Geriatrics Flashcards
Define Delirium
A state of mental confusion that develops quickly and fluctuates in intensity
What are the associated features of delirium?
Disordered thinking/Delusions Euphoria/depression/mood changes Language impairment Inattention Reversal of sleep wake cycle Illusions Unawareness/disorientation Memory defects
What is the most common, and most frequently misdiagnosed, type of delirium?
Hypoactive delirium
What would indicate an abnormal Abbreviated Mental Test Score? What is the next step?
<8
Confusion Assessment Method
What tool can diagnose delirium?
Confusion Assessment method
Name 5 1st line investigations in delirium:
FBC, glucose, CXR, TFT, LFT, U&E
What are the 4 fields of management for delirium?
- Find and treat underlying cause
- Manage symptoms
- Prevent complications
- Explain to family
Which sedative for delirium is contraindicated in parkinson’s?
Haloperidol - so lorazepam is used instead
Name a drug that causes overflow incontinence?
Amitriptyline
Name a simple investigation of incontinence
Frequency volume charts
What is it called if 1/3 of urine is excreted at night?
Nocturnal polyuria
How many mls a day is the maximum to urinate?
2500, any more is polyuria
What are the causes of incontinence? (DIAPPERS)
Delirium Infection Atrophy Psychological Pharmacalogical Excess urine out put Restricted mobility Stool impaction in constipation
What are the patient education methods of managing incontinence?
Smoking cessation and weight loss advice
Reduce caffeine and alcohol intake
Manage constipation
What drugs are used in overactive bladders?
Antimuscarinic drugs
Name 3 medical treatments of over active bladder?
Antimuscarinic drug
Botox
Intravaginal oestrogen
Name 2 drugs used to treat BPH in men
Alpha 5 reductase inhibitors
Alpha blockers e.g. sdoxazocin
Define falls
When a person comes inadvertantly to the floor or to a lower level
Name some intrinsic risk factors to falls
Cataracts, muscle strength, CI
Name some extrinsic risk factors to falls
Home hazards, medications, walking aids
Name the 4 important factors in the medical assessment of falls:
- Medication review
- DEXA scan
- Find medical reason for falls
- Manage conditions which cause the falls
Name an exercise which can reduce falls risk
Tai Chi
Why are old people more likely to be inappropriately prescribed?
- more chronic illness
- more polypharmacy
- physiological changes due to age
How should you alter the dose of hepatic-route drugs in older patients?
Lower the dose, increase the dose interval
What are the consequences of inappropriate prescribing?
Longer hosptal stays, death, drug reactions, poor compliance
What are the 4 criteria for assessing a patient’s capacity?
- Are they able to understand the information needed to make the decision?
- Are they able to retain this information long enough to make the decision?
- Are they able to weigh up the pros and cons of a decision?
- Are they able to communicate their decision?
If a patient lacks capacity, can they make any decisions?
Yes e.g. what to have for dinner
When can you restrain someone who lacks capacity?
Only when not doing so would cause harm to the patient
What is unusual about the presentation of depression in older adults?
Physical symptoms may be more prominent
May present as confusion and memory loss
Give 3 medications that may worsen depression
beta blockers, parkinson’s medications and CCB
Where are pressure ulcers most likely to occur?
Bony prominences e.g. buttocks, heels, between the shoulder blades
What may predispose an ulcer?
Skin feeling warmer or cooler on one area, colour or texture change
What are 3 risk factors for developing a pressure sore?
Immobility
Sensory loss
Vascular problems/insufficiency
poor nutrition and hydration
What surgery can be used to treat a pressure ulcer?
Surgical flap reconstruction
What is advanced care planning?
Discussing care plans for patients when they are still competent, about future treatment preferences when they lose the ability to make decisions
What are the 2 ways of having an advanced care plan?
- Living will
2. Power of attorney
