Geriatrics Flashcards
What is the aim of geriatric practice
This is to achieve max independence for the patient in their given environment
Define frailty
This is a state of being in weak health
Who are the most at risk geriatric medicine patients
1.Those over 75
2. Female
3. Recently bereaved
4. Living alone
5. Functionally or cognitively impaired
6. Progressive physical illness
7. Socially disadvantaged
What are the 5 main medical assessments that need to be made on an elderly patient
- Identify the pathologies and the illnesses that they are struggling with
- Assess whether the chronic diseases are stable or progressing
- Screen for hearing and visual decline
- Optimise the medical treatment of conditions to decreases side effects and morbidity
- Assess the patient’s nutritional status
What are the 3 main psychological assessments that need to be made
- Cognitive function
- Mood
- Psychotic and behavioural problems
What are the 2 components of a functional assessment
- Occupational therapist needs to assess whether the patient is able to carry out the tasks of daily living
- Physical therapist needs to check the patient’s gait and balance to see if they are at risk of falling
What are the assessments that can be made by a social worker 4
- If the patient has support
- If the patient needs any care resources
- Financial resources of the patient
- Barriers to transport and measures on how to combat those
What are the 2 components of the environmental exam
- Safety hazards in the home especially for cognitively impaired and frail patients
- Physical barriers e.g. steps
What is the function of the social worker
Puts in place the support that the patients care givers need to cope in the community or arranges placement in a facility appropriate to the patients needs.
What is the function of the occupational therapist
gives education and aids to improve independence in daily functioning and recommends alteration to the environment to lessen hazards to falling and improve independence
What is the function of the physio
Improve strength and balance
What is an impairment
These are abnormalities of the body structure or organ
What is a disability
consequences of impairments in terms of functional performance and activities by the individual
What is a handicap
These are the disadvantages that a patient experiences as a result of their impairments and disabilities
What are the elements that contribute to a patient function and ultimately leads to their handicaps
- Environment
- Physical handicap
- Mental capability
What are the 3 main advantages to a formal tool that can be used to assess function
- It ensures that no area is overlooked
- It is validated
- It is consistent
What is the test that is used to assess Basic activities of daily life
Barthel index
What is the test that is used to assess Instrumental Activities of Daily Living that allow an individual to live independently e.g. managing finances
Lawton IADL index
What is the use of the Lawton and the barthel indexes
They are used to assess a patient’s function allowing us to understand whether additional care is needed e.g. step down
What is the function of the frontal lobe
It is used for planning and judgment
Which area of the brain is affected by alzheimer’s and how does it affect memory
The amygdala is affected, it causes the progressive loss of recent memories and slowly further into the past
What is meant by a word finding difficulty
This is where a person finds it difficult to express themselves
What is circumlocutory speech
a language disorder where a person uses excessive words or describes characteristics instead of using a name to refer to an object, event, or person
What is meant by paraphrasia
This is where the patient uses words that sound similar or are connected to the word that they are looking for in someway e.g. spoon instead of fork
What is Viseospatial ability
This is the ability to interpret and relate visual information to the space around you e.g. using a map to navigate
What is apraxia
This is the inability to perform learned motor actions despite intact motor function e.g. tying a shoe lace [Loss of muscle memory]
What is meant by agnosia
This is the loss of the ability to recognise objects
What are the 10 components of the mini mental state exam
- Orientation to time
- Orientation to the place
- Repetition of 3 words
- Attentension by spelling a word backwards
- Recalling the 3 words after a distraction task
- Repeating a phrase completely correctly
- Naming 2 common objects
- 3 step command test
- Apraxia test
- Visuospatial assessment
What is the cognitive test that is used to check planning
Clock face test
How to check generativity and initiation in a patient
Phonemic fluency test, this is where you ask the patient to start words with the same letter and then see how many words they can generate 12 is normal
How is abstract thought assessed
It is assessed by asking the person a proverb in their mother tough
How to check the patient’s ability to shift focus and attention
You provide the patient with a connect the numbers where they have to switch between numbers and letters
How do we assess motor sequencing
Luria hand sequence test: This is where you ask the patient to repeat 3 hand movements and see if they are able to do it
Which test gives better overall assessment than the MMSE
Montreal cognitive assessment MOCA
What are the 4 factors that influence physical function
- Sensation: The vision and hearing ability
- Skeletal integrity
- Motor coordination
- Endurance
How do you assess gait and mobility
Get up and go test
What is the interpretation of a romberg test
It evaluates the sensation in the proprioceptive pathways. A postural sway in the patient indicates that the patient has poor or slow peripheral nerve sensation or poor cognitive processing ability
How is the aerobic capacity of a patient tested
This is done with a 6 min walk
Define frailty
This is an older person with increased risk of morbidity, dependance and so mortality. It has no reversal capacity
What are the 4 main causes of frailty
- Sarcopenia [Loss of lean muscle]
- Atherosclerosis [Decreased aerobic capacity]
- Cognitive impairment
- Malnutrition
What are the social risk factors for becoming frail
- Low income
- Low education
- Lack of support structures
What are the primary and secondary causes of frailty
Primary: As a result of neuro hormonal and inflammatory changes in older people
Secondary: Due to advanced disease of any of the other systems
How can we measure the musculoskeletal function 2
- Grip strength
- Sitting up from a chair
How can we assess a persons aerobic capacity 3
- 6 min walk
- Sub maximal treatmill test
- 5m walk test
How can the neurological function be assessed 3
- Mini mental state exam
- Static balance test [Romberg]
- Sternal nudge
How can the nutritional state of a person be assessed 3
- BMI
- Arm muscle area
- Skin fold thickness
What are the 3 factors in frailty that lead to reduced mobility
- Sarcopenia
- Neurological impairment
- Skeletal changes
What are the 3 main modifiable risk factors for cognitive decline in frail patients
- Vascular: Screening and detection of risk factors like smoking, hypertension and dyslipidemia
- Hypothyroidism
- Vit deficiencies
What are the 2 interventions that should be done on all geriatric patients
- Vit d supplementation
- Review of medication
What is meant by functional incontinence
This is when a patient if physically incapable of getting to the toilet or is too confused to get there.
