Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Speciality teaching > Geriatrics > Flashcards

Geriatrics Flashcards

1
Q

Why are people getting older?

A

Increased resources
Better economic environment
Screening and diagnosis improved
Better outcomes following majorr events

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Compare primary and secondary ageing.

A

Primary = caused by being biologically old e.g osteoarthritis and secondary = consequence of primary ageing e.g reduced mobility from OA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the stochastic theory of ageing?

A

Random cumulative damage e.g from oxidative stress and micro trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the programmed theory of ageing?

A

Predetermined from changes in gene expression during various stages

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What happens with inter-individual variability with age?

A

Increases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Why does serum creatinine stay roughly the same?

A

creatinine clearance goes down and you have less muscle mass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What happens to blood pressure with age?

A

SBP tends to increase

DBP peaks around 60 and then starts to drop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Why is there more side effects from antihypertensives in those over 60?

A

SBP tends to increase

DBP peaks around 60 and then starts to drop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What happens to CO with age in general?

A

Gets worse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What happens to lung capacity with age?

A

Total lung capacity stays the same but vital capacity reduces over time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Discuss frailty and homeostasis?

A

Frailty = progressive dyshomeostasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Define frailty.

A

Susceptibility state that leads to a person being more likely to lose function in the face of a given environmental challenge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are “frailty syndromes”?

A

Falls, delirium, immobility, incontinence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Why might elderly be unable to compensate for a change in BP?

A

problems with carotid sensitivity (OVER OR UNDER), sympathetic nervouse system may be less effective (e.g due to meds), heart less able to pick up rate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the consequences of frailty for thermoregulation?

A

reduced peripheral vasoconstriction, don’t sweat as much, reduced metabolic heat production, little change in basal body temperature, smaller increase in CO, less redistribution of blood flow from renal and splanchnic circulations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is “social” dyshomeostasis?

A

Difficulty caused by environmental insults e.g social

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How does hyperthyroidism presentation differ in people with frailty?

A 
Depression 
Cognitive impairment 
AF 
Muscle weakness
Delirium 
Falls 
Immobility 
Incontinence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are two main implications of an ageing population?

A

Multimorbidity Frailty

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is frailty?

A

A susceptibility state which is the end result of acquired problems. Overlaps multi morbidity and disability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is ageing?

A

Progressive accumulation of damage to a complex system resulting in loss of system redundancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Define frailty.

A

A reduced ability to withstand illness without loss of function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How do you identify someone with frailty?

A

Frailty index

Fried criteria

“Frailty syndromes”

HIS ‘Think Frailty’

Clinical frailty scale

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the Fried criteria?

A

3 of 5 of:

Unintentional weight loss 
Exhaustion 
Weak grip strength 
Slow walking speed 
Low physical activity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Name the frailty syndromes.

