Geriatrics Flashcards
Intervention with highest benefit to reduce risk falls
Exercise (in a patient at home not RACF)
CAM
Confusion assessment method- Delirium screen
Must have both Acute Onset and inattention plus one of disorganised thinking or altered consciousness
Multi-factorial interventions to prevent progression of dementia
Diet
Exercise
Cognitive training
Vascular risk reduction
FINGER STUDY
Most common type of urinary incontinence in elderly
Urge incontinence
Definition of frailty
Three or more of;
- Unintentional weight loss
- Self reported exhaustion
- Decreased grip strength
- Slow walking pace
- Low physical activity
Clinical frailty score
- Very fit - regular exercise, motivated, robust, no medical problems
- Well - occasional exercise, no medical problems
- Managing Well - Seasonal exercise, medical problems well controlled
- Vulnerable.- Symptoms limit ADLs but not yet reliant on others
- Mildly Frail - require assistance with higher order ADLs - transport, bills, shopping, cooking
- Moderately frail - require stand-by assist for all ADLs
- Severely frail - completely dependent on others
- Very severely frail - EOL care and likely to die of even a mild illness
- Terminal ill - < 6 months to live but are otherwise not evidently frail
Only intervention proven to reduce frailty
Exercise
Test of the benefits of exercise in elderly
6 minute walk test
Affects on sleep in elderly
NOT DECREASED need for sleep
- Increased nocturnal awaking or arousal
- Decreased Non-REM sleep (preserved REM sleep)
- Fragmented sleep-wake cycle
Definition of dementia
Chronic > 6 months, impairing personal or occupational activities with 2 or more impairment in
- Memory
- Executive function
- Attention
- Language
- Social cognition and judgement
- Psychomotor speed
- Visioperceptual or vsiospatial abilities
MUST have neuroimaging to make diagnosis
MMSE < 24
Side effects of Donepezil
Cholinergic side-effects
- Diarrhoea and GI upset is most common!
- Urinary frequancy
- Asymptomatic bradycardia
- Vivid dreams
- Headache
- Long QT
- Lowers seizure threshold
CADASIL
Cerebral Autosomal Dominant Arteriopathy with Subcortical infarcts and Leukoencephalopathy
Recurrent strokes/TIA in young patents 40 - 50 without risk factors, due to smooth muscle atrophy in blood vessels
Causes Vascular dementia
Notch 3 gene on Chromosome 19
Muscle biopsy will show arterioles with dense bodies
No treatment
Complicated by migraines, urinary incontinence, pseudobulbar palsy
Anti-psychotics for use in dementia/delirium
Respiridone in dementia
Haloperidol in delirium (does not sedate patients)
Drugs contributing to falls
Anti-depressants - SSRI (highest)
Anti psychotics
Benzos
Sedatives
Some Anti-HTN’s (highest shortly after commencement)
NSAIDs
Diuretics
Beta blockers and digoxin
Perindopril and indapamide protective!
Drugs contributing to falls
Anti-depressants - SSRI (highest)
Neuroleptics
Benzos
Sedatives
Some Anti-HTN’s (highest shortly after commencement)
NSAIDs
Diuretics
Beta blockers ad digoxin
Perindopril and indapamide protective!
Which medication is protective against falls?
Perindopril and indapamide
Medications associated with weight loss in elderly
Digoxin
Theophylline
Antipsychotics
SSRIs (Citalopram, Fluoxetine, Paroxetine) -> Amitryptaline causes weight gain!
Frusemide
Metformin
Cardiovascular changes in elderly
- Decrease in maximum heart rate
- Increase in end diastolic and end systolic volume
- Increase in stroke volume
- Reliance on Frank Starling mechanism
Weight re-distribution in elderly
Decrease in Subcut and appendicular fat
Increase in Visceral and Truncal fat
Changes in muscle fibres with ageing
Decreased Type 2 muscle fibres for gross, sustained movements
Preserved Type 1 muscle fibres for fine and precise movements
i.e. can knit but can’t run!
Changes in respiration with ageing
Increased Residual capacity and functional residual capacity
Decreased FEV1 > FVC
Decreased DLCO
Reduced respiratory drive to hypoxia and hypercapnia
Stable total lung capacity
Cause of Nocturia in elderly
Increased ANP in response to fluid retention
Visual impairment
Visual impairment
Visual impairment
Visual impairment
Strongest risk factor for fall
Prior falls
Strongest risk factor for delirium
Restraint Use
Malnutrition with BMI < 20
INCREASE BY FOUR-FOLD
HELP Model of delirium management
Orientation
Vision and Hearing aids
Early mobilisation
Non-drug approaches to sleep and anxiety
Fluid Replacement
Noise reduction
Drugs with reduced incidence of dementia
Perindopril and Indapamide
Barthol Score
For ADLs
- Feeding
- Bathing
- Dressing
- Grooming
- Toileting
- Bowels
- Bladder
- Mobility on flat surface
- Stairs
- Transfer bed to chair
The need for supervision renders the patient not independent
Worst Parkinsons Meds for side effect of psychotic symptoms
In order;
Anticholinergics (Amantadine, Selegiline)
Dopamine agonists (Pramipexole, Ritigotine)
Dopamine replacement (L.Dopa)
NH patient Vs community dweller risk of falling each year
Around 50% Vs. 30% (but increases to 50% > 80 years even in community dwellers)
Time to up and Go test
> 13.5 seconds indicates increased risk of falls
Visual aid interventions that improve falls risks
Cataracts
Singles lens help with outside falls only
Interventions to reduce falls in NH patients
Vitamin D supplementation for deplete patients (otherwise nothing)
Types of Fronto-temporal dementia
Behavioural - disinhibited, apathetic
Progressive Non-fluent Aphasia - slowed speech and problems understanding speech
Semantic - Problems recognising people or items, trouble finding the right word for objects
Types of Fronto-temporal dementia
Behavioural - disinhibited, apathetic
Progressive Non-fluent Aphasia - slowed speech and problems understanding speech
Semantic - Problems recognising people or items, trouble finding the right work for objects
Genes associated with Alzheimers
APOe4 - Late onset alzheimers and cardiovascular disease
Presenilin 1
Presenilin 2
Amyloid precursor proteins
Protective: APOe2
Types of Fronto-temporal dementia
Behavioural - disinhibited, apathetic
Progressive Non-fluent Aphasia - slowed speech and problems understanding speech
Semantic - Problems recognising people or items, trouble finding the right work for objects
Protein deposition and types of dementia
Alzheimers - Extracellular Beta Amyloid and intracellular Tau proteins forming Neurofibillary tangles
Lewy body dementia - intracellular Alpha-synuclein
Vascular dementia/Picks disease - Intracellular Tau proteins
FTD - Intracellular Tau and TDP-43
PSP - Intracellular Tau
CBD - Intracellular Tau
MSA - Alpha-synuclein
Mixed (LATE neuropathology) - Tau, Beta amyloid, alpha-synuclein, TDP-43
