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Geriatrics Flashcards

1
Q

What is delirium?

A

Syndrome of disturbed conciousness accompanied by change in cognition not accounted for by pre- existing dementia

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2
Q

What can delirium be thought of as?

A

Acute brain failure syndrome characterised by impaired conciousness

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3
Q

What causes delirium?

A

Pain
Infection
Medications
Electrolyte and fluid imbalance
Alcohol or drug intoxication
Cardiac, Respiratory or Liver failure
Endocrine dysfunction
Epilepsy
Intracranial pathology

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4
Q

What medications can cause delirium?

A

Anticholinergics
Anxiolytics
Hypnotics
Anticonvulsant
Opiates
Corticosteroids
Lithium
Digoxin
L-dopa

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5
Q

What is the pathophysiology of delirium?

A

Reversible impairment in cerebral oxidative metabolism, neurotransmission abnormalities and cholinergic deficiency

Stress also potentiates response

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6
Q

Why does stress play a role in pathophysiology of delirium?

A

Upregulation of sympathetic activity results in down regulation of parasympathetic tone furthering cholinergic deficiency.

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7
Q

Why are older patients at higher risk of delirium?

A

More vunerable to reduced cholinergic transmission

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8
Q

How is delirium classified?

A

Hyperactive, hypoactive and mixed

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9
Q

What are the risk factors for delirium?

A

Increasing age
Medical condition or taking regular medication
Poor hearing or vision
Infection
Poor dietary intake

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10
Q

What are the features of hyperactive delirium?

A

Restless and agitated
Aggression
Unusually vigilant

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11
Q

What is the presentation of hypoactive delirium?

A

Withdrawn, feeling lethargic and tired
Drowsy
Unusually sleepy
Unable to stay focused when awake

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12
Q

What is the presentation of mixed delirium?

A

Symptoms of both hypoactive and hyperactive delirium

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13
Q

What are the features of delirium?

A

Acute or subacute onset
Reversible
Diurnal or hour to hour fluctuation
Disturbance to circadian rhythm
Elements of hallucinations or misinterpretation
Behaviours of fear, agitation and aggression
Disturbed psychomotor behaviour
Poor short and long term memory
Poor insight

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14
Q

What investigations are performed to diagnose delirium?

A

MSE
Assess cognition
Urine dip to rule out UTI
FBC, CRP, LFT, glucose, U+E
Blood culture
Blood gas
Chest X-ray
Lumbar puncture
CT/ MRI

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15
Q

What is the management for delirium?

A

Treat the cause

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16
Q

How should delirium be managed in an unknown cause?

A

Supportive measures
Continually reassess and consider other tests

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17
Q

What medication can be given for symptom management in delirium?

A

Haloperidol

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18
Q

What are the complications of delirium?

A

Weakness
Malnutrition
Permanent cognitive decline

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19
Q

What is benign paroxysmal positional vertigo?

A

Peripheral vestibular disorder manifesting as a sudden, short lived episode of vertigo elicited by specific head movements

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20
Q

At what age is BPPV more likely to affect patient?

A

50 and 70 years

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21
Q

What is the cause of BPPV?

A

Primary/ idiopathic

Head trauma
Labyrinthitis
Vestibular neuronitis
Meniere’s disease
Migraines
Iatrogenic; Otological/ nonotological surgery, repositioning manoeuvres

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22
Q

What is the pathophysiology of BPPV?

A

Abnormal signals arising from semicircular canals leads to misinterpretation of movement
Mechanisms involve Canalithiasis, Cupuloithasis

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23
Q

What are the risk factors for BPPV?

A

Increasing age
Female sex
Head trauma
Vestibular neuronitis
Labyrinthitis
Migraines
Inner ear disease
Meniere’s disease
Otitis media
Osteoporosis

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24
Q

What is the clinical presentation of BPPV?

