geriatrics Flashcards
describe the 4AT Test
Alert -
AMT4- name, DOB, place, year
Attention - months backwards from december
Acute changes
what are consequences of decreased hepatic metabolism of drugs in the elderly
Toxicity
Reduced first pass metabolism
(↑ in bioavailability with some drugs e.g. propranolol
Can cause ↓ bioavailability of pro-drugs e.g. enalapril)
which sex is Urinary retention with overflow incontinence more common in
males
list some drugs that can increase your chances of falling
TCA antidepressants antipsychotics anticholinergics/ antimuscarinis benzodiazepines anti-hypertensives diuretics alcohol
what pathology arises when the bladder outlet is too weak
stress incontinence
list some causes of syncope
neurally mediated - vasovagal/ carotid sinus hypersensitivity, situational postural hypotension carotid arrhythmias seizure structural heart disease
what are causes of incontinence that are extrinsic to the urinary system
Physical state and co-morbidities Reduced mobility
Confusion (delirium/ dementia) Drinking too much or at the wrong time
Diuretics Constipation
Home/ social circumstances
what diseases common in the elderly decrease total serum a albumin
heart failure, renal disease, rheumatoid arthritis, hepatic cirrhosis and some malignancies.
what are some causes of incontinence that are necessary to refer from the onset
Vesico-vaginal fistula
Palpable bladder after micturition or confirmed large residual volume of urine after micturitionDisease of the CNS
Certain gynaecological conditions (e.g. fibroids, procidentia, rectocele, cystocele)
Severe benign prostatic hypertrophy or prostatic carcinoma
Patients who have had previous surgery for continence problems
who is involved in a comprehensive geriatric assessment
Geriatrician Occupational therapy Physiotherapist Skilled Nurses GP Other doctors Social worker Home care Dietician
what is a positive romberg test
sway when eyes are closed
what in involved in the societal health domain
attitude - asset or burden
technology
politics - money
accessibility - bus pass, disabled
list some cardiac or cardiopulmonary diseases that may lead to syncope
Cardiac valvular disease i.e. aortic stenosis Acute myocardial infarction/ischaemia Obstructive cardiomyopathy Atrial myxoma Acute aortic dissection Pericardial disease/tamponade Pulmonary embolus/pulmonary hypertension
what are ECG abnormalities after syncope
inappropriate bradycardia
long QT >450ms
abnormal t wave inversion
what are characteristic features of urge incontinence
Detrusor contracts at low volumes
Sudden urge to pass urine immediately
Patients often know every public toilet/ never leave house due to fear – isolating
how would you investigate an unexplained seizure in an under 60
holter monitor
when is urine leaked during stress incontinence
movement, coughing, laughing, squatting
what things can precipitate delirium
Infection (but not always a UTI!) Dehydration
Biochemical disturbance (high low Na/Ca)
Pain
Drugs – opiates (indirect - NSAID/ ACEi > AKI)
Constipation/Urinary retention
Hypoxia Alcohol/drug withdrawal
Sleep disturbance Brain injury -Stroke/tumour/bleed etc
Changes in environment – new social set up
why is it more difficult to prescribe for the elderly
little evidence of drug efficacy and safety
multiple medications
adverse drug reactions
what symptoms may indicate a seizure over syncope
A bitten tongue
Head-turning to 1 side during episode
No memory of abnormal behaviour that was witnessed before, during or after episode by someone else
Unusual posturing
Prolonged, simultaneous limb-jerking
Confusion after the event
Prodromal déjà vu or jamais vu (recognisable but unfamiliar)
how would you investigate syncope
history/ collateral history examination 12 lead ECG BP echo/ halter monitor
what are some non pharmacological ways of managing dementia
Support for person and carers Cognitive stimulation
Exercise - fitenss slows down cognitive decline Environmental design
Avoiding changes in environment/social support
Advanced care planning – progressive decline, will lose capacity
what happens to rate of absorption of drugs in the elderly
declines
what are some prescribing guides for the elderly
BNF
Beer’s criteria
STOPP START criteria
NHS scotland polypharmacy