GERIATRICS Flashcards
DELIRIUM
what are the causes of delirium?
PINCH ME –
- Pain
- Infection (UTI, pneumonia, septicaemia)
- Nutrition (thiamine, B12 + folate deficiency)
- Constipation (faecal impaction)
- Hydration (dehydrated)
- Metabolic/medication
- Environment/electrolytes (changes in environment, hyper/hypo Ca2+, Na+, K+)
DELIRIUM
What is a suitable screening tool for delirium?
4AT (≥4 = likely) –
- Alertness
- AMT4 (age, DOB, hospital name, year)
- Attention (list months backwards)
- Acute change or fluctuating course
DEMENTIA
What might a MMSE score indicate in dementia?
MMSE (/30) –
- 21–26 = mild, 14–20 = mod, 10–14 mod-severe, <10 = severe cognitive impairment
ALZHEIMER’S DISEASE
What is the management of Alzheimer’s?
- No cure, does not improve life expectancy but thought to slow rate of decline + allow functioning at higher level
- 1st line = AChEi (donepezil, rivastigmine) for mild–mod
- 2nd line = NMDA antagonist (memantine) for mod–severe
LEWY-BODY DEMENTIA
What is the clinical presentation of Lewy-Body dementia?
- Fluctuating onset, progression, cognition + consciousness
- Vivid visual hallucinations (small children, animals)
- Parkinsonism (tremor, stooped + shuffling gait, hypomimia)
- Frequent falls
- REM sleep behaviour disorder (sleep walking, aggression) commonly precedes other Sx
- Rapid decline more so than other types
LEWY-BODY DEMENTIA
What is the management of Lewy-Body dementia?
- Conservative management
- mild/mod = donepezil or rivastigmine (galantamine if both are contraindicated)
- severe = donepezil or rivastigmine (memantine if both are contraindicated)
- SENSITIVE to antipsychotics, can make worse + lead to neuroleptic malignant syndrome
POSTURAL HYPOTENSION
What investigations would you do to diagnose postural hypotension?
Lying + standing blood pressure
- Abnormal drop in BP of ≥20/10mmHg within 3 minutes of standing (<20/10 is physiological)
Investigate medical causes (FBC, U+Es, B12 + folate, TFTs, LFTs, CRP/ESR, ECG)
PHARMACOLOGY
What is the mechanism of action of N-methyl D receptor antagonists (NMDA)?
- Protects brain cells from excess glutamate (excitatory neurotransmitter) released from cells affected by Alzheimer’s to prevent further damage, good for agitation + BPSD
DEMENTIA
What might an Addenbrooke’s cognitive examination III (ACE-III) score indicate in dementia?
ACE-III (/100) –
- <82 likely dementia + need abnormal scores in ≥2 domains (attention/orientation, memory, language, visuospatial, fluency)
FT DEMENTIA
What are some pathological features of frontotemporal dementia?
- Microscopic = ubiquitin + tau deposits (pick bodies)
FALLS
What clinical scale can be used to assess frailty?
- Rockwood clinical frailty scale (from very fit, vulnerable, moderately frail to terminally ill)
PHARMACOLOGY
When should NMDA be avoided?
Do not give in renal failure (low GFR) as nephrotoxic
PHARMACOLOGY
What are some side effects of NMDA?
- Confusion,
- hallucinations,
- agitation,
- paranoid delusions
COTE ASSESSMENT
What is frailty?
- State of increased vulnerability resulting from ageing-associated decline in reserve + function across multiple physiological systems resulting in compromised ability to cope with everyday or acute stressors
COTE ASSESSMENT
What are the geriatric giants?
What do they represent?
4Is – - Instability (falls) - Immobility - Intellectual impairment (confusion) - Incontinence They are not diagnoses but more general things that COTE pts present with, often indicator of underlying problem
POLYPHARMACY
Give some specific pharmacokinetic issues in geriatrics.
- Hepatic first pass metabolism declines
- Reduced absorption as gastric pH increases due to atrophy
- Vascular system less responsive due to calcification of vessels
MENTAL CAPACITY ACT
What are the 4 aspects of assessing capacity?
- Does the pt UNDERSTAND the information?
- Can the pt RETAIN that information?
- Can the pt use the information to WEIGH UP the pros + cons?
- Can the pt COMMUNICATE their decision back (ensure different methods explored)
MENTAL CAPACITY ACT
What are the 5 principles underpinning the MCA?
- Assume capacity until proven otherwise
- Maximise decision-making capacity (all practical support to help them make decision given)
- Freedom to make seemingly unwise choice (unwise decision ≠ incapacity)
- All decisions on behalf of patient in best interests
- Least restrictive option should be chosen
DOLS
What is the acid test for DoLS?
Must meet 3 criteria –
- Lack of capacity to consent to the arrangements or their care
- Subject to continuous supervision + control
- Not free to leave their care setting