A

Head movements provoke symptoms
Brief duration of sudden onset episodic vertigo lasting less than 30 seconds
Nausea, imbalance, lightheadedness
Positive Dix- Hallpike manoeuvre
Normal neurological and otological examination

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25
What investigations are used to diagnose BPPV?
Dix- Hallpike manoeuvre Supine lateral head turns Audiogram Brain MRI
26
What are differentials for BPPV?
Meniere's disease Vestibular neuronitis Labyrinthitis Perilymphatic fistula CNS disorders
27
What is the management for BPPV?
Patient education and reassurance Repositioning manoeuvre Vestibular rehabilitation exercise Vestibular suppressant medication (Benzodiazepines, Antihistamines) Surgery
28
What is the monitoring need for BPPV?
Follow up few weeks post surgery Repeat Dix- Hallpike manoeuvre
29
What are the complications of BPPV?
Peri or post manoeuvre related BPPV Autonomic dysfunction Accident at work or home Hearing loss
30
What is the prognosis of BPPV?
Highly treatable
31
What are the differentials for delirium?
Depression Dementia Mental illness Hypothyroidism
32
What is a hip fracture?
Fracture of distal femur to the femoral head and proximal toa level few centimetres below lesser trochanter
33
What is the epidemiology of hip fractures?
More common in those over 65 years Average age is 83 years If below 40 years trauma is most likely to cause fracture
34
What are the causes of hip fractures?
Fall from standing height Osteopenia Osteoporosis High energy trauma
35
What is the pathophysiology of hip fracture?
Cortical disruption, periosteal damage, damage to intramedullary and cancellous architecture Cortical thinning and decrease in trabecular bone mass results in low bone quality Results in decreased mechanical strength resulting in fracture
36
How are hip fractures classified?
Intracapsular Extracapsular
37
What is the potential complication of intracapsular fracture?
Avascular necrosis due to cdamage to retinacular vessels
38
What are risk factors for hip fracture?
Osteoporosis Osteopenia Falls Low BMI Female sex High energy trauma
39
What is the clinical presentation of a hip fracture?
History of trauma or fall Pain in affected hip, groin, thigh Inability to bear weight on affected hip Shortened, externally rotated hip
40
Investigations used to diagnose hip fracture?
X-ray Blood screen ECG
41
What is seen on X-ray radiograph in a hip fracture?
AP view; interruption of shenton's line Lateral view; anterior displacement of femoral shaft/ neck relative to head
42
Differentials for hip fracture?
Acetabular fracture Pubic rami fracture Femoral shaft or subtrochanteric femur fracture Femoral head fracture Septic hip
43
What is the management of a hip fracture?
ABCDE Consider urgent trauma call Primary survey of patient Analgesia and nerve block Surgical management
44
What is the management for hip fracture if patient cannot tolerate surgery?
Analgesia, nerve block Bed rest Continue to monitor and reassess suitability for surgery Consider palliative care
45
What are the complications of a hip fracture?
Thromboembolic events Avascular necrosis Non uniform/ failure of fixation
46
What is the prognosis of hip fracture?
30% mortality at 1 year Majority of patients do not regain pre_fracture level of function Extracapsular fractures have a better prognosis
47
What is frailty?
Distinctive health state related to ageing process in which multiple body systems gradually lose their built in reserves Long term condition but not an inevitable part of ageing
48
What is the epidemiology of frailty?
10% of people over 65 25-50% of people over 85 years
49
What are the features of frailty?
Varies in severity Not static, can improve or decline Causes serious, adverse outcomes for patient
50
What is the pathophysiology of frailty?
Certain aspects of patients health or lifestyle lead to active inflammation in the system which becomes chronic Inflammatory mediators and response leads to pathological changes in muscle, endocrine system, the blood and heart All leads to signs and symptoms of frailty
51
Risk factors for frailty?
