Geriatrics Flashcards
Delerium
Acute, fluctuating change in mental status with inattention, disorganised thinking and altered levels of consciousness
Types of delerium
- hypoactive: lethargy, decreased motor activity, incoherent speech, lack of interest
- hyperactive: restless, agitation, hallucination
- mixed
What are the causes of delerium?
- change in environment and sensory impairment
- UTI
- constipation
- Hypoxia
- infection
- metabolic disturbance
- pain
- nurtrition
- lack of sleep
- hypothermia/pyrexia
- organ dysfunction
- environmental change
Investigation for delirium
- cognitive assessment: MMSE, AMTS
- confusion screen: FBC, UEs, LFTs, coagulation/INR, TFTs, calcium, B12, folate, glucose, blood cultures
- urinalysis
- consider imaging
What is the management of delerium?
- 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
What are the common causes of dementia?
- alzheimers
- cerebrovascular disease (vascualr alzheimers)
- lewy body dementia
Alzheimers disease
- memory loss
- loss of social and occupational functioning
- diminished executive function
- speech and motor deficit
- personality change
- behavioural and psychological disturbance
Investigation for alzheimers
- bedside cognitive
- FBC to rule out anaemia
- metabolic panel
- TSH to rule out thyroid
- B12
- CT/\MRI
Management of alzheimers
- supportive care: education, support, resources
- Occupational therapist: home safety evaluation
- Cholinesterase inhibitor: donepezil
presentation of lewy body dementia
- hallucination
- delusion
What is malnutrition?
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
Screening for malnutrition
MUST
Investigation for malnutrition
- FBC
- urinalysis
- serological testing for coeliac disease
What is the management of malnutrition?
- Dietician if high risk
- food first approach with clear instruction
- oral nutritional supplements between meals
What are the complications of malnutrition?
- impaired immunity
- poor wound healing
- growth restriction
- unintentional weight loss
- multi organ failure
What is sarcopenia?
Loss of skeletal muscle mass and strength
Investigaation for sarcopenia
- grip strength
- muscle mass DXA
- gait speed/timed up and go test
What are the causes of sarcopenia?
- nutritional
- inactivity
- disease: bone/joint, metabolic disorder, endocrine, cancer
- iatrogenic
How can you differentiate between sarcopenia and malnutrition?
- Sarcopenia: Decreased muscle mass and strength
- Malnutrition: decreased muscle mall with normal strength
What is the management of sarcopenia
- resistance exercise
What is the presentation of depression?
- 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
Investigation for depression
- FBC
- metabolic panel
- TFTs
Management of depression
- psychosocial intervention (CBT/guided self help/mindfulness). Antidepressant if patient preferance (SSRI)
SSRI
Citalopram or sertraline
What are the complications of depression?
- suicide
- substnace misuse
- persistnet symptoms
- recurrence
- reduced quality of life
What is multimorbidity?
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
What are the risk factors for multimorbidity?
- age
- female
- low socioeconimic status
- tobacco and alcohol usage
- lack of physical activity
- poor nutrition adn obesity
What are the complications of multimorbidity?
- decreased quality of life and life expectancy
- increased treatment burden
- mental health issues
- polypharmacy
- negaitv eimpacts on carers welfare
Assessment of multimorbidity
- 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
Management of multimorbidity
- 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
