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Year 4 > Geriatrics > Flashcards

Geriatrics Flashcards

1
Q

define the pathophysiology of ageing

A

Major categories of impairment that appear with old age and affect the physical, mental and social domains of the elderly, usually due to many predisposing and precipitating factors, rather than a single cause

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2
Q

neurological physiological changes in ageing

A

Decreased wakefulness, brain mass, cerebral blood flow, increased white matter changes

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3
Q

neurological pathological changes in ageing

A

Increased insomnia, neurodegenerative disease, stroke, decreased reflex response

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4
Q

special senses physiological changes in ageing

A

Decreased lacrimal gland secretion, lens transparency, dark adaption, decreased sense of smell and taste

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5
Q

special senses pathological changes in ageing

A

Increased glaucoma, cataracts, macular degeneration, presbycusis, presbyopia, tinnitus, vertigo, oral dryness

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6
Q

CV physiological changes in ageing

A

Increased sBP, dBP, decreased HR, CO,

Decreased vessel elasticity, cardiac myocyte size and number, b-adrenergic responsiveness

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7
Q

CV pathological changes in ageing

A

Increased atherosclerosis, CAD, MI, CHF, hypertension, arrythmias, orthostatic hypotension

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8
Q

Resp physiological changes in ageing

A

Increased tracheal cartilage calcification, mucous gland hypertrophy
Decreased elastic recoil, mucociliary clearance, pulmonary function reserve

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9
Q

resp pathological changes in ageing

A

Increased COPD, pneumonia, PE

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10
Q

GI physiological changes in ageing

A

Decreased oesophageal peristalsis, gastric acid secretion, liver mass, hepatic blood flow, calcium and iron absorption

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11
Q

GI pathological changes in ageing

A

Increased cancer, diverticulitis, constipation, faecal incontinence, haemorrhoids, intestinal obstruction, malnutrition, weight loss

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12
Q

Renal physiological changes in ageing

A

Increased proteinuria, urinary frequency

Decreased renal mass, creatinine clearance, urine acidification, hydroxylation of vitamin D, bladder capacity

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13
Q

renal pathological changes in ageing

A

Increased urinary incontinence, nocturia, BPH, prostate cancer, pyelonephritis, nephrolithiasis, UTI

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14
Q

repro physiological changes in ageing

A

Decreased androgen, oestrogen, sperm count, vaginal secretion
Decreased ovary, uterus, vagina, breast size

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15
Q

repro pathological changes in ageing

A

Increased breast and endometrial cancer, cystocele, rectocele, atrophic vaginitis

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16
Q

endocrine physiological changes in ageing

A

Increased NE, PTH, insulin, vasopressin

Decreased thyroid and adrenal corticosteroid secretion

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17
Q

endocrine pathological changes in ageing

A

Increased NE, PTH, insulin, vasopressin

Decreased thyroid and adrenal corticosteroid secretion

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18
Q

MSK physiological changes in ageing

A

Increased calcium loss from bone

Decreased muscle mass, cartilage

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19
Q

MSK pathological changes in ageing

A

Increased arthritis, bursitis, osteoporosis, muscle weakness, gait abnormalities, polymyalgia rheumatica

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20
Q

skin physiological changes in ageing

A

Atrophy of sebaceous sweat glands

Decreased epidermal and dermal thickness, dermal vascularity, melanocytes, collagen synthesis

21
Q

skin pathological changes in ageing

A

Increased lentigo, cherry haemangiomas, pruritis, seborrheic keratosis, herpes zoster, decubitis ulcers, skin cancer, easy bruising

22
Q

psychiatric physiological changes in ageing

A

Increased bilateral brain activity for memory tasks and loss of synaptic plasticity

23
Q

psychiatric pathological changes in ageing

A

Increased depression, dementia, delirium, suicidality, anxiety, sleep disruption

24
Q

general term for why old people are admitted

A

decompensated frailty syndrome

25
Q

name the decompensated frailty syndromes

A

falls
delirium
poor mobility

26
Q

list causes of frailty

A

Mets, malnutrition, cachexia
Resp failure
Renal failure
Steroid myopathy, diabetes, osteoporosis, vision loss
Hepatic failure
Major depression, psychosis, poor functional status, cognitive loss
Malabsorption, poor glucose homeostasis, end organ damage
Malabsorption, malnutrition
Functional impairment
Malabsorption, malnutrition
Cardiac failure
Chronic infection, functional impairment
Chronic inflammation
Dysphagia, depression, cognitive loss, functional impairment
Chronic infection