Advancing age Genetic Lifestyle; smoking. poor nutrition Environment
52
What is the clinical presentation of frailty?
Weakness Weightloss Exhaustion Low activity Slowed performance
53
What investigations are used to assess frailty?
Clinical frailty score
54
What are the complications of frailty?
Falls Disability Dependancy for ADL Surgery risks Death
55
What is Parkinson's disease?
Chronic progressive neurodegenerative disorder characterised by bradykinesia, resting tremor, rigidity
56
What is the epidemiology of Parkinsons disease?
Mean age of onset is 65 years Increasing prevalance with increasing age Greater incidence in men More common in white ethnicity
57
What is the pathophysiology of Parkinson's disease?
Mitochondrial dysfunction and oxidative stress results in degeneration of dopaminergic neurones from pars compacta Results in reduced striatal dopamine meaning thalamus is inhibited resulting in bradykinesia
58
What is the cause of Parkinson's disease?
Mitochondrial dysfunction Chronic heavy metal exposure Oxidative damage by free radicals Pesticides MPTP found in illegal opiates
59
How is Parkinson's classified?
According to age of onset Juvenile parkinsonism; under 21 years Young onset; between 21 and 40 years
60
Risk factors for Parkinson's?
Increasing age Family history Mutations in gene encoding Glucocerebrosidase MPTP exposure Male sex Head injury Chronic metal exposure Higher educational status
61
What is the clinical presentation of Parkinson's?
Asymmetrical Bradykinesia Resting tremor Cogwheel rigidity Parkinsonian gait Postural instability Micrographia Fatigue Depression and anxiety Sleep disorder Urinary problems
62
How is parkinsonian gait described?
Stooped posture, small shuffling gait, reduced arm swing, narrow base Difficultly initiating movement
63
What investigations are used to diagnose Parkinson's?
Clinical presentation and history Dopaminergic agent trial; improved symptoms MRI head
64
What is seen in a head MRI?
Brain atrophy Lewy bodies
65
What are the differentials for Parkinson's?
Essential tremor Dementia Drug induced parkinsonism Metabolic abnormalities Corticobasal degeneration
66
What is the non medical management for parkinsons?
Physiotherapy, Occupational therapy, Speech therapy Gait specific training
67
What is the medical management of Parkinson's?
Levodopa Decarboxylbase inhibitor e.g Co-careldopa Dopamine agonist e.g Ropinirole MOAB inhibitors e.g Selegiline COMT inhibitors e.g Entacapone Surgical ablation
68
Complications of Parkinsons ?
Levodopa induced dyskinesia Motor fluctuations Dementia Constipation, bladder dysfunction Depression, psychosis, anxiety
69
What is the prognosis of Parkinson's disease?
Symptom control as there is no curative or disease modifying medication Eventual cognitive dysfunction
70
What factors predict a poorer prognosis for Parkinson's disease?
Older age at symptom onset Rigidity, hypokinasia as presenting symptoms Decreased response to dopaminergic medications
71
What is dementia?
Syndrome characterised by deterioration in cognition resulting in impairment in ADL
72
What are the main types of dementias?
Alzheimer's dementia Vascular dementia Fronto temporal dementia Lewy body dementia
73
What is alzheimer's dementia?
Primary chronic neurodegenerative disease with insidious onset, progressive and slow decline
74
What is the epidemiology of Alzheimers disease?
Most common type of dementia More common in women, black and hispanic people Incidence rises with increasing age
75
Aetiology of Alzheimers dementia?
Build up of interneuronal amyloid peptides Autosomal dominant variant
76
What is the pathophysiology of Alzheimers dementia?
Overproduction or diminished clearance of beta amyloid protein leads to build up and formation of dense extracellular amyloid oligomers which are deposited as diffuse plaques Plaques lead to inflammatory process causing neuritic plaque formation resulting in cell and synaptic death Tau protein's accumulate in intraneural spaces as neurofibrillary tangles causing dystrophic neunites
77
What is a neurofibrillary tangle?
Intracellular aggregation of tau proteins
78
