia
What system assess frailty in elderly patients?
PRISMA-7
What factors are considered in PRISMA-7?
- Age
- Sex
- Health problems
- Assistance required
- Walking aid
What is first line for mild-moderate Alzheimers disease?
Acetylcholinesterase inhibitors e.g. donepezil
What is second line for Alzheimers disease?
- Memantine
- Used for moderate/severe
What screening tool is used to assess starting new medications in elderly patients?
START
What screening tool is used to assess which drugs can be discontinued in a patient with poly pharmacy?
STOPP
Which type of dementia is likely to present with visual hallucinations?
Lewy-body dementia
Management of acute confusional state?
- Treat underlying cause
- Change environment
- Haloperidol e.g. oral/IM
Causes of delirium in the elderly?
- UTI
- New surroundings
- Community-acquired pneumonia
New surroundings can cause what in elderly patients with cognitive impairment?
Delirium
What medication should be stopped in patients with dementia due to risk of further cognitive impairment?
TCAs such as Amitriptyline
What kind of drug is Haloperidol and what conditions is it C/I with?
Dopamine antagonist
Parkinson’s disease
What type of dementia presents with step-wise progression?
Vascular
Which medications should be avoided in the elderly due to the risk of adverse reactions/increased mortality?
Antipsychotics such as Haloperidol
Which type of dementia has social disinhibition and often a family history?
Frontotemporal dementia
What class of drug is Memantine?
NMDA Antagonist
Why is digoxin a dangerous drug in the elderly?
Narrow therapeutic index and toxicity can be triggered by illness/renal failure/hypokalaemia
What are symptoms of digoxin toxicity?
- GI disturbances e.g. nausea, vomiting, abdominal pain
- Arrhythmias
- Blurred vision
- Drowsiness
What type of drugs can cause gout?
- Loop diuretics
- Thiazide diuretics
Symptoms of hypoactive delirium?
- Withdrawn
- Lethargy
- Slow to respond to questions
What type of dementia is associated with visual hallucinations?
Lewy-body dementia
What is the risk score for pressure sores?
Waterlow score
ICD-10 criteria for delirium
1.) Impairment of consciousness and attention
2.) Global disturbance in cognition
3.) Psychomotor disturbance
4.) Disturbance of sleep-wake cycle
5.) Emotional disturbances
S/E of acetylcholinesterase inhibitors?
Cholinergic effects -> diarrhoea, incontinence, N+E, increased salivary production
Delirium
- Acute
- Fluctuating course
- Inattention
- Altered level of consciousness
- Reversible
- Associated with underlying medical cause
Delirium causes?
Pain
Infection
Nutrition
Constipation
Hydration
Medication (withdrawal/overdose)
Environment
What domains are in comprehensive geriatric assessment?
- Physical Health
- Mental health
- Social aspects
- Functional aspects
- Environment
Complications of long lie down following a fall?
- Pressure ulcers
- Dehydration
- Rhadbomyolysis
Iv for pressure ulcers?
- Bloods - CRP, ESR, WCC
- Swabs and blood cultures
- X-ray for bone involvement
Tx for pressure ulcers?
- Abx
- Wound dressing
- Analgesia
- Debridement
How often should you/patient move to prevent pressure ulcers?
Low risk - 6 hours
High risk - 4 hours
Risk factors for osteoporosis?
Steroid use
Hyperthyroid/parathryoid/calcaemia
Alcohol/Tobacco
Thin
Testosterone decreased
Early menopause
Renal/Liver failure
Erosive inflammatory bone disease (RA)
Dietary reduced
Geriatric Giants
- Immobility
- Instability
- Incontinence
- Interllectual impairment
Risk factors for Pressure Ulcers?
- Immobility
- Malnutrition
- Dehydration
- Sensory impairment
- Obesity
- Urinary/Faecal incontinence
- Reduced tissue perfusion
Causes of falls in elderly?
- Drugs
- MSK
- Syncope/Stroke/Tia
- Vertigo
- Pos HTN
- Hypoglycaemia
- Visual impairment
- Dementia
Prevention of pressure ulcers?
- Barrier creams
- Pressure redistribution (mattress, cushions, heel support)
- Repositioning
- Regular skin assessment
What is levodopa commonly combined with?
Decarboxylase inhibitor e.g carbidopa to prevent peripheral metabolism of levodopa to dopamine
Hypocalcaemia symptoms?
- Peripheral paraesthesia
- Muscle cramps
- Seizures
- Prolonged QT
Hypercalcaemia symptoms?
- Bone pain
- Fractures
- Renal stones
- Drowsiness/Delirium
- N+V, Weight loss, shortened QT
What MMSE score supports dementia?
<25
What should be done after 5 years of bisphosphonate Tx?
- Repeat DEXA/FRAX and stop bisphosphonate is low risk and review in 2 years
How do bisphosphonates work?
- Pyrophosphate analogues -> inhibit osteoclasts
Bisphosphonate S/E?
- Dizziness
- Electrolyte imbalance
- GI disorders (oesophagitis for Alendronic)
- Anaemia
- Headache
- Myalgia
Causes of malnutrition?
- Starvation
- Increased nutrient requirement (sepsis/injury)
- Malabsorption
Diagnosis malnutrition
- BMI < 18.5
- > 10% weight loss in last 3-6 months
- BMI < 20 and weight loss
Causes of malnutrition
Intake: mealtimes, feeding problems, appetite, pain, surgery, medication
Increased requirement: trauma, surgery, malignancy
Loss: diarrhoea, vomiting, IBD, surgery
Consequences of malnutrition
- Impaired immunity
- Impaired wound healing
- Muscle mass loss
- Resp function loss
- Longer recovery from illness
- Lower quality of life
Mental Capacity Act Guidelines
- Assume capacity
- Maximise decision-making capacity
- Freedom to make unwise decisions
- Best interests
- Least restrictive option
Advanced directions
Advanced refusal - legally binding
Advanced requests - not legally binding but considered
- Allows people to state treatment wishes in advance to authorise certain procedures and refuse treatment
- It must be an adult, fully competent at that time, applicable to current circumstances and no reason to believe they have changed their mind
DOLS
- Person does not consent to care/treatment
Lasting Power of Attorney
- Nominate someone else to make decisions on their behalf
- Registered with Office of the Public Guardian
IMCA
- Support and represent people who lack capacity and do not have anyone else to represent them
What is frailty?
State of increased vulnerability resulting from ageing-associated decline in functional reserve
Assessment tool for delirum?
4-AT
What tool is used to assess nutritional status?
MUST tool
Complications of re-feeding syndrome?
- Cardiac arrhythmias
- Coma
- Convulsions
- Cardiac failure
Blood tests to exclude treatable causes of dementia?
- Vitamin B12, thiamine, folate
- Thyroid
- FBC
- Syphillis serology
- LFTs
3 adverse effects of bisphosphonates?
- Oesophagitis
- Osteonecrosis of the jaw
- Increased risk of atypical stress fractures of the proximal fracture shafts
Role of vit D
Increase Ca2+ absorption in the gut
Increased Ca2+ release from the bone
