Geriatrics Flashcards
What are the symptoms of hyperactive delirium?
Confusion/disorientated, motor agitation, restlessness, aggression, hallucinations
What are the symptoms of hypoactive delirium?
Confusion/disorientated, motor retardation, apathy, slowing of speech, appear sedated, hallucinations
What are the common causes of delirium?
Pain, infection, nutrition, constipation, hydration, medication, environment (PINCH ME)
What are the risk factors for developing delirium?
Old age, dementia, sensory impairment, change of environment, sleep deprivation
How can you diagnose delirium?
Collateral history, MMSE
How can you differentiate delirium from dementia?
Delirium has sudden onset and fluctuates over days to weeks, variation in consciousness, impaired attention, psychomotor changes
What is involved in a delirium screen?
FBC, U+E, LFTs, TFTs, B12, folate, calcium, magnesium, syphilis serology, urine dipstick/MC+S, CXR
How do you treat agitation caused by delirium?
Haloperidol 0.5mg PO or IM= 1st line
Lorazepam = 2nd line
But try modifying the environment and reassurance/escalating techniques first
What are the risk factors for developing Alzheimer’s?
Early onset = autosomal dominant disease, Down’s syndrome
General = insulin resistance, high cholesterol, family history, hypothyroid, depression, HIV, Parkinson’s
What is the pathophysiology of Alzheimer’s?
General atrophy of brain tissue with frontal and temporal lobes being most affected (temporal will show first signs)
Amyloid plaques and Tau protein deposition in cortex
What are the features of vascular dementia?
Occurs in patients that have had strokes/hypertension/heavy smokers etc. due to multiple small infarcts in brain
Stepwise progression where there is period of stability followed by acute decline
What are the features of Lewy body dementia?
Vivid visual hallucinations, Parkinsonism (cognitive decline will precede this), sleep disorders, fluctuating cognition
What are the features of Fronto-temporal dementia?
Often family history
More common in people under 65
Changes in personality and behavior
What medications can be used in Alzheimer’s?
Donepezil (1st line if mild-to-moderate)
Memantine (1st line if moderate to severe)
Only initiate drug therapy in those with MMSE >12 as otherwise side effects will likely outweigh benefits
How is vascular dementia treated?
Reduce vascular risk factors - aspirin/warfarin, BP control
How is Lewy body dementia managed?
1st line = donepezil, rivastigmine
What medications can increase risk of falls?
Laxatives - urgency to go to toilet
Pain killers - can cause confusion
Diuretics/antihypertensives- drop in BP and postural hypotension
Benzodiazepines - cause sedation
What are some common causes of falls?
Postural hypotension, infection, cognitive impairment, hypoglycaemia, peripheral neuropathy, anaemia, dehydration, electrolyte abnormalities, chronic alcohol use, hearing/visual issues, environmental hazards, polypharmacy
What is the definition of postural hypotension?
Systolic drop >20mmHg when going from sitting to standing
Measure BP at 1 min and 3 min after standing
What medications can cause postural hypotension?
Nitrates, diuretics, anticholinergic, antidepressants, beta blockers, l-dopa, ACE inhibitors
What is the definition of a fragility fracture?
Fractures that result from mechanical forces that would not ordinarily result in fractures i.e. standing height or less
What are the risk factors for fragility fractures?
Increasing age, female, low body mass, steroid therapy, Cushing’s syndrome, excessive alcohol intake, falls
What is the definition of frailty?
A distinct health state characterised by a reduction in physiological reserve resulting in adverse outcomes following minor stressor events such as fall or infection
How can you manage frailty?
Regular review of medications, assess physical and mental health needs, address any risk factors for falls, create personalised care plan, support them to eat well
What are risk factors for incontinence in the elderly?
Dementia, UTIs, prostate issues, Parkinson’s, stool impaction
How can you manage urinary incontinence in the elderly?
Avoid caffeine, keep pathways clear and clutter free, regular bathroom breaks, bladder retraining, pads
What scoring system is used to identify patients at risk of developing pressure ulcers?
Waterlow score
What is the management of pressure ulcers?
Wound dressing, appropriate analgesia, nutritional assessment, pressure relieving support e.g. mattress
Only give antibiotics if there is signs of infection
When withdrawing treatment can you withdraw basic care needs such as food and drink?
No this must always be offered even if patient refuses
Can only withdraw advanced care needs like antibiotics
What is a lasting power of attorney?
Needs to be put in place when the patient has capacity
1 person for health and welfare and 1 person for financial - they are able to make decisions for you if you lack capacity
What is a court appointed deputy?
When patient has already lost capacity you can apply to court to act as someone’s deputy and make decisions on their behalf
What is an independent mental capacity advocate?
Person lacks capacity at the time the decision needs to be made and nobody else is willing to represent them
What is a deprivation of liberty safeguards?
Only applies to people who live in care homes or in hospital - the patient is unable to leave the place where they are cared for
How do you assess capacity?
Need to assess, retain, weigh up and communicate their decision
How can you differentiate depression and dementia?
Factors that suggest depression over dementia:
Short history/rapid onset
Weight loss, sleep disturbance
Patient worried about poor memory
Reluctant to do MMSE/tests
Global memory loss as opposed to short term memory loss