What are the risk factors for Alzheimers dementia?
Advancing age, family history Genetics; Down's syndrome, PSEN 1, PSEN2, Amyloid precursor protien Female sex Below secondary school education, Unemployment Lifestyle; smoking, midlife obesity, alcohol, T2DM
79
What is the clinical presentation of Alzheimer's dementia?
Memory loss Disorientation to time and place Dysphasia Apathy Change in personality Poor abstract thinking Constructional dyspraxia
80
What is seen on MRI scan in Alzheimer's dementia?
Generalised cerebral atrophy Predominance in medial temporal lobe and lateral parietal lobe
81
Investigations to diagnose and rule out differentials for dementia?
Bedside cognitive test ; MOCA, MMSE Bloods ; FBC, U+E, LFT, TFT, B12, Vitamin D, folate Urine drug screen CT Head
82
Differentials for dementia?
Delirium Depression Parkinsons disease Hypothyroidism B12, folate deficiency Bipolar disorder Major depression Substance misuse Normal pressure hydrocephalus HIV associated dementia
83
What medications can be used in Alzheimer's dementia?
Cholinesterase inhibitors e.g Donepezil, rivastigmine, galantamine NMDA receptor antagonist e.g Memantine Insomnia management ; Trazodone
84
What are the monitoring requirements for Alzheimers?
Every 6 months to evaluate functional and cognitive change, issues with medication, new signs and symptoms and review management
85
What are the complications of Alzheimers dementia?
Pneumonia institutionalisation Urinary tract infection Falls Weight loss Elderly abuse
86
What is frontotemporal dementia?
Primary neurodegenerative brain disease resulting in personality change, disruption in social conduct and language
87
What are the types of frontotemporal dementia?
Behavioural variant Primary progressive aphasia Movement disorders
88
What is the epidemiology of Frontotemporal dementia?
Midlife onset typically between 45 and 65 years Peak prevalance in 7th decade of life Male predominance
89
Aetiology of frontotemporal dementia?
Autosomal dominant mutations in microtubule associated genes Environmental causes; TBI, lifestyle factors
90
What is the pathophysiology of Frontotemporal dementia?
Neuronal loss, gliosis and microvascular changes in frontal lobes, anterior cingulate cortex and and insular cortex Abnormal intracellular accumulation of hyperphosphorylated tau proteins leads to abnormal neuronal communication
91
Risk factors for frontotemporal dementia?
Mutations in MAPT gene (FTD with parkinsonism phenotype) Mutations in GRN gene (FTD with behavioural phenotype) Traumatic brain injury
92
What in the clinical presentation of Frontotemporal dementia?
Disregard to social conventions Impatience and irritability Slovenly appearance Child like impulsive actions Poor emotional processing Progressive loss of language fluency or comprehension Memory impairment, disorientation Progressive self neglect, abandonment of work, activities and social contacts
93
What is seen on Brain MRI in frontotemporal dementia?
Focal atrophy in frontal and anterior temporal lobe Assymmetry between left and right side
94
What is the management of frontotemporal dementia
Supportive care and therapy Antidepressants and Antipsychotics Amantadine
95
What kind of supportive care is needed in frontotemporal dementia?
Home modification Occupational therapy Speech and language therapy Physiotherapy Behavioural management Will creation while cognition is still intact
96
What are the monitoring requirements for Frontotemporal dementia?
Comprehensive cognitive and behavioural evaluation every 6-12 months Assess driving status every 6 months
97
Complications of frontotemporal dementia?
Financial crisis Dangerous driving Problems with relationships Falls Legal crisis
98
What is the prognosis of frontotemporal dementia?
Shorter survival and faster rate of cognitive and functional decline than Alzheimers dementia
99
What is vascular dementia?
Chronic progressive impairment of cognitive function predominantly caused by vascular problems
100
Epidemiology of vascular dementia?
Second most common type of dementia More common in men
101
Aetiology of vascular dementia?
Infarction Leukoaraiosis Haemorrhage
