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Specialties > Geriatrics > Flashcards

Geriatrics Flashcards

1
Q

What type of history is key when dx cognitive impairment

A

3rd party

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2
Q

What are the 2 commonest causes of impaired cognition

A

Delirium

Dementia

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3
Q

Is delirium acute or chronic onset

A

Acute

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4
Q

Types of delirium

A

Hypoactive
Hyperactive
Mixed

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5
Q

Which type of delirium can be more difficult to spot

A

Hypoactive

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6
Q

Key features of delirium

A 
Acute onset and fluctuant 
Disturbance of sleep wake cycle 
Disturbed psychomotor behaviour 
Emotional disturbances 
Delusions (psychotic symptoms)
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7
Q

Who is most likely to get delirium

A 
Affects extremes of ages
Very young
Very old 
Frail
People with cognitive frailty (Parkinson's MS, Dementia)
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8
Q

What is the commonest complication of hospitalisation

A

Delirium

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9
Q

What morbidity and mortality is associated with delirium

A

Increased risk death
Longer length hospital stay
Increased rates institutionalisation
Persistent functional decline

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10
Q

Potential precipitates of delirium

A 
Infection 
Dehydration 
Biochemical disturbance (Na+ and Ca)
Pain 
Drugs
Constipation 
Urinary Retention 
Hypoxia 
Alcohol/drug withdrawal 
Sleep disturbance 
Idiopathic
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11
Q

What is the pathophysiology of delirium

A

Unknown

No one really knows why it happens

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12
Q

What is the delirium screening tool

A

4AT

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13
Q

Who receives the 4At

A

Everyone >65yrs who is admitted to hospital

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14
Q

What can be used to assess the causes/triggers for dementia

A

Time bundle

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15
Q

Management for delirium

A

Non-pharmacological
Re-orientate and reassure agitated patients
Use families and carers
Correction of sensory impairment
Normalise sleep wake cycle
Ensure continuity of care (avoid frequent ward or room transfers)
Avoid urinary catheterisation/venflons

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16
Q

Pharmacological management of delirium

A

Treat cause (use Time bundle to identify)
Stop bad/precipitating drugs
Stop sedatives
Stop anticholingercis
Drug treatment of delirium not usually necessary

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17
Q

What is dementia

A

Acquired decline in memory and other cognitive functions in an alert person

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18
Q

Types of dementia

A 
Alzheimers
Vascular dementia 
Mixed alzheimer's/Vascular 
Dementia with Lewy Body 
Reversible causes (e.g NPH)
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19
Q

What is the commonest cause of dementia

A

Alzheimer’s

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20
Q

Features of Alzheimer’s

A

Slow insidious onset
Gradually progressive
Loss of memory
Progressive functional decline

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21
Q

Risk factors for dementia

A

Increased age
Vascular risk factors
Genetics

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22
Q

What type of progression occurs in vascular dementia

A

Step wise

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23
Q

What causes vascular dementia

A

Vascular damage in the brain

E.g mini strokes

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24
Q

Risk factors for vascular dementia

A 
Often have vascular risk factors e.g:
Type II DM 
AF 
IHD 
PVD
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25
Q

Which disease is linked to dementia with lewy body

A

Parkinson’s

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26
Q

Key features of Lewy body dementia

A

Often very fluctuant
Hallucinations common
Falls common

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27
Q

Features of frontotemporal dementia

A 
Early behavioural changes (aggression)
Language difficulties 
Memory early on often not affected
Lack of insight into difficulties 
Will do very strange things (e.g pee on the floor)
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28
Q

History tools for dementia

A

MMSE
MOCA
Collateral history

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29
Q

Non-pharmacological Rx of dementia

A 
Support for person and carers
Cognitive stimulation 
exercise 
Environmental design 
Avoid changes in environment/social support 
Advanced care plannig
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30
Q

Pharmacological Rx Alzheimers

A

Choliniterase inhibitors (Donepezil)

Glutamate Receptor Antagonist
Memantine

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31
Q

Should anti-psychotics be used in dementia

A

Avoid if possible

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32
Q

Reversible causes od dementia

A 
Hypo/hyperthyroidism 
Intracerebral bleeds/tumours 
B12 deficiency 
Hypercalcaemia 
Normal pressure hydrocephalus 
Depression
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33
Q

What is capacity specific to

A

Decision specific

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34
Q

What is a welfare POA

A

Somebody appointed by the person

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35
Q

What is a guardian

A

Somebody appointed by the court

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36
Q 
89yr M
Normally lives independently
“off legs, confused”
reduced mobility 
Febrile, “smells of urine”, looks dry
Normally independent
Still travelling the world 
No memory problems 
Falls and subsequent sore knee recently 
GP started a new tablet

What is the most likely diagnosis?

