Geriatrics Flashcards

1
Q

Delerium

A

Acute, fluctuating change in mental status with inattention, disorganised thinking and altered levels of consciousness

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2
Q

Types of delerium

A
  • hypoactive: lethargy, decreased motor activity, incoherent speech, lack of interest
  • hyperactive: restless, agitation, hallucination
  • mixed
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3
Q

What are the causes of delerium?

A
  • change in environment and sensory impairment
  • UTI
  • constipation
  • Hypoxia
  • infection
  • metabolic disturbance
  • pain
  • nurtrition
  • lack of sleep
  • hypothermia/pyrexia
  • organ dysfunction
  • environmental change
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4
Q

Investigation for delirium

A
  • cognitive assessment: MMSE, AMTS
  • confusion screen: FBC, UEs, LFTs, coagulation/INR, TFTs, calcium, B12, folate, glucose, blood cultures
  • urinalysis
  • consider imaging
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5
Q

What is the management of delerium?

A
  • identify and treat the cause
  • keep a consistent nursing and medical team
  • ensure patient is as independent as possible and has required aids
  • clock and orientation reminders, familiar objects, involve the family
  • Haloperidol if necessary
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6
Q

What are the common causes of dementia?

A
  • alzheimers
  • cerebrovascular disease (vascualr alzheimers)
  • lewy body dementia
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7
Q

Alzheimers disease

A
  • memory loss
  • loss of social and occupational functioning
  • diminished executive function
  • speech and motor deficit
  • personality change
  • behavioural and psychological disturbance
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8
Q

Investigation for alzheimers

A
  • bedside cognitive
  • FBC to rule out anaemia
  • metabolic panel
  • TSH to rule out thyroid
  • B12
  • CT/\MRI
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9
Q

Management of alzheimers

A
  • supportive care: education, support, resources
  • Occupational therapist: home safety evaluation
  • Cholinesterase inhibitor: donepezil
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10
Q

presentation of lewy body dementia

A
  • hallucination
  • delusion
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11
Q

What is malnutrition?

A

BMI<18.5 or unintentional weight loss greater than 10% with the last 3-6 months or a BMI of <20 and unintentional weight loss of >5% within the last 3-6 months

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12
Q

Screening for malnutrition

A

MUST

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13
Q

Investigation for malnutrition

A
  • FBC
  • urinalysis
  • serological testing for coeliac disease
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14
Q

What is the management of malnutrition?

A
  • Dietician if high risk
  • food first approach with clear instruction
  • oral nutritional supplements between meals
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15
Q

What are the complications of malnutrition?

A
  • impaired immunity
  • poor wound healing
  • growth restriction
  • unintentional weight loss
  • multi organ failure
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16
Q

What is sarcopenia?

A

Loss of skeletal muscle mass and strength

17
Q

Investigaation for sarcopenia

A
  • grip strength
  • muscle mass DXA
  • gait speed/timed up and go test
18
Q

What are the causes of sarcopenia?

A
  • nutritional
  • inactivity
  • disease: bone/joint, metabolic disorder, endocrine, cancer
  • iatrogenic
19
Q

How can you differentiate between sarcopenia and malnutrition?

A
  • Sarcopenia: Decreased muscle mass and strength
  • Malnutrition: decreased muscle mall with normal strength
20
Q

What is the management of sarcopenia

A
  • resistance exercise
21
Q

What is the presentation of depression?

A
  • depressed mood/loss of interest, most of the day, everyday for 2+ weeks
  • diminished pleasure/interest in all/most activities everyday for 2+ weeks (anhedonia)
  • functional impairment
  • weight change
  • libido change
  • sleep disturbance
  • low energy, poor concentration, excessive guilt
  • suicidal ideation
22
Q

Investigation for depression

A
  • FBC
  • metabolic panel
  • TFTs
23
Q

Management of depression

A
  • psychosocial intervention (CBT/guided self help/mindfulness). Antidepressant if patient preferance (SSRI)
24
Q

SSRI

A

Citalopram or sertraline

25
Q

What are the complications of depression?

A
  • suicide
  • substnace misuse
  • persistnet symptoms
  • recurrence
  • reduced quality of life
26
Q

What is multimorbidity?

A

Presence of two or more long term health conditions including: defined physical or mental health conditions, learning disabilities, symptoms complexes such as chronic pain, sensory impairements and alcohol or substance misuse

27
Q

What are the risk factors for multimorbidity?

A
  • age
  • female
  • low socioeconimic status
  • tobacco and alcohol usage
  • lack of physical activity
  • poor nutrition adn obesity
28
Q

What are the complications of multimorbidity?

A
  • decreased quality of life and life expectancy
  • increased treatment burden
  • mental health issues
  • polypharmacy
  • negaitv eimpacts on carers welfare
29
Q

Assessment of multimorbidity

A
  • establish the extent of disease burden
  • ask about social circumstances
  • assess adequacy of pain management
  • assess frailty through gait speed, PRISMA-7 or self reported health status
30
Q

Management of multimorbidity

A
  • maximise benefits of existing treatments
  • reduce numbers of high risk meds and consider non pharmacological interventions
  • STOPP/START
  • individualised managment plan
  • promote self management
  • support carers and families