102
What is the pathophysiology of vascular dementia when infarction is the cause?
Large infarct will exhaust compensatory mechanisms leading to widespread neuronal damage and dementia Small infarct affecting basal ganglia and thalamus lead to dementia
103
What is the pathophysiology of vascular dementia when Leukoaraiosis is the cause?
Loss of axons, myelin and oligodendrocytes Perivascular tissue is lost leading to dilation of perivascular space causing damage to capillaries and break down of BBB Can lead to haemorrhage and infarction
104
Risk factors for vascular dementia?
Over 60 years of age Obesity Hypertension Cigarette smoking Diabetes mellitus Hypercholesterolemia Alcohol misuse
105
What is clinical presentation of vascular dementia?
History of strokes Signs of frontal cognitive syndrome Impaired gait Focal neurological signs
106
What are signs of frontal cognitive syndrome?
Difficulty solving problems Apathy Disinhibition Slowed processing of information Poor attention Retrieval memory deficit Frontal release reflex ; glabella tap, jaw jack, grasp
107
What in the management of vascular dementia?
Lifestyle modification Antiplatelet therapy if atherosclerotic aetiology Anticoagulation if cardio-embolic aetiology Carotid endartectomy if stenosis over 70% Treat co-morbid conditions
108
What are the monitoring requirements for vascular dementia?
Every 4-6 months to monitor condition and after treatment Home safety assessment Assess driving status every 6 months
109
Complications associated with vascular dementia?
Depression Agitation Falls Stroke Aspiration pneumonia Decubitis ulceration
110
What is lewy body dementia?
Neurodegenerative disorder with parkinsonism, progressive cognitive decline, prominent executive dysfunction
111
What is the least common type of dementia?
Lewy body dementia
112
What is the aetiology of lewy body dementia?
Toxic protein aggregation Abnormal phosphorylation Nitration, oxidative stress, inflammation, lysosomal dysfunction Genetics; Autosomal dominant
113
What is the pathophysiology of Lewy body dementia?
Lewy bodies accumulate in CNS, density and location correlate to symptoms Cholinergic deficit
114
What is a Lewy body?
Alpha synuclein inclusion
115
What other inclusions may be present in Lewy body dementia?
Neurofilament light Ubiquitin
116
What is the clinical presentation of Lewy body dementia?
Fluctuation in cognition, attention and arousal Visual hallucination Motor symptoms REM sleep and behavioural disturbance Depression, anxiety Delusions and hallucination
117
What is seen on an MRI in Lewy body dementia?
Generalised cortical atrophy
118
What is the management for Lewy body dementia?
Supportive care Memantine Antipsychotics and antidepressants
119
What are the monitoring needs for Lewy body dementia?
Individual case If on cholinesterase inhibitor should be seen every 3-6 months
120
Complications of Lewy body dementia?
Pneumonia Institutionalisation Dysphagia Antipsychotic sensitivity Urinary incontinence Falls risk Elderly abuse
121
Prognosis of Lewy body dementia?
Progressive disease with steady decline in function, loss of independance and eventual death Mean survival post diagnosis is 5 years
122
What is mixed dementia?
Combination of dementia aetiologies producing a more severe phenotype in patient
123
What is a fall?
Fall as a result of chronic impairment in cognition, vision, balance or mobility
124
What isthe epidemiology of a fall?
More likely in older adults, 30% over 65 years will have a fall, and 50% over 80 years
125
What is the aetiology of falls?
Neuropsychiatric; Visual impairment, peripheral neuropathy, vestibular dysfunction, hearing impairment, gait and balance problems Cardiovascular; Syncope, orthostatic hypotension, carotid sinus syndrome, post prandial hypotension Musculoskeletal; Joint instability, mechanical problems, sarcopenia, osteosarcopenia, Sarcopanic deconditioning Toxic; Medications, Polypharmacy, Substance misuse Environmental hazards Poor lighting, uneven floor, presence of clutter, lives alone
126
Risk factors for falls?
