Geriatrics Flashcards
Elderly women often get recurrent UTIs, what is the main reason for this?
Oestrogen deficiency
What is the treatment of urinary incontinence?
- Pelvic floor exercises for at least 3m
2. Anticholinergic medications may be used as monotherapy or in conjunction with pelvic floor exercises.
What drugs might exacerbate urinary incontinence?
Acetylcholinesterase inhibitors
Which type of dementia is likely most susceptible to an episode of delerium leading to deterioration of baseline cognitive function?
Lewy-body dementia
Give 4 potential causes of constipation in the elderly population in nursing homes.
- Laxative abuse
- Polypharmacy
- Poor dietary habits
- Sedentary lifestyle
What is the MOST common cause of blindness in elderly Caucasians?
Macular Degeneration
Give 4 preventative strategies that reduce the risk of hip fractures in the elderly female nursing home patient.
- Oestrogen replacement therapy
- Bisphosphonates
- Balance and muscle strenghtening exercises
- Hip protectors
T/F: Calcium supplements in elderly nursing home patients reduce the likelihood of hip fractures.
False.
What is the most common cause of disability in the Australian elderly population great than 65 years?
Arthritis
What is the life expectancy of the ‘average’ elderly Caucasian male?
80yrs
In the treatment of depression in the elderly, why do SSRIs have fewer SEs that TCAs?
Which of these is therefore first line treatment?
TCA (e.g. amitryptiline, doxepin) = inhibit the reuptake of
SSRIs BOTH serotonin and noradrenalin. Also blocks histamine, acetylcholine, and alpha1-adrenergic receptors conferring worse SE profile.
SSRIs (e.g. citalopram, fluoxetine) = more selective in in inhibiting reuptake of serotonin and weaker with noradrenalin, therefore fewer SEs.
SSRIs are therefore preferable and 1st line.
In Alzheimer’s Disease - what is the pathophysiological finding on autopsy?
Mis-folded proteins: amyloid plaques and neurofibrillary tangles.
In Alzheimer’s Disease - what regions of the brain are found to have hypometabolism and decreased cerebral blood flow in?
Parietal and temporal lobes.
In Alzheimer’s Disease - which brain regions are likely to have ATROPHY?
- Hippocampus
- Amygdala
- Entorhinocortex
Why is there detrusor overactivity in the elderly?
- Detrusor contraction is mediated by PSNS and inhibited by SNS.
- Less inhibition leads to detrusor overactivity.
Why do elderly patients tend to have orthostatic hypotension?
Decreased baroreceptor sensitivity
Why to elderly patients tend to have a widened pulse pressure?
Stiffening of blood vessels cause reduced arterial compliance that leads to widened pulse pressure.
What happens to the following parts of the heart in the elderly:
- LA
- LV
- Valves
- LA - enlarges
- LV - stiffens
- Valves - stiffens
Which pituitary hormones are INCREASED with normal ageing?
ADH
FSH / LH
T/F: insulin levels decrease with normal ageing.
False - INCREASED due to insulin resistance
T/F: PTH is reduced in normal ageing.
False - INCREASED and associated with bone resorption
What occurs to the following brain parameters in normal ageing:
- Brain volume
- Cerebral blood flow
- Neurotransmitters
ALL decrease
What type of protein deposition is found in increasing levels with the normal ageing process?
Neurofibrillary tangles (NFT) and amyloid deposits
T/F: Memory loss is NOT considered a part of normal ageing.
True
T/F: minor slowing in cognitive processing speed is NOT associated with normal ageing.
False - it is.
With normal ageing, what occurs to the following renal characteristics:
- Renal blood flow
- Nephron number
- Glomeruli number
ALL decrease
Smaller kidney with decreased concentration capacity and reduced GFR
Regarding renal physiology, what occurs to the following with normal ageing:
- Serum renin and aldosterone levels
- Vit D activation
Both REDUCED
Early onset Alzeihmer’s Disease (AD) is less than 1% off all and due to increased levels of amyloid beta protein.
What 3 causative genotypes have been described?
Are they worth testing?
All known to cause increase of amyloid beta protein.
