Geriatrics Flashcards
risk factors for dementia (modifiable and non modifiable)
- Non-modifiable
- Age
- Female > Men
- Genetic factors
- Down syndrome
- Family history
- Modifiable
- Smoking
- Alcohol intake
- Level of education
- Level of physical activity
clinical features of dementia
- Activities of daily living
- loss of independence in accustomed ADL
- Behaviour (altered)
- Cognitive: Memory deficits (recent > remote)
reversible causes of dementia
- Drugs (anti-cholinergics, H2 blockers, BZPs)
- Emotional (Depression)
- Metabolic (Hypothyrodism, hypercalcemia)
- Eyes and ears (sensory isolation)
- Normal pressure - Hydrocephalus
- Broad-based gait
- Tumour or other space-occupying lesion
- Infection (syphilis, HIV)
- Anemia (vitamin B12 deficiency)/ Alcoholism
irreversible causes of dementia
- Degenerative Brain Disease
- Alzheimer’s disease (MUST KNOW)
- Parkinson’s disease (MUST KNOW)
- Lewy body dementia
- Frontotemporal dementia
- Progressive supranuclear palsy
- Genetic (e.g. Huntington’s, Wilson’s)
- Vascular dementia
- step-wise decline in severe infarcts
- Prion diseases
4 As of alzheimers
Amnesia, Apraxia, Aphasia, Agnosia (inability to recognise and identify objects)
what is the most common cause of dementia
alzheimers
morphology of alzheimers
- Morphology
- Gross
- brain appears smaller and atrophied
- Cortical atrophy leads to the widening of the cerebral sulci
- Histology
- abnormal protein deposition in the
hippocampus, neocortex, and amygdala - amyloid plaques deposited extracellularly
- neurofibrillary tangles
- abnormal protein deposition in the
- Gross
risk factors for depression
- Biological
- Family history
- Past history of depression
- Social
- Loss of family and friends (bereavement)
- Isolation
- Loss of job/income
- Physical
- Specific diseases such as CVS, thyroid disorders, cancers
- Chronic medical conditions, chronic pain
- Psychological
- Anxiety
- Dementia
- Substance abuse
clinical features of depression
- Affective (Mood): Low mood, sadness, loss of interest or pleasure in usual activities, feelings of guilt, suicidal
- Behavioural: psychomotor slowing or agitation, fatigue, loss of energy, poor sleep, altered appetite
- Cognitive: poor concentration, memory or decision making
causes of delirium in elderly
- D: Drugs
- E: eyes, ears
- L: low oxygen state (AMI, stroke, GI Bleed)
- I: Infection
- R: Retention of urine or faeces
- I: Ictal
- U: Underhydration, undernutrition
- M: Metabolic
- S: Subdural
delirium diagnosis via Confusion Assessment Method (CAM)
Diagnosis: Must have 1 and 2 & either 3 or 4
- Acute change in mental status and fluctuating course
- Inattention
- Disorganised thinking
- Altered level of consciousness
- can be hyper-alert, drowsy or unarousable
morbidities from falls in the elderly
- Minor injuries (very common): bruising, abrasions, lacerations, strains and sprains
- Major injuries (10-15% of falls): fractures, head/brain injuries, soft tissue injuries
- Death: leading cause of death in persons > 65 years old
- Fear of falling → self-imposed restriction in mobility → functional decline (cycle)
- present in 30-73% of elderly (post fall anxiety syndrome)
intrinsic factors that cause falls
- Neuromuscular conditions
- Parkinson’s, stroke, postural hypertension, stroke, arthritis
- Sensory Impairment
- Vision impairment, hearing loss,
lower limb numbness
- Vision impairment, hearing loss,
- Cognitive impairment and dementia
- Poor attention, poor safety awareness, poor problem solving
- Polypharmacy and side effects of medication
- Antihypertensive, anti-depressants, anti-parkinsonian
extrinsic factors that cause falls
- Extrinsic factors (environment)
- Poor building design
- Cracked/uneven sidewalks,
narrow corridor
- Cracked/uneven sidewalks,
- Cluttered walkways
- Slippery floors, loose rugs, poor lightning etc
- Inappropriate footwear
- Poor building design
- Extrinsic factors (Socio-economic)
- Low income/education (e.g. unable to afford home modifications/services etc)
- Poor social support (e.g. single elderly household, elders with no living relatives etc)
- Lack of community resources
Fall risk increasing drugs and their mechanisms for falls
In decreasing order*:
antidepressants (SSRIs, TCAs) -> Confusion, blurry vision
antipsychotics -> Rigidity, shuffling gait, slow movement
Sleeping pills (benzodiazepines) -> Confusion, slowed psychomotor effects
CVS drugs (BP medication) -> Hypotension/postural hypotension
opiate drugs -> Sleepiness, dizziness, confusion
diuretics -> Hypotension
antiepileptics -> Confusion, dizziness
management strategies to prevent falls
- medication review
- home assessment: non-slip mats and grab bars
- check if patient has caregiver or living alone
- assistive devices and training: appropriate walking aids if needed
- assessment of visual acuity before discharge
physiological changes in elderly that will predispose them to falls
- Sarcopenia: age-related loss of skeletal muscle mass and strength
- Neurodegeneration: causes general slowing of psychomotor and cognitive speed
- Presbyopia, due to elastic degeneration of lens
- Postural changes
differences between dementia, depression and delirium
Delirium: acute onset, fluctuating course, clouded disorientation
Dementia: insidious (gradual) onset, steadily progressive course, clear consciousness and orientation until later stages
Depression: variable onset, diurnal variable course, generally unimpaired consciousness and orientation
*Inattention differentiates delirium from dementia (delirium has inattention)