27
Q

list the transient causes of incontinence

A 
Delirium
Infection
Atrophic urethritis/vaginitis
Pharmaceuticals
Excessive urine output
Restricted mobility
Stool impaction
28
Q

list the ADLs

A 
ABCDE-TT
Ambulating
Bathing
Continence
Dressing 
EatingTransferring
Toileting
29
Q

list the IADLs

A 
SHAFT-TT
Shopping
Housework
Accounting/Managing finances
Food preparation
Transportation
Telephone
Taking medications
30
Q

define delirium

A

A sudden state of severe confusion and rapid changes in brain function, sometimes associated with hallucinations and hyperactivity

31
Q

how can you prevent delirium in the elderly?

A
  1. Ensure optimal vision and hearing
    1. Provide adequate nutrition and hydration
    2. Encourage regular mobilisation to build and maintain strength, balance and endurance
    3. Avoid unnecessary medications and monitor for drug interactions
    4. Avoid catheterisation (if possible)
      Ensure adequate sleep
32
Q

describe the 4AT assessment

A

alertness
age, DOB, place, current year
months backwards
acute change or fluctuating course

33
Q

clinical features of delirium

A 
• Onset rapid over hrs/days
	• Marked fluctuation
	• Reversal of sleep wake cycle
	• Altered consciousness 
	• Inattention
	• Disturbed cognition
	• Illusions
	• Hallucinations 
	• Delusions
Fear, bewilderment, restlessness or hypoactivity
34
Q

list causes of delirium

A

CNS
Stroke, abscess, tumour, subdural haematoma
Drugs (or withdrawal)
Anticholinergics, antiemetics, antipsychotics, corticosteroids, digoxin, levodopa, TCAs, opioids, alcohol
Endocrine
Hyperparathyroidism, hyper/hypothyroidism
Infection/injury
Encephalitis, meningitis, pneumonia, sepsis, UTI, burns, hypothermia
Metabolic
Acid-base disturbance, hepatic encephalopathy, uraemia, hypo/hyperglycaemia, electrolyte abnormalities, thiamine/vitamin B12 deficiency
Other
Post-operative states, other mental disorders, sleep depravation

35
Q

treatment of delirium

A

Treating the underlying cause or removing aggravating drugs is the principle treatment.
Environmental management: nurse patients in a quiet and well-lit room.
Minimise sensory deficits (check hearing aids/glasses etc.)
Agitation can be managed with haloperidol (0.5-1.0mg PO) or lorazepam (0.5-1.0mg PO), however, they should be avoided as they may worsen or prolong delirium.

36
Q

causes of falls in the elderly

A

Intrinsic Factors

• Age related changes and diseases associated with ageing: 
	○ MSK (arthritis, muscle weakness)
	○ Sensory (visual, proprioceptive, vestibular)
	○ Cognitive (3Ds, anxiety)
	○ CV (CAD, arrhythmia, MI, low BP)
	○ Neurological (stroke, LOC, gait disturbances/ataxia, seizure. Peripheral neuropathy)
	○ Metabolic (glucose, electrolytes)
• Orthostatic/syncopal
• SE of medications and substance abuse
• Acute illness, exacerbation of chronic illness
• Vasovagal 
• Intoxication
• BBPV – benign paroxysmal positional vertigo

Extrinsic Factors

• Environmental (home layout, slippery surfaces, overcrowding, new environments) Situational (rushing to the toilet, walking while distracted)
37
Q

falls history

A
  1. Previous falls and/or gait inability
    1. Enquire about intrinsic, extrinsic and situational factors
    2. Associated symptoms
      a. Palpitations
      b. Dizziness
      c. Tongue biting
      d. Incontinence
      e. Did they bang their head
      f. World spinning - BPPV
      g. Chest pain
      h. Numbness, weakness
    3. Eyesight
    4. After turning head to one side may suggest carotid sinus hypersensitivity
    5. Onset - sudden/gradual
    6. Previous similar episodes
    7. Injuries
    8. LOC
    9. Medication and alcohol
      Have a witness (if possible) for interview
38
Q

examination of a falls patient

A 
• Cardio and resp
		○ Pulse
		○ Heart sounds
		○ Chest sounds
		○ Temperature
		○ Arrhythmia, signs of chest infection, dehydration
	• GALS
	• ECG
	• Lying and standing BP
		○ Significant postural drop is > 20 sBP or >10 dBP
	• Urinalysis
	• Visual acuity
	• Feet and footwear
Timed up and go
39
Q

investigation of falls

A

• CGA
• FBC, electrolytes, BUN, creatinine, glucose, Ca, TSH, B12, urinalysis, cardiac enzymes, ECG, CT head
• CRP, WCC, CK
Xrays

40
Q

prevention of falls

A

• Multidisciplinary, multifactorial, health, and environmental risk factor assessment and intervention programs in the community
• Muscle strengthening, balance retraining, and group exercise programs
• Home hazard assessment and modification
• Vit D
• Gradual discontinuation of psychotropic meds
• Postural hypotension, HR and rhythm abnormalities management
• Eyesight and footwear optimisation
• Support hose for varicose veins and ankle swelling
Alarm system

41
Q

list some drugs that may cause falls in the elderly

A 
Diuretics, CCB, b-blockers
Codeine, morphine
Chlorpropamide, glibenclamide
Haloperidol, chlorpromazine, risperidone
Long acting benzos
TCAs more than SSRIs and SNRIs
Phenytoin
Carbamazepine
Digoxin
Alcohol
42
Q

causes of constipation in the elderly

A 
• GI (colon Ca, diverticulosis)
	• Neurologic (stroke, dementia, Parkinson's)
	• Psychiatric (depression, anxiety)
	• Drugs
Diet (dehydration, tea and toast diet)
43
Q

drugs associated with constipation

A 
• OTC (antihistamines, NSAIDs)
	• Opioids
	• Psychotropic (antipsychotics, TCAs)
	• Anticholinergics
	• CCB
	• Diuretics
Iron/calcium supplements
44
Q

define faecal incontinence

A

Involuntary passage or the inability to control the discharge of faecal matter through the rectum
Severity can range from unintentional flatus to the complete evacuation of bowel contents

45
Q

describe the subtypes of faecal incontinence

A
  1. Passive incontinence: involuntary discharge of stool or gas without awareness
    1. Urge incontinence: discharge or faecal matter in spite of active attempts to retain bowel contents
      Faecal: leakage of stool following otherwise normal evacuation
46
Q

causes of faecal incontinence

A

• Physiological changes with age > 80
○ Decreased EAS strength, decreased resting tone of IAS, weakened anal squeeze, increased rectal compliance, impaired anal sensation
• Trauma
○ Vaginal delivery, pudendal nerve damage, cauda equina
• Iatrogenic
○ Surgical
§ Anorectal surgery, lateral internal sphincterotomy, haemorrhoidectomy, colorectal resection
○ Radiation
§ Pelvic radiation
• Neurogenic
○ Neuropathy, stroke, MS, diabetic neuropathy
• Anorectal/colorectal disease
○ Rectal prolapse, haemorrhoids, IBD, rectocele, cancer
• Medication
○ Laxative, anticholinergics, antidepressants, caffeine, muscle relaxants
• Cognitive
○ Dementia, wilful soiling with psychosis
Constipation/faecal impaction

47
Q

investigations for faecal incontinence

A 
• Differentiate true incontinence from frequency and urgency (IBS, IBD)
	• Stool studies
	• Endorectal ultrasound
	• Colonoscopy, sigmoidoscopy, anoscopy
Anorectal manometry/functional testing
48
Q

management of faecal incontinece

A

• Physiological changes with age
○ Medication management (anti-motility agents e.g. loperamide, diet/bulking agents for loose stool)
○ Increase fluid intake
○ Biofeedback
○ Retraining of pelvic floor muscles
○ Surgery
• Trauma
○ Direct surgical repair or augmentation of the sphincters
• Iatrogenic
○ Surgical repair, artificial sphincters
• Neurogenic
○ Medication management, abdominal massage, digital stimulation for dysfunction, biofeedback and behavioural training, prevent autonomic dysreflexia in spinal injury

• Anorectal/colorectal disease
	○ Treat underlying cause (optimise IBD meds), surgical (e.g. mass removal, prolapse repair, haemorrhoid removal, colostomy)
• Medication-related causes
	○ Stop laxatives, lower dose or discontinue offending drugs
• Cognitive
	○ Regular defecation program in patients with dementia, psychiatric consult 
• Constipation/faecal impaction Disimpaction, prevent impaction, enema or rectal irrigation

Year 4 (5 decks)

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