A

Delirium

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37
Q

T or F
92yr lady
PMH diverticular disease
Admitted with vomiting and abdominal pain
Diagnosed with diverticulitis
Treated with IV fluids, IV abx
Agitated and aggressive overnight and very unsteady on feet

• What are we going to do to help Betty?
1. Keep her in bed to reduce risk of fall and fracture

A

False

We want to keep her mobile keeping her up and about

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38
Q

T or F
92yr lady
PMH diverticular disease
Admitted with vomiting and abdominal pain
Diagnosed with diverticulitis
Treated with IV fluids, IV abx
Agitated and aggressive overnight and very unsteady on feet

• What are we going to do to help Betty?
Insert catheter so not needing to get up to toilet

A

False

Only catheterise if real reason to do so

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39
Q

T or F
92yr lady
PMH diverticular disease
Admitted with vomiting and abdominal pain
Diagnosed with diverticulitis
Treated with IV fluids, IV abx
Agitated and aggressive overnight and very unsteady on feet

• What are we going to do to help Betty?
Early mobilisation?

A

True
Get her up and about
allow her to explore her environment

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40
Q

T or F
92yr lady
PMH diverticular disease
Admitted with vomiting and abdominal pain
Diagnosed with diverticulitis
Treated with IV fluids, IV abx
Agitated and aggressive overnight and very unsteady on feet

• What are we going to do to help Betty?

Phone her son?

A

True

Familiarise her

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41
Q 
82yr old man
Brought to A&E as found walking down street with his pyjamas on
D/w family
Increasingly forgetful over last year
Burns pans
Frequent phone calls to daughter
Accusing carers of stealing
Gradual decline over last 2 years
No significant PMH
Bloods - normal

• What is the most likely Dx?

A

Alzheimers

42
Q

Which of the following drugs is most likely to exacerbate Dementia with Lewy body?

o	Codydramol, 
o	Thyroxine, 
o	Tamsulosin, 
o	Omeprazole, 
o	Metoclopramide, 
o	Ramipril, 
o	Amlodipine
A

Metoclopramide

Its a dopamine antagonist

43
Q

2 peaks of urinary incontinence

A

Old age

Middle age 3x more common Females

44
Q

Who is urinary incontinence common in

A

Women
Residential care
Nursing home care
Hospital care

45
Q

Types of incontinence

A

Stress
Urge
Overflow
Mixed

46
Q

What are the 2 sphincters of the bladder

A

Internal urethral sphincter

External urethral sphincter

47
Q

Where do the ureters enter the bladder

A

Vesico-ureteric junction

48
Q

What is the main muscles of the bladder

A

Detrusor muscle

49
Q

Is the external urethral sphincter voluntary or involuntary

A

Involuntary

50
Q

Parasympathetic innervation of the bladder

A

S2-S4
Secretomotor to the bladder
Detrusor contraction

51
Q

Sympathetic innervation of the bladder

A

T10-L2 (detrusor muscle relaxation)

T10-S2 internal sphincter contraction and neck of bladder contraction

52
Q

Describe stress incontinence

A 
Urine typically leaks with increased abdominal pressures e.g:
Coughing 
Sneezing 
Laughing 
Standng up
53
Q

Causes of stress incontinence

A

Weak externa sphincter

Weak pelvic floor muscles

54
Q

What is a major cause of weak pelvic floor muscles

A

Childbirth

55
Q

Is stress incontinence more common in F or M

A

Females

56
Q

Non-surgical Rx for stress incontinent

A

Pelvic floor exercises
(Kegel Exercises)
Oestrogen cream
Duloxetine (SSRI)

57
Q

Aids for pelvic floor muscles

A

Biofeedback
Vaginal cones
Electrical stimulation

58
Q

Surgical Rx for pelvic floor muscles

A

TVT

Colposuspension

59
Q

Describe urge incontinence

A

Incontinence associated with sudden urge to pass urine

Overactive bladder

60
Q

Symptoms of urge incontinence

A

Frequency
Sudden urge
Nocturnal incontinence

61
Q

What is the most common cause of urge incontinence

A

UMN lesion s
Or
Detrusor muscle disorder

62
Q

Non-pharmacological Rx for urge incontinence

A

Bladder retraining programme

63
Q

Medication Rx for urge incontinence

A

Anti-cholinergics (e.g oxybutynin)
Beta-3-adrenorecepotr agonist (Merabegron)
Botulinum toxin
Sacral nerve stimulation

64
Q

Describe overflow incontinence

A

Urine is retained in the bladder with subsequent overflow

65
Q

Most common cause of overflow incontinence

A

Often due to bladder outlet obstruction

More common in older males due to BPH

66
Q

Symptoms of overflor incontinence

A

Hesitancy
Reduced stream
Post-micturition dribble

67
Q

Rx for overflow incontinence

A 
Prostate:
Finasteride (5 alpha reductase inhibitor)
Alpha blocker (Tamsuosin)
Catheter (often suprapubic)
TURP
68
Q