A

Falls
Immobility
Delirium
Functional loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What causes decompensated frailty syndromes?
Reoccuring problems with illness/insult
26
What is health?
A dynamic process rather than a binary state
27
Describe the illness trajectory for frailty.
Decline -> crisis -> admission -> reablement | reoccurs over time
28
What is a comprehensive geriatric assessment?
Process to asses and manage illness in older people with frailty.
29
What does the comprehensive geriatric assessment do?
Determine what problems are Determine what can be reversed/made better Produce a management plan
30
What is the comprehensive geriatric assessment centred around?
Person-centred/ Goal centred (NOT problem centred)
31
Name some health domains important to consider in a geriatric assessment.
``` Medical Spiritual (= person-centred) Psychological Functional Environmental Behavioural Nutritional ```
32
Who are important members of the MDT responsible for a comprehensive geriatric assessment?
Geriatrician, OT, PT, skilled nurse
33
Can CGA only be done in hospital?
No, also in community
34
Why is an early CGA important?
More likely to get patient back up to pr-morbid level of function. Better outcomes!
35
What are risks of hospital?
``` Disorientation and delirium Learned dependency Deconditioning Iatrogenic harm HAI ```
36
At what ages does the incidence of incontinenece increase?
Postmenopausal and extreme age
37
What are potential causes of incontinence?
Extrinsic to the urinary system (environment, habit, physical fitness, medications, constipation) Intrinsic to urinary system (bladder or urinary outlet problems) Bit of both
38
What are extrinsic factors for incontinence in elederly?
``` Medications Constipation Home circumstance Social circumstances Confusion Reduced mobility Physical state and co-morbidities ```
39
What is the normal capacity of the bladder?
400-600ml (sensation of needing at 250ml, 400ml is urgent)
40
What does the SNS do to the detrusor muscle?
Relax
41
Summarise intrinsic factors that can cause incontinenece.
Problem with bladder or outlet. They are either too weak or too strong,
42
What happens if bladder outlet too weak?
Stress incontinenece ---> Urine leak on movement, weak pelvic floor muscles
43
What are treatments for stress incontinenece?
Physio, oestrogen cream and duloxetine Surgery: TVT/colposuspension Pelvic floor exercises Pelvic floor stimulators
44
Why is oestrogen cream or pessaries given for stress incontinenece?
After menopause, no oestrogen which is a natural catabolic hormone which builds up pelvic floor muscles
45
What happens if the bladder outlet is too strong?
Urinary retention with overflow incontinence | -> poor urine flow, double voiding
46
who commonly gets urinary retention and overflow incontinence?
Older men with BPH
47
Who commonly gets stress incontinence?
Females who have had children or after menopause
48
How do you treat urinary retention in a male with BPH?
``` Alpha blocker (relaxes sphincter e.g tamsulosin) or anti-androgen (shrinks prostate e.g finasteride) or surgery (TURP) May need suprapubic catheter ```
49
What happens when the bladder muscle is too strong?
Urge incontinenece | detrusor contracts at low volumes
50
How do you treat urge incontinence?
Anti-muscarinics e.g oxybutinin, tolterodine, solfineacin b3 adrenoceptor agonists (relix detrusor) e.g mirabegron
51
What is the only type of incontinence most common in males?
Urinary retention with overflow incontinence
52
What drugs can be given to relax sphincter, bladder neck i.e stop overflow incontinenece?
Alpha-blockers e.g tamsulosin, terazosin, indoramin
53
What is a neuropathic bladder?
Underactive bladder (rare)
54
What causes an underachieve/neuropathic bladder?
Neurological disease e.g MS or stroke Prolonged catheterisation
55
What may help neuropathic bladder?
Parasympathomimetics may help. Catheterisation is only effective treatment option.
56
How do you assess incontinence?
``` Hx Social Hx (for extrinsic factors) Intake chart and UO diary General ex + rectal and vaginal Urinalysis and MSSU Bladder scan for residual vol physio medical Rx Surgical Rx ```
57
When should you refer to specialist for incontinence?
After failure of initial management (max 3 months of pelvic floor exercises, cone therapy, habit retraining and/or appropriate medication)
58
When should you refer to specialist at onset?
``` Vesico-vaginal fistula Palpable bladder after micturition Disease of CNS Certain gynaecology conditions e.g fibroids If previous surgery for continence ```
59
If all treatments fail for incontinenece, what next?
``` Incontinence, Urosheaths intermittent catheterisation Long term urinary catheter Suprapubic catheter ```
60
What are the key features of delirium?
Disturbed consciousness Change in cognition Acute onset Fluctuation
61
What are other common features of delirium?
Disturbance of sleep wake cycle Disturbed psychomotor behaviour Emotional disturbance Physical function affected