Define delerium
This is a complex neuropsychiatric syndrome that is categorised by fluctuating awareness and impairments in memory and attention
What are the 4 criteria of delirium
- Disturbances of consciousness e.g. reduced clarity
- Changes in cognition e.g. memory deficits
- The episodes fluctuate over time
- There is a cause e.g. neuronal loss
What is the difference between delirium and dementia 5
- Delirium has a rapid onset while dementia has a delayed onset
- Delirium causes early loss of attention while dementia only causes loss of attention later
- In delirium there is variable loss of arousal whereas in dementia only has late loss
- In dementia there are hallucinations but in dementia the hallucinations only happen later on
- Patient with dementia often develop fears later on whereas delirium patient have early fears
Define dementia
Any disease process that causes progressive decline in cognative function
What is the DSM 5 definition of dementia
This is a progressive decline in 2 or more spheres of cognitive function
What are the 4 spheres of cognitive function
- Memory
- Language [Word finding difficulties, circumlocutory speech and parapharasia
- Apraxia [inability to perform learned and purposeful movements]
- Executive function [Abstract thought]
What are the 6 possible causes of dementia
- Alzheimers
- Vascular: This is caused by reduced blood flow to the brain
- Infective causes like HIV and tertiary syphilis
- Metabolica causes e.g. hypothyroidism and B12 def
- Structural causes: Fronal lobe tumors and normal pressure hydrocephalus
- Neurodegenerative conditions
What are the tests that are appropriate for dementia
- Electrolyte and renal function
- Chest X ray and ECG
- TSH
- B12
- HIV
- Syphilis
What are the behavioral problems that often occur in dementia
- Depression
- Psychotic symptoms e.g. delusion, illusions or hallucinations
- Problems with aggression and agetation
What is the treatment given to slow cognitive impairment
- Cholinesterase inhibitors
- Memantine
Why are falls significant and when should they trigger a full workup
Falls are normally the presenting complaint of an underlying condition and if an elderly patient has fallen more than 2 times in the last year that should trigger a workup.
What are the 3 main medical causes of a fall
- Cardiovascular syncope: Postural hypotension [20mmHG in 3 mins], decreased intravascular volume, vasodilator drugs and autonomic failures
- Neurological: Strokes, epilepsy and dementia
- Musculoskeletal causes
What are the 4 conditions that cause vertigo without loss of consciousness
- Benign paroxysmal positional vertigo: Dx using the hallpike maneuver and is caused by otoliths in the semicircular canals
- Vestibular neuronitis: Associated with an URI
- Meniere’s disease: excess endolymph production
- Vertigo due to brainstem lesion
What causes dizziness/ presyncope without vertigo [No spinning only lightheaded] 5
- Postural hypotension
- Exertion
- Vertebrobasilar insufficiency
- Carotid sinus hypersensitivity
- Generalised anxiety disoder
What is the differential diagnosis for a fall with loss of consciousness 2
Seisures and syncope
What causes neurogenic syncope
This is caused by an over tiggering of the vagal tone resulting in decreased blood flow to the brain
What is carotid body hypersensitivity
This is when the carotid body in the neck becomes overly stimulated as a result of pressure on the neck resulting in overreaction triggers the parasympathetic nervous system
What are the 5 types of urinary incontinence
- Urge incontinence
- Stress incontinence
- Overflow incontinence
- Functional
- Mixed
What is urge incontinence
Characterized by a sudden, intense urge to void followed by involuntary urine leakage. It is often caused by overactivity of the detrusor muscle, which may be triggered by infections, bladder stones, or neurological conditions like stroke or multiple sclerosis.
What is stress incontinence
This occurs when there is leakage during activities that increase intra-abdominal pressure, such as coughing, sneezing, or exercising. More common in women
What is outflow incontinence
This type involves leakage due to an overfilled bladder, often caused by mechanical obstruction
What is functional incontinence
This is when an individual is not able to reach a toilet in time
What causes an urge incontinence
Overactivity of the bladder wall as a result of UTI, MS and bladder stones
What causes stress incontinence
Weak pelvic floor
What causes overflow incontinence
This is caused by a mechanical obstruction e.g. BPH
What is the management of urinary incontinence
- Behavioral management: Pads, and exercises
- Medical management: With anticholinergic drugs
- Surgical management: Strengthen the pelvic floor
What are the 3 possible causes of faecal incontinence
- Neurological lesions
- Structural lesions: Fecal impaction and masses
- Functional