Muscle weakness Poor balance Foot deformities Memory loss, confusion, difficulty with cognition Syncope Polypharmacy Substance misuse Drinking too much alcohol Bowel and bladder conditions MSK disorders
127
What investigations are performed following a fall?
Turn 180 test Time up and go test
128
What should be done after a fall?
Assess severity of fall Perform a risk assessment Educate on fall prevention
129
What emergencies can arise following a fall?
Sudden onset change in conciousness New head trauma Fractures
130
What is a pressure sore?
Localised damage to skin and underlying soft tissue usually cover bony prominence or around medical/ non medical device
131
Epidemiology of pressure sores?
Incidence increases with age Upto 2/3 in over 70 year olds 1 in 4 spinal injuries patients
132
Aetiology of pressure sore?
Pressure Shear Moisure Friction
133
What is the pathophysiology of pressure sore?
Deformation of cells from pressure and shear forces disrupts all structure resulting in death Compression of blood vessels causes transient ischaemia Blockage of lymphatics causes accumulation of toxic waste Can have some reperfusion injury and inflammatory response
134
Risk factors for pressure sores?
Immobility Sensory impairment Older age Surgery Intensive care stay Malnourishment History of pressure ulcer Environmental causes; surface and position Diabetes and peripheral vascular disease
135
How is a pressure sore graded?
Graded between stage 1 and 4 based on skin changes
136
How is a stage 1 pressure sore described?
Non blanching erythema, purple or maroon localised area of decoloursed intact skin
137
How is a stage 2 pressure ulcer described?
Shallow open wound or loss of fissue on area subject to pressure
138
How is a stage 3 pressure ulcer described?
Full thickness wound on areas subjected to pressure with or without underming
139
How is a stage 4 pressure sore described?
Full thickness wound with involvement of major tissues with/ without underming Exposed bone, tendon, muscle
140
What in the clinical presentation of a pressure sore?
Localised tenderness or erythema Increased exudate/ foul odour
141
What investigations are performed to diagnose a pressure sore?
Clinical diagnosis Swab wound to rule out infection Deep tissue biopsy
142
Why is it important to take pictures of pressure sores?
Monitor progression and compare to previous presentation
143
Differentials for pressure sore?
Moisture associated dermatitis Venous ulcer Arterial ulcer Diabetic neuropathy Pyoderma gangrenesum Osteomyelitis
144
What is the management of pressure sores?
Pressure reducing aids Reposition patient Hygiene and cleansing with dressings Analgesia For stage 3/4 ulcers consider antibiotic therapy or surgery
145
What are the monitoring requirements of pressure sores?
Assess risk routinely Regular repositioning of patient Swab sore for infection Regular dressings
146
Complication of pressure sores?
Sepsis Cellulitis Osteomyelitis Mortality
147
What in the prognosis of pressure sores?
High risk of recurrence especially in spinal injuries patients
148
What is elderly abuse?
Intentional act or failure to act that causes harm or creates risk to an older adult
149
What is the frequency of elder abuse?
Reported cases of 2.6% For every reported case upto 24 go unreported
150
Aetiology of elder abuse?
Physical and cognitive decline Psychosocial abnormalities in alouser Carer stress Environmental factors
151
Types of elder abuse?
Physical injuries Mental abuse Financial abuse Sexual abuse Neglect
152
Risk factors for elderly abuse?
Age over 75 years Cognitive impairment Dependance on carer for personal carer Depression /other mental illness Substance misuse in carer Financial dependance of older adult
153
Presentation of elder abuse?
Self report abuse Inconsistent history from carer and patient Agitated state Social isolation Physical injuries Malnutrition Improper medication use Carer dominance Pressure ulcers Shabby appearance
154
Differentials for elderly abuse?
Dementia Falls in elderly Medicine non adherence Substance abuse Depression
155
Investigations for elderly abuse?
Clinical photographs X-ray, CT head, abdomen Serum drug and toxicology screen