62
Who is at risk of delirium?
Extremes of age although anyone can get it.
63
What is important when assessing delirium?
History especially collateral. Generally, if normal very intelligent and fit (usually precipitated by large insult e.g space occupying lesion, severe sepsis) whereas if normally frail then likely to be lots of smaller insults causing it
64
What precipitates delirium?
ANYTHING OFTEN MULTIPLE TRIGGERS ``` Infection Hypo and hypernatraemia Hypercalcaemia Hypoxia Pain Alcohol/drug withdrawal, Brain injury Drugs Dehydration Social/emotional distress ```
65
What is the most common complication of hospitalisation?
Delirium
66
Why do we care about delirium?
``` Increased mortality Increased hospital admission Increased chance of nursing home admission Increased risk of developing dementia Persistent functional decline ```
67
What is the delirium screening tool?
4AT score
68
What do you do when you confirm delirium?
Full history and exam TIME bundle Explain diagnosis (give leaflet)
69
What is the main stay of delirium management?
Non-pharmacological: re-orientate and reassure (use family/carers) ``` Encourage early mobility and self care Normalise sleep-wake cycle Ensure continuity of care Avoid catheters and venflons Discharge asap ```
70
What is the pharmacological treatment of delirium?
Stop bad drugs Drug treatment usually not necessary unless danger to themselves (12.5mg quetiapine orally, start low and slow)
71
How can you reduce the risk of delirium?
``` Promote sleep hygiene Pain control prevention of post-op complications Regulation of bladder and bowel function Medication review Early mobilisation ```
72
What are important points to remember for people with delirium?
Capacity Do they have a POA or guardian Risk of falls
73
Is there an association between delirium and falls?
Yes, 4.5x more likely to fall if have delirium Therefore delirium prevention reduce falls also
74
What is the relationship between UTIs and delirium?
More likely to be an over diagnosis of UTI - High percentage with asymptomatic bacteriuria
75
Should you dipstick urine to diagnose a UTI in older people?
No, Sign 88 guidelines
76
What drugs commonly cause falls?
``` Antihypertensives Beta blockers Sedatives Anticholinergics Opioids Alcohol ```
77
wHat are potential causes of falls?
``` MSK Drugs Neurological Sensory CVS Being generally unwell Incontinence Alcohol ```
78
What MSK problems could cause falls?
Arthritis Sarcopenia Deformities of feet e.g Charcot's Muscle weakness (POLYMYALGIA RHEUMATICA)
79
What neurological conditions commonly cause falls?
Stroke Parkinsons Dementia Delirium
80
What CVS problems can cause falls?
Postural hypotension Arrhythmia HF Aortic stenosis
81
Why do drugs increase the risk of falls?
``` Increase UO Increase sedation Hallucination qTC Dizziness ```
82
What should you ask about in a falls history?
``` Detail of fall What were they doing Who with? What happened? What happened next? How did they get up? Systematic symptoms - before e.g palpitations could suggest cardiac causes ```
83
What should be included in a systematic enquiry for falls?
Memory Urinary symptoms Has walking changes recently
84
How do you examine a patient with a history of falls?
``` Get patient on couch Top to toe Cranial nerves Check for neglect and cerebellar signs Check for Parkinsonism Pulse Heart sounds Kyphosis Look at feet Vibration sense (for peripheral neuropathy) Test co-ordination Romberg's Assess gait ```
85
What does an ataxic gait suggest?
Cerebellar damage
86
What does an arthralgia gait suggest?
Arthritis
87
What does a hemiplegic gait suggest?
Stroke
88
What does small steps, shuffling suggest?
Vascular Parkinsons
89
What does a high stepping gait suggest?
Peripheral neuropathy
90
What would you do for someone admitted to A&E after a fall?
``` ABCDE Secondary survey Check CK if long lie (checks for rhabdomyolysis) Any cognitive impairment Any incontinence any syncope Are they drunk? Look at ambulance sheet Talk to relative ```
91
What Ex and IX would you carry out in A&E for a patient who has fallen?
``` Neuro exam Look at legs Full set of abs ECG Bloods for B12, Folate, CK, TFTs 4AT ECG Consider CT head ```
92
When should you do a CT head after fall?
``` If Anticoagulated Neurological signs Head injury If GCS <13 Focal neurology Seizure Vomiting ```
93
What are the three main things you should do to assess a fallen patient?
ABCDE Check glucose Top to toe survey
94
What should you do if you are called to a patient who has fallen in hospital?
Immediately assess for serious injury (post fall assessment sheet) Consider cause of fall
95
What must you not miss after an inpatient fall?
- Subdural haemorrhage | - Hip fracture
96
When should you do an X-Ray after a fall?
Pain on moving a joint have low threshold of X-ray Pain on weight-bearing
97
Mary 88 has had a fall. She is on apixaban, levothyroxine, bisoprolol, donezipezil. What could have caused her fall?