General Ix for incontinence

A 
Bladder diaries 
Examination (abdo./PV/PR)
Urinanalysis/MSSU 
Bladder scan 
Urodynamics
69
Q

2 types of urodynamic studies

A

Cystometry

Uroflowmetry

70
Q

General Rx for incontinence

A

Weight control
Fluid control (reduce caffeine and fruit juice)
Pelvic floor exercises
Bladder retraining

71
Q

What is a neuropathic bladder

A

Underactive bladder

72
Q

What can neuropathic bladder be secondary to?

A

Prolonged catheterisation

73
Q

Causes of neuropathic bladder

A

Rare
Secondary to neurological disease
Typically seen MS or stroke

74
Q

Rx for neuropathic bladder

A

Catheterisation (even though prolonged catheter may have been the original cause)

75
Q

Criteria for catheter use

A

Sympathetic urinary retention
Bladder outflow tract obstruction
Undue stress caused by alternative management in elderly/frail/dying

76
Q

Is age or frailty more important in geriatrics

A

Frailty

77
Q

Why is geriatrics important

A

Continuing increase in life expectancy

Decrease in total fertility rates

Older people are living for longer

78
Q

Why are people getting older

A

Increased resources available
Better economic conditions
Improved screening programmes with earlier Dx and Rx
Better outcomes following major events (e.g stroke)

79
Q

What are some theories of ageing

A

Stochastic (cumulative damage)
Programmed (predetermined, changes in gene expression during various stages)
Homeostasis failure

80
Q

How does ageing affect the kidney

A

Decrease in kidney function
Creatinine though stays the same due to decreased muscle mass
But creatinine clearance declines with age

81
Q

How does age affect the CVS

A

Increase BP
Less reserve for diastolic BP
Decreased CO

82
Q

How does ageing affect resp. system

A

Decreased vital capacity

83
Q

What is dyshomesotatis

A

When impaired function of any organ system makes it more difficult for the body to maintain a steady state

Essentially fraility is a progressive dyshomeostasis

84
Q

What is social dyshomeostasis

A

Difficult causes by environmental insults not only bio-medical
Different ability to compensate for social events (e.g death, going on holiday)

85
Q

Do medical conditions in the elderly always present in the same as in adults

A

No

Conditions might have different presenting signs and symptoms in people with frailty

86
Q

How does hypothyroidism typically present

A

Weight loss
Anxiety
Tremor
Diarrhoea

87
Q

How does hypothyroidism present in an older person

A 
Depression 
Cognitive impairment 
Muscle weakness 
Atrial fibrillation
Heart failure 
Anginga
88
Q

What is the evidence gap

A

Although many conditions are more common in older people

Few trials of medications are carried out in older people

89
Q

What is the main focus of geriatrics

A

Frailty

90
Q

What does dyhomeostasis lead to increased risk of

A

Frailty

91
Q

What is frailty

A

A susceptibility state

Increased risk of death or debility following exposure to an environmental stressor

92
Q

Describe the frailty phenotype

A

Used to spot frailty
3 of 5 criteria

  1. Unintentional weight loss
  2. Exhaustion
  3. Weak grip strength
  4. Slow walking speed
  5. Low physical activity
93
Q

Name some frailty syndromes

A

Falls
Immobility
Delirium
Functional loss

94
Q

What is meant by a person centred/goal centred approach

A

Do hat the patient wants

Preserve autonomy

95
Q

Which domains of health can people be fail in

A 
Medical 
Psychological 
Functional 
Behavioural 
Nutritional 
Spiritual 
Environmental 
Social 
Societal
96
Q

How can psychological domain be affected in elderly

A

Mood (low mood anxiety)
Confidence (fear of falling)
Cognition (delirium, dementia)

97
Q

How can functional domain be affected in the elderly

A

Mobility
Activities of daily life
Community living skills

98
Q

Which tool must be used for assessing nutrition

A

MUST screening tool

99
Q

How can social domain be affected in elderly

A

Support networks:
Practical/emotional
Formal/Informal

Potential for abuse:
Financial 
Physical 
Sexual 
Neglect
100
Q

Key professions involved in geriatrics

A

Geriatrician
OT
PT
Skilled nurses

101
Q

Other professions involved in geriatrics

A 
GP 
Other doctors
Social worker 
Home care
Dietician 
SALT
102
Q

Aims of Good Geriatric Care (GCA)

A

Early identification of need
Early comprehensive geriatric assessment
Early provisions of appropriate level or care needs

Specialties (9 decks)

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