Geriatrics Flashcards
What are predisposing and precipitating factors (>9) of delirium?
Age >65, dementia, visual/hearing impairment, alcohol, comorbidities, depression. Hip #, kidney/liver failure, cardiac event, constipation, infection (CNS, urine, lung), bleed/stroke, seizure, BSL, sodium, steroids, opioids, anticholinergics.
What workup is recommended for delirium?
Collateral history, vitals, pain assessment, ECG, FBE, UEC, Ca, LFTs, BSL. CTB if old/blood thinner. Consider CXR, trop, urine, bladder U/S, LP.
How is delirium managed?
Treat pain, manage bowel/bladder function, involve family, quiet environment, use hearing and visual aids, adequate daytime lighting, support safe mobilisation. Meds: haloperidol (not in PD), quetiapine, maybe olanzapine.
What are 4 features of end of life care discussions? What is included in an advance care directive?
Ensuring information is verified, check pt understanding and how much they want to know, provide info as requested, document. Goals of care, place of care, appointing substitute decision maker.
When is a syringe driver indicated? What medications are used? SE?
Aspiration risk, N/V, reduced LOC, poor enteral absorption. Morphine (10mg/24 + PRN) midaz/clonaz for dyspnoea/agitation, glycopyronnium or hyoscine butylbromide for secretions, maxalon. N/V, constipation, drowsy, itch.
What are some differentials for confusion in an older person? 9
Delirium, dementia, CVA, depression, cancer, normal pressure hydrocephalus, hyponatraemia, hypo/hyper thyroid, B12 deficeincy.
What are known risk factors for dementia?
Sedentary lifestyle, excess alcohol, smoking, head injury, social isolation, Fhx, air pollution, hearing impairment, depression.
What tests are indicated in a dementia workup?
FBE, UEC, ESR, LFT, Ca, glucose, TFT, B12, folate, CT brain. Can add: CXR, lipids, urine, HIV, syphilis.
What are the 6 non-pharm aspects of dementia management?
Info (dementia australia), medication aids, myaged care for support services, review driving - authority notified by pt, encourage healthy lifestyle (exercise, smoking, alcohol, sleep) , consider MTDM and ACD.
What 1st line medication for dementia - SE, forms, use,C/I
Acetylcholinesterase inhibitor for alzheimers and lewy body: donepezil, galantamine, rivastigmine patch, if MMSE >10 and specialist diagnose. N/V/D, dizzy, vivid dreams, urinary incontinence, drowsy. C/I: PUD, GI/ureteric obstruction.
What 2nd line medication for dementia?
NMDA receptor antagonist - memantine. For more severe, MMSE 0-14. C/I in epilepsy.
How do you screen for falls?
Ask - presenting following a fall, 2 or more in falls in 12mo, difficulty with walking or balance. If any positive, do multifactorial risk assessment.
How are UTIs tested for and managed in RACF?
Consider sample and treating if: acute dysuria OR fever/confusion + urinary symptoms/exam findings OR catheter with fever/confusion/flank pain. Asymptomatic bacteruia is common, don’t screen or treat.
What are the causes and workup of weight loss in the elderly?
Intentional, cancer, GI (PUD, IBD), psych (depression, eating disorder), thyroid, diabetes, TB, HIV, dementia, alcohol. FBE, iron, folate, UEC, CMP, diabetes, TSH, LFT, FOBT.