PS1 (presenilin 1) - chromosome 14
PS2 (presenilin 2) - chromosome 1
APP (amyloid precursor protein) - chromosome 21
Yes - worth testing
Late onset Alzeihmer’s Disease (AD) is less than 1% off all and due to increased levels of amyloid beta protein.
What 1 genotypes have been described?
Is it worth testing for?
APOE-epsilon 4 - increased likelihood for developing AD.
No - no point testing, patient already with AD.
Elderly patient have present differently with depression.
Describe 4 features of an elderly patient with depression.
- Poor memory / concentration
- Irritability
- Slowed cognition
- Executive dysfunction
What are the 3 types of incontinence in the elderly?
- Urge incontinence: involuntary urine loss preceded by urgency
- Stress incontinence: involuntary leakage from stress or exertion
- Mixed incontinence: mix of above
What is the treatment of urge incontinence in the elderly?
- Reduce detrusor muscle contractility
- Bladder training
What is the treatment of stress incontinence in the elderly?
- Increase urethral resistance
- Bladder training and pelvic flow exercises +/- Sx
For STRESS incontinence in the elderly sling surgery (pubovaginal/urethral) give better symptomatic relief at 1 yr compared to just pelvic floor exercises alone.
Which test must precede surgery to exclude URGE incontinence?
Why is this important?
Urodynamic studies - if urge incontinence demonstrated then the surgery may WORSEN symptoms.
What are the 4 principles of medical decision making?
- Autonomy: informed, capacity, voluntary with no coercion
- Justice: equality
- Beneficence
- Non-Maleficence
Elderly patient is too unwell and cannot make a decision regarding medical treatment. Which of the following can NOT be refused by a ‘Enduring Guardian’ or ‘Medical Enduring Power of Attorney’:
- Withdrawal of futile or burdensome treatment by medical professionals
- Appropriate palliative care
Both.
Which of the following locations in hospital is most likely to be associated with delerium in the elderly:
- Medical ward
- Surgical ward
- ED
- ICU
ICU
What are 5 parameters of Frailty in the elderly (SEWWW):
SEWWW:
Sedentary - low physical activity Exhaustion - self-reported Weight loss Weakness Walking slow
T/F: Presence of frailty is a predictor of increased falls, poor recovery, protracted hospital stay, disability, need for NHP and mortality.
True
T/F: Falls are more common in nursing homes compared to the community in the elderly population.
True: NHP (50% of population) vs. community (30% of population)
What percentage of elderly patients have fear of falling post-fall:
- 10%
- 25%
- 50%
- 80%
50%
Comment on the following clinical features of delerium in the elderly:
- Onset
- Course
- Cognition / Attention / GCS
- Delusions / hallucinations
- Sleep-cycle
- Emotional state
- Onset - acute onset
- Course - fluctuant
- Cognition / Attention / GCS - fluctuant
- Delusions / hallucinations - common
- Sleep-cycle - reversed
- Emotional state - labile
Which is associated with a worse outcome, hyperactive or hypoactive delerium?
Hypoactive delerium
Elderly patient is discharged after an admission with delerium. What is the % mortality at:
- 6-12months
- 5 years
HIGH
- 6-12months - 40%
- 5 years - 50%
What percentage of patient has delerium NOT fully resolved at time of discharge from hospital:
- 10%
- 25%
- 50%
- 80%
- 95%
95%
T/F: Dexmedetomodine reduces post-op delerium in non-cardiac surgery patients.
True
Which of the following 2 are useful in reducing the incidence of delerium in the elderly:
- Melatonin agonist (Ramelteon)
- 2nd generation antipsychotics (olanzepine, risperidone)
Both
The NSW Guardianship Act has a clear heirachy for decision-making in a patient that cannot decide.
What is the 4 tiered hierarchy?
If there is a conflict - what is the means of escalation?
- Court appointed or enduring guardian
- Most recent de-facto with ongoing relationship
- Primary unpaid carer
- Relative or friend with close relationship
Escalation = Guradianship Tribunal
What is a biomarker for Alzeihmer’s disease on a CTB?
Mesial temporal atrophy (aka hippocampal atrophy)