Bisoprolol - postural hypotension, bradycardia Donezipezil - bradycardia Underrated hypothyroidism - bradycardia
98
What can antidepressants cause in elderly?
Falls
99
What can codeine cause in elderly patients?
Constipation --> delirium, falls, hyponatraemia and hypercalcaemia
100
List some common iatrogenic drug problems.
``` Confusion Dry mouth Constipation Blurred vision Urinary retention Orthostatic hypotension Falls Loss of function Incontinenece Depression ```
101
Why is polypharmacy more common in elderly?
- Increase in co-morbidities - More doctor visits - Drugs often given to counteract SEs, - little continuity of care, - Prescriber issues (e.g not getting right diagnosis, little time for appointment, assuming patient wants a quick fix tablet) - diseases have different symptoms in elderly
102
Name 3 drugs with ADRs associated with hospital admission.
NSAIDs Diuretics Warfarin
103
What two types of drugs have the most ADRs?
Anticholinergics | Sedatives
104
What are common anti-muscarinic drug effects?
``` Dry mouth and eyes Constipation Pupillary dilation Tachycardia Inhibition of erection Memory impairment Confusion Hallucinatiosn Falls Delirium ```
105
Discuss the clinical pharmacology of old age relating to absorption.
- Absorption: rate changes as you get older since GI system slower, less saliva e.g affects absorption go GTN
106
Discuss the clinical pharmacology of old age relating to distribution.
-Distribution: body composition changes (increase in adipose, reduce body water), protein binding changes, increased BBB permeability
107
Discuss the clinical pharmacology of old age relating to metabolism.
- Metabolism: decreased liver mass and blood flow
108
Discuss the clinical pharmacology of old age relating to excretion.
Kidneys lose function as we get older Renal function decreases with age Increased half life of drug --> increased toxicity
109
What is generally needed when prescribing drugs in elderly?
Low doses or reduced frequency administration "Start low and go slow"
110
What is Beer's criteria?
List of 'inappropriate' drugs for older people, updated occasionally but many weakness
111
What us the START-STOPP criteria?
Screening tool for older persons prescriptions, advice on medical optimisation
112
What happens when prescribing opioids in elderly?
More sensitive to effects
113
What happens when prescribing NDAIDs in elderly.
Increased renal impairment and GI bleeding
114
What happens when you prescribe Digoxin to elderly?
Increased toxicity | Lower doses needed
115
What happens to elderly on anti-hypertensives?
Exaggerated effects on BP and HR e.g postural hypotension | renal adverse effects
116
What is the difference of elderly taking warfarin compared to young and healthy?
More sensitive, greater risk of bleeding
117
What happens when giving antibiotics to elderly.
Increased ADRs, diarrhoea and c.diff infection, seizures, renal impairments
118
What can quinolone cause in elderly patients?
Delirium
119
What can trimethoprim and co-trimoxazole cause in elderly patients?
Blood dycrasias
120
Who are most at risk from medication errors?
- Those undergoing cardiothoracic surgery, vascular surgery or neurosurgery - Thos with complicated conditions - Those in A&E - Those looked after by inexperienced doctors - Elderly
121
What are people related causes of medication errors?
Fatigue, hungry, concentration, stress, distraction, lack of training, lack of access to info, other factors (e.g alcohol, drugs, illness etc)
122
Where do medication errors occur?
Prescribing Transcribing Dispensing Administering
123
What are common prescribing errors?
``` Wrong dose Wrong drug Inappropriate units Poor/illegible prescriptions Failure to take into account drug-drug interactions, omission, calculation errors Illegible handwriting ```
124
How do you prevent medication errors?
5 Rs: ``` Right patient Right drug Right dose Right route Right time ```
125
Who assess and authorise medicinal products in the UK?
MHRA (Medicines and Healthcare products Regulatory Agency)
126
What is the European equivalent of the FDA?
European Medicines Agency
127
Who makes decisions on the cost effectiveness of new/existing pharmaceutical products in respect of their use in NHS Scotland?
Scottish medicines consortium
128
Who makes decisions on the cost effectiveness of new/existing pharmaceutical products in respect of their use in NHS England?
NICE
129
What doe the patient access schemes assessment group (PASAG)?
Advise on acceptability of patient access schemes within NHS Scotland
130
Why do we have local formularies (Area drugs and therapeutics committees - ADTCs) in Scotland under the Scottish medicines consortium?
Local ownership of decisions, implement SMC advice and SIGN guidelines, deal with drugs not on SMC agenda, deal with unlicensed products, education and communication, patient group directives, prescribing errors

Speciality teaching (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions