Geriatrics Flashcards
What are the risk factors for developing delirium?
Age > 65 years
Background of dementia
Significant injury
Frailty/multimorbidity
Polypharmacy
What are potential causes of delirium?
Infection (especially UTI)
Metabolic (eg. hypercalcaemia, hypoglycaemia, hyperglycaemia, dehydration)
Change in environment
Significant cardiovascular/respiratory/neurological/endocrine condition
Severe pain
Alcohol withdrawal
Constipation
What are the features of delirium?
Memory disturbance (particularly short term memory)
Agitation/withdrawal
Disorientation
Mood changes
Visual hallucination
Disturbed sleep cycle
Poor attention
What is the management of delirium?
Treat underlying cause
Modify the environment
First line sedative = haloperidol or olanzapine
What are the risk factors for Alzheimer’s disease?
Increasing age
Family history
Caucasian
Down’s syndrome
What changes in the brain are seen in Alzheimer’s
Widespread cerebral atrophy (especially cortex and hippocampus)
Cortical plaques due to deposition of beta-amyloid
Neurofibrillary tangles due to tau protein
What is the presentation of Alzheimer’s disease?
Gradually worsening memory loss
Decline in cognitive ability
Able to remember events in the long-term past
What is the management of Alzheimer’s disease?
Offer a range of activities to promote wellbeing
Cognitive rehabilitation
Mild to moderate –> ACh-esterase inhibitors (donepezil, galantamine, rivastigmine)
Second line or severe dementia = memantine
What are the features of Lewy body dementia?
Progressive cognitive impairment (attention and executive functioning impairments rather than just memory loss as in Alzheimer’s)
Parkinsonism
Visual hallucinations
What is the management of Lewy body dementia
Acetylcholinesterase inhibitors (eg. donepazil, rivastigmine)
Memantine
What are the common features of frontotemporal dementia?
Personality change
Impaired social conduct
Hyperorality
Disinhibition
Increased appetite
Perseveration
What are risk factors for developing pressure ulcers?
Malnourishment
Incontinence
Lack of mobility
Pain (leads to reduction in mobility)
What is the grading system for pressure ulcers?
Grade 1 = Skin intact, discolouration, oedema, warmth
Grade 2 = Partial thickness skin loss, superficial, presents as an abrasion or blister
Grade 3 = Full thickness skin loss, damage/necrosis of subcutaneous tissue, extending due to (but not through) underlying fascia
Grade 4 = Extensive destruction with damage to muscle, bine or supporting structures, with or without full thickness skin loss
What is the management of pressure ulcers?
Maintain a moist wound environment to encourage healing –> hydrogels/hydrocolloid dressings
Avoid antibiotics unless indications of infection
May require surgical debridement
What is the START tool?
Screening Tool to Alert doctors to the Right Treatment
Used in multimorbid patients to decide whether the introduction of a new medication would be beneficial
