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3 - Specialities > Geriatrics > Flashcards

Geriatrics Flashcards

1
Q

Theories of aging

A

Stochastic: random, cumulative damage

Programmed: predetermined changes in gene expression

Homeostatic failure

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2
Q

Frailty is…

A

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

effectively… Progressive dyshomeostasis
(impaired function of any organ system makes homeostasis more difficult)

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3
Q

The core concept of geriatric medicine is…

A

Frailty

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4
Q

Frailty syndromes:

A

Falls
Delirium
Immobility
Incontinence

(how patients present)

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5
Q

Fried’s criteria for frailness

A 
3 of of 5 of the following...
o	Unintentional weight loss
o	Exhaustion
o	Weak grip strength
o	Slow walking speed
o	Low physical activity
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6
Q

Health domains

A 
o	Medical
o	Spiritual
o	Psychological
o	Functional
o	Behavioural
o	Nutritional
o	Environmental
o	Social
o	Societal
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7
Q

Benefits to being in hospital

A

o Access to clinical expertise
o Access to complex tests and interventions
o Rapid access to supervised care support

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8
Q

Risks to being in hospital

A 
o	Disorientation and delirium
o	Learned dependency
o	Deconditioning
o	Iatrogenic harm
o	Hospital acquired infection
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9
Q

Extrinsic causes of incontinence

A 
o	Co-morbidities
o	Reduced mobility
o	Confusion
o	Drinking too much/ at the wrong time
o	Medications
o	Constipation
o	Home/ social circumstances
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10
Q

Intrinsic causes of incontinence

A

Outlet too weak = stress incontinence

Outlet too strong (e.g. BPH) = Urinary retention with overflow incontinence

Bladder too strong = urge incontinence/ overactive bladder (OAB)

Bladder too weak = neuropathic bladder
- No awareness of bladder filling –> overflow incontinence (Secondary to neurological disease/ prolonged catheterisation)

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11
Q

Assessing incontinence

A 
o	History (inc. social history)
o	Urinary diary (fluid input + output)
o	General examination (inc. vaginal and rectal)
o	Urinalysis + MSSU
o	Bladder scan for residual volume
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12
Q

Risk factors/ causes of delirium

A
  • Infection (NOT always a UTI!*)
  • Dehydration
  • Biochemical disturbance
  • Pain
  • Drugs
  • Constipation/ urinary retention
  • Hypoxia
  • Alcohol/ drug withdrawal
  • Sleep disturbance
  • Brain injury (stroke, tumour, etc.)
  • Change in environment/ emotional distress

*do not use dipstick test to diagnose UTI in the elderly

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13
Q

Presentation of delirium

A

Disturbed consciousness
- Hypoactive/ hyperactive/ mixed

Change in cognition
- Memory/ perceptual/ language/ illusions/ hallucinations

Acute onset and fluctuant

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14
Q

Diagnosis of delirium

A

4AT score (rapid clinical test for delirium)

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15
Q

Management of delirium

A

Prevention!!

Non-pharmacological measures

  • Re-orientate and reassure
  • Encourage early mobility and self-care
  • Correction of sensory impairment
  • Normalise sleep cycle
  • Ensure continuity of care
  • Avoid urinary catheterisations
  • Discharge ASAP/ avoid hospitalisation

Pharmacological management:

  • STOP BAD DRUGS
  • 12.5mg quetiapine orally (ONLY if a danger, no evidence it improves delirium)
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16
Q

Types of causes of falls

A 
Musculoskeletal
Drugs
Neurological
Sensory
Cardiovascular
Illness
Incontinence (rushing to toilet)
17
Q

Clues in the history of a fall

A
  • No memory = syncope/ cognition
  • Clear history = sensory
  • On turning = postural instability
  • Near misses = unsteady on standing
  • Syncope on exertion = aortic stenosis
18
Q

CT immediately for a head injury with 1+ pf the following…

A
  • GCS <13
  • Still confused after 2 hours
  • Focal neurology
  • Signs of skull fracture
  • Seizure
  • Vomiting
  • Anticoagulation
19
Q

Common ADRs caused by anticholinergics in the elderly…

A 
Confusion, 
dry mouth, 
constipation, 
blurred vision, 
urinary retention 
orthostatic hypotension
20
Q

Common ADRs caused by Tricyclics in the elderly…

A

Confusion

Unsteady gait

21
Q

Common ADRs caused by long acting benzodiazepines in the elderly…

A

CNS toxicity (falls + confusion)

22
Q

Common ADRs caused by Narcotics in the elderly…

A

confusion

23
Q

Changes in the Absorption of drugs from the GI tract in the elderly

A

Decreased rate of absorption (may lead to delayed onset of action)

No changes in extent of absorption

24
Q

Changes in the Distribution of drugs in the elderly

A

↑adipose tissue –> ↑duration of action of fat-soluble drugs (e.g. diazepam)

↓body water –> ↑serum levels of water-soluble drugs (e.g. digoxin)

↓albumin –> ↓binding–> ↑serum levels of acidic drugs (e.g. furosemide)

↑permeability across blood-brain barrier

25
Q

Changes in the Metabolism of drugs in the elderly

A

↓liver mass and blood flow –> ↓hepatic metabolism

↑first pass metabolism

26
Q

Management of incontinence

A

Lifestyle/ behaviour changes
Stop unnecessary drugs

Physio/ medical / surgical
Referral to incontinence clinic for difficult cases (failed management)

If all else fails… incontinence pads/ catheterisation

3 - Specialities (4 decks)

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