Geriatrics

Question 1

define frailty

Answer 1

• all organ systems working at max capacity on a daily basis, making them very vulnerable to decompensation in the presence of a minor stressor.
• (multi-system impairment associated with increased vulnerability to stressors )

Question 2

frailty is exclusive to the elderly T/F

Answer 2

False
pts with long term conditions such as diabetes can experience frailty.

Question 3

frailty is irreversible T/F

Answer 3

False

Question 4

most common presenting complaints

Answer 4

• The 4 I’d
• Instability -falls
• Intellectual impairment - confusion
• Incontinence
• Immobility - off legs
  also:
  chest pain, SOB, urinary sym ptoms.

Question 5

what are the geriatric giants

Answer 5

• desciptions not diagnoses - e.g. pt presents with delerium but the diagnosis = UTI
• have multiple causes
• often have chronic causes
• cause a loss of independence
• no simple cure

Question 6

elderly pateints’ disease presentation is the same as younger counter parts T/F

Answer 6

False - elderly pts can have a different pattern of disease preentation

e.g. pneumonia but with no breathlessness

Question 7

problems with polypharmacy

Answer 7

• prescribing cascade e.g. long terms aspirin +clopi requires a PPI
• repeated drugs
• contrasting drugs - B-blocker +B-agonists
• interactions

Question 8

define deconditioning

Answer 8

• deterioration that occurs in the context of an acute illness
• caused by
  
  • being bed bound for days –> loss of muscle
  • confusion from the illness
  • poor nutritional state
• results in reduced ability to walk, –> falls –> inability to look after themselves.

Question 9

what is a comprehensive geriatric assessment

Answer 9

• Multidimensional, multidisciplinary diagnostic process. (Not a form.)
• Focused on determining a frail older person’s medical, psychological and functional capability.
• Develop co-ordinated, integrated plan for treatment
• consists of: a medical, functional, psychological and social and environmental assessments

Question 10

what is rehabilitation

Answer 10

• process of restoring the pt to max function - pre-morbid fx.
• MDT approach
• can happen in or out of hospital
• leads to discharge planning

Question 11

3 ways to assess frailty

Answer 11

1. clinical frailty scale CFS
2. wlaking speed - timed up and go test <12 secs
3. poor grip strength

• also what the pt looks like and cumulative deficit model where more problems = worse prognosis

Question 12

what might indicate pt is approaching end of life

Answer 12

• situation specific - i.e. pt has multiple co-morbidities and one or more acute conditions on top and not improving
• clinical indicators:
  
  • 2 or more unplanned hospital visits in the last 6 months
  • persistent and recurent infections
  • weight loss >5% in the last 6months
  • dementia and frailty combined
  • delerium
  • rapidly rising frailty score over time
  • increasing pt or carer distress
  • mulimorbidity in addition to frailty

Question 13

define sarcopenia

Answer 13

loss of muscle mass or function

Question 14

what can be used to assess sorcopenia

Answer 14

• gait speed
• grip strength

Question 15

causes of sarcopenia

Answer 15

• aging
• disease
• chronic undernutrition
• disuse atrophy - seen during hospital admissions

Question 16

what is a major consequence of sarcopenia

Answer 16

• reduced VO2 max = lungs ability to breath –> huge conseqences for day to day activities especially in management of pts with acute resp failure

Question 17

how is sarcopenia + frailty managed

Answer 17

Question 18

define delerium

Answer 18

• An acute confusional state that fluctuates in severity + is usually reversible
• Usually the result of another organic process

Question 19

define dementia

Answer 19

• A syndrome of acquired, chronic, global impairment of higher brain function, in an alert patient, which interferes with the ability to cope with daily living.

Question 20

define BPSD

Answer 20

• Behavioural and psychological symptoms of dementia
• Heterogenous group of non cognitive symptoms and behaviours e.g. agitation, irritability, depression, disinhibition, hallucinations.

Question 21

what is included in a confusion screen blood test

Answer 21

• calcium [hypercalcaemia]
• B12
• folate
• TFT
• when deranged can cause confusion

Question 22

types of delerium

Answer 22

1. hyperactive delerium
   2.hypoactive delerium

Question 23

features of hyperactive delerium

Answer 23

• agitation
• delusions
• hallucinations
• wandering
• aggression

Question 24

risk factors of hyperactive delerium

Answer 24

• old age
• dementia
• past hx of delerium
• significant comorbidities
• sensory impairment
• change of environment

Question 25

causes of hyperactive delerium

Answer 25

• infection
• drugs - initiation or withdrawal
• metabolic
• neurological
  PINCHME

Question 26

management of hyperactive delerium

Answer 26

1. non-pharmacological = 1st line
   
   • orientation, reassurance, continuity (staff/ environment), provide hearing aids/ glasses, quiet environment etc
2. sedation = 2nd line
   
   • when pt is a risk to themselves or others
   • use lowest possible dose (lorazepam, haloperidol)

Question 27

risk factors of hypoactive delerium

Answer 27

• old age
• dementia
• past hx of delerium
• significant comorbidities
• sensory impairment
• change of environment

Question 28

causes of hypOactive delerium

Answer 28

• infection
• drugs - initiation or withdrawal
• metabolic
• neurological
  PINCHME

Question 29

symptoms of hypoactive delerium

Answer 29

• Lethargy
• slowness with daily task
• excessive sleeping
• inattention

Question 30

what can hypoactive delerium be mistaken for

Answer 30

depression