156
Management of elderly abuse?
Treat injuries Involve social services Report incidents to authorities
157
Complications of elderly abuse?
Pressure ulcer Fractures; Hip, ankle, wrist, rib, spinal compression fracture Brain injury Depression Delirium PTSD Death
158
What is polypharmacy?
Prescribing of medications no longer clinically indicated, appropriate or optimised for that person Combination of medications has potential to cause harm Practicalities of using medicines prescribed is unmanageable, causing harm or distress
159
Benefits to patient for tackling polypharmacy?
Fewer adverse drug reactions Fewer hospital admissions Improved patient outcome Shared decision making leading to greater commitment to treatment Improved relationship between patient and healthcare proffesional, education and managemencent of wider health issues
160
Benefits to healthcare system for management of polypharmacy?
Reduced burden on repeat prescribing systems Reduced waste medication Better value from funded medication Fewer avoidable hospital admissions
161
How common is constipation in elderly?
Affects over 1/3 of patients over 60 years
162
What is the aetiology/ risk factors for constipation?
Female sex Older age Inactivity Low calorie intake Low fibre diet Polypharmacy Low income
163
What is the clinical presentation of constipation?
Straining while opening bowels Difficulty passing stool Incomplete evacuation Hard stool Abdominal pain
164
What is the management of constipation?
Lifestyle changes; increased physical activity, adequate dietary fibre intake and fluids, reduce coffee, tea and alcohol Bowel training Provide laxative Enemas
165
Complications of constipation?
Syncope Anorexia Nausea Pain Ulcer which can perforate
166
What is urinary incontinence?
Involuntary accidental leakage of urine
167
What is the aetiology of urinary incontinence?
Weak bladder or pelvic floor muscles Overactive detrusor muscle Damage to nerves innerrating bladder Arthritis and mobility problems can delay reaching toilet Pelvic organ prolapse Injury during surgery
168
What are the types of urinary incontinence?
Stress incontinence Urge incontinence Overflow incontinence Functional incontinence
169
What are treatment options for incontinence?
Bladder control exercises Mediation Pessary Catheter Electrical nerve stimulation Surgery
170
What is malnutrition?
Deficiency or excessive nutrient intake, imbalance of essential nutrient utilisation leading to poor health and growth Affects all systems of the body, increasing vulnerability to illness
171
Epidemiology of malnutrition?
1 in 20 adults in UK are affected Costing NHS £20 billion per year
172
What in the aetiology of malnutrition?
Mental health condition Change in mental state; bereavement Low intake of food Social and mobility issues Digestive tract disorder; malabsorption, inflammatory bowel disease, IBS, dysphagia Dementia Alcohol use
173
Risk factors for malabsorption?
Increasing age Social isolation Low income Serious illness
174
Clinical presentation of Malnutrition?
Tiredness and low energy Loss of appetite Unintentional weightloss Clothes become lose Loss of fat, muscle mass and tissue Longer healing after cuts/ infection Dizziness / headache Difficulty keeping warm
175
Investigations for malnutrition?
MUST screening tool History + examination Blood texts to rule out organic cause
176
Management of malnutrition?
Involve dietician to start nutrition Monitor for re-feeding syndrome
177
Complications of malnutrition?
Re-feeding syndrome Fatigue and lethargy Falls Difficulty coughing Heart failure Anxiety, depression, psychosocial problem Reduced ability to fight infection
178
What is a DOLS?
Procedure described in law where it is necessary to deprive a patient or resident of their liberty who lacks capacity to consent to care/ treatment
179
Where is DOLS applicable?
Nursing home or hospital in England or Wales
180
What is a DNACPR?
In a situation in which patients heart stops beating or they stop breaking the healthcare team will not perform CPR

Phase 3A (7 decks